CARDIOVASCULAR OUTCOMES Flashcards
BLOOD PRESSURE: def, formula
= force of blood against blood vessel
BP = CO (Q) x TPR
CARDIAC OUTPUT: unit, formula, characteristics of each components
L/min
= heart rate x stroke volume
Heart rate
- divided in intrinsic (sino-atrial node) & extrinsic (Autonomic nervous system with sympathetic that increases HR & parasympathetic which decreases HR)
Stroke volume
= amount of blood pumping during each cardiac cycle
1) Preload = amount of blood coming to ventricle = venous return → Affects by valves function, muscles pump and posture
2) Afterload = how much resistance ventricle must to overcome squeeze blood → Affects by hypotension, vasoconstriction, stenosis of valves
3) Contractility
→ Affects by exercises & autonomic nervous system (sympathetic increases contractility & parasympathetic decreases contractility)
Total periphery resistance: def & characteristics
= friction of blood against blood vessel, as vessel relaxes → resistance decreases
Radius impact → vasoconstriction
→ Affects by hormones (epinephrine), temperature (cold = vasoconstriction), exercise & autonomic nervous system (sympathetic innervates vessel → vasoconstriction // parasympathetic does not innervates vessel)
BP: Invasive method: characteristics, ≠ types, utilization, common sites & risk
C: direct
≠: intravascular (tip catheter) & extravascular (arterial line with external transducer)
U: Tube inserted into artery & connected through saline fluid filled line to electrical pressure transducer
→ Catheter line must be free of air. Cannula & tubing stiff & short
CS: brachial, radial & femoral arteries
R: risk of infection
BP: non invasive method: characteristics, intermittent values, continuous waveform & goals
C = indirect
IV:
- Auscultatory (Korotkoff method)
- Oscillometric
- Ultrasonic method
CW:
- Tonometric
- Volume clamp (Penaz method)
G: Auscultatory technique, allowing measurement of both systolic & diastolic blood pressure
BP: office: description, traditional manual measurement & automated measurement
D: = most commonly basis for hypertension diagnosis & follow-up
- 2-3 office visits at 1-4 week intervals (except of BP>180/110 mmHg)
- Diagnosis confirmed by out of office BP measurement
Traditional manual BP measurement
- Mainstay of BP measurement
- Limited by lack of medical staff
- Inability to assess circadian variation
- Increase white-coat HTN diagnosis leading to over-diagnosis & over-treatment of HTN
Automated office BP measurement
- Decrease white-coat response
- Prediction of cardiovascular events - 3 to 5min period of quiet rest
- 2 to 3 BPs which are averaged
BP: Out of office: home monitoring & ambulatory monitoring
Home BP monitoring
- Improved motivation in self-care
- Increase adherence to anti hypertensive medications
- Take at least 2 readings 1 min apart in morning before taking medications & in evening before supper
Ambulatory BP monitoring
- Valuable tool for measuring BP variation day & night in patients with CKD
- Superior to office-measured BP to predicting CKD progression & cardiovascular risk
BP: initial evaluation: description & rules
Measure BP in both arms, preferably simultaneously. If consistent ≠ between arms >10 mmHg in repeated measurements, use arm with higher BP
- If ≠ >20 mmHg consider further investigation
Rules
- Back supported
- No talking during & between measurements
- Cuff it fit arm size (small, usual, large)
- Arm bare & resting. Mid-arm at heart level
- Feet flat on floor
- Validated electronic upper arm cuff or manual auscultatory
- Quiet room, comfortable temperature
- No smocking, coffee, exercise for 30 min
- Empty bladder
- Relax for 3-5min
- Take 3 measurements at 1min intervals
- Use average of last 2 measurements
BP: values
Tableau
PULSE ASSESSMENT: ≠ types of measure, why?, ≠ values, how measure
- Estimate with pulse
- Measure with smart watch or electrocardiogram - Measure with belt which measure HR
- Stethoscope & listen pulse during 1 min at least
- To assess patient’s pulse rate & to assess strength, regularity & character of pulse
- Pulse measured at several points in body. Points are where artery situated under skin, where it compressed against bone, allowing us to feel each beat
Tableau for values
- Wash hands to prevent cross-infection & explain what you are about to do
If you’ve been active or had stimulant like nicotine/caffeine in last 20min, you’ll need to wait at least 5-20min before taking pulse
Place tips of first & second finger on inside of patient’s wrist (radial pulse)
Press gently against pulse
Defintion heart rate
= how fast heart contracting at given time (bpm)
Definition pulse rate
= Number of times blood flows in arteries
2 ≠ types of cardiovascular measurements
Echocardiogram
Electrocardiogram
ECHOCARDIOGRAM: def, how to assess, description
D: = type of ultrasound scan to look at heart, structures & nearby blood vessels
To assess
- Myocardial thickness
- Mobility & competence of heart valves
- Dimensions of heart chambers
- Blood flow direction
- General systolic function: assessment of EF & velocity of myocardial shortening
- Changes on cardiac chambers: diseases that increase end- diastolic volume
- Valve insufficiency or stenosis
ELECTROCARDIOGRAM: how work
Sensors attached to skin used to detect electrical signals produced by heart each time it beats
