Cardiovascular & Peripheral Vascular Flashcards
What are the Modifiable risk factors for CVD?
Modifiable risk factors: factors that can be changed by lifestyle choices or medical interventions, such as smoking, diet, physical inactivity high blood pressure, cholesterol, and diabetes.
1) High BP
- High blood pressure makes your heart work harder, damages your blood vessels, and can also cause greater plaque build-up.
- this leads to heart damage
2) Smoking
- nicotine causes arteries of the heart to narrow.
- carbon monoxide released from cigarettes causes damage to the walls of the arteries, creating the build up of fat on those walls.
3) Diabetes
- Up to 10 years before diagnosis, insulin resistance occurs causing blood glucose levels to rise particularly after meals (Prediabetes). - this can lead to insulin deficiency.
- Insulin: hormone that unlocks cell doors so that glucose can be taken up as fuel.
- These abnormalities lead to an inflammatory response in the vessel wall which cause growth of the atherosclerotic plaque and can cause instability and plaque rupture.
4) Sedentary Lifestyle
- Irregular exercise increases a person’s chances of being overweight, of having high blood pressure and of developing other conditions that make cardiovascular disease more likely.
5) Obesity
- Eating an unhealthy diet and being physically inactive are both contributing factors to being overweight
6) High Cholesterol
- Cholesterol: a fat-like substance that is produced mostly in the liver, although some of the cholesterol in blood comes from the foods we eat.
- Low density lipoprotein cholesterol (LDL) causes a build-up of cholesterol plaque on the wall of the arteries in the heart.
What are the Non-Modifiable risk factors for CVD?
1) Race and ethnicity
- The ethnic group or race a patient belongs to can have a genetic makeup and environmental influences that predispose its members to CVD.
- Higher risk ethnicities include: Indigenous peoples, People of African & Asian Descent
2) Family History
- A family history of CVD is a strong indicator of personal risk for CVD.
- A positive family history involving first relatives is generally associated with a two-fold increase in the risk for CVD.
3) Biological Sex
- Men have a higher risk for heart attack than women, but the difference narrows after women reach menopause (as a result of a drop in estrogen levels).
- After the age of 65, the risk for heart disease is about the same between the sexes when other risk factors are similar.
4) Age
- As people get older, the risk for cardiovascular disease increases due to aging and narrowing arteries.
- CVD becomes a bigger threat after the age of 55 for men, and 65 for women.
What are the Physical Exercise Recommendations for a Healthy Heart?
For non hypertensive individuals (to reduce the possibility of becoming hypertensive) or for hypertensive patients (to reduce their blood pressure),
- prescribe 30-60 minutes of moderate-intensity dynamic exercise (e.g., walking, jogging, cycling, or swimming) 4-7 days per week in addition to routine daily activities
- Higher intensities of exercise are not more effective
- For non hypertensive or hypertensive individuals with SBP/DBP of 140-159/90-99 mm Hg, the use of resistance or weight training exercise (ie.free-weight lifting, fixed-weight lifting, or handgrip exercise) does not adversely influence blood pressure (Grade D
What are the Weight Reduction Recommendations for a Healthy Heart?
Maintenance of
- healthy body weight (BMI 18.5–24.9)
- waist circumference < 102 cm for men and < 88 cm for women
….is recommended for nonhypertensive individuals to prevent hypertension and for hypertensive patients to reduce blood pressure
- All overweight hypertensive individuals should be advised to lose weight
- Weight loss strategies should use a multidisciplinary approach that includes dietary education, increased physical activity, and behavioral intervention
What are the Alcohol Consumption Recommendations for a Healthy Heart?
- In healthy adults, abstaining from alcohol or reducing alcohol intake to 2 drinks per day or less is recommended to prevent hypertension
What are the Diet Recommendations for a Healthy Heart?
Hypertensive patients and normotensive individuals at increased risk of developing hypertension should consume - fruits
- vegetables
- low-fat dairy products
- whole grain foods rich in dietary fibre
- protein from plant sources while being reduced in saturated fat and cholesterol
What are the Sodium Intake Recommendations for a Healthy Heart?
- To prevent hypertension and reduce blood pressure in hypertensive adults, consider reducing sodium intake toward 2000 mg (5 g of salt) per day
What are the Stress Management Recommendations for a Healthy Heart?
- In hypertensive patients where stress might be contributing to high BP, stress management should be considered as an intervention
Symptoms of Potential Cardiovascular Origin
Symptoms (apparent to patient)
- Chest Pain (left-sided) which can radiate to chest, jaw, neck, left shoulder, left arm
- Chest Pressure like an “elephant sitting on my chest”
- Shortness of breath
- Cough
- Diaphoresis
- Nausea and Vomiting
- Lightheadedness
- Leg pain
- Racing heart
- Fatigue
- Indigestion
Signs of Potential Cardiovascular Origin
- Signs (what physician perceives)
- Dyspnea/Orthopnea (difficulty breathing/difficulty breathing lying down)
- Paroxysmal Nocturnal Dyspnea (sudden respiratory distress that wakes the patient up at night)
- Leg ulcers
- Edema (swelling)
- Palpitations/dysrhythmias
What are the Key cardiovascular symptoms?
1) Palpitations
2) Syncope
3) Oedema
4) Intermittent Claudication
5) Systemic Symptoms
What are Palpitations?
Palpitation: sense of fast beating, fluttering, or pounding heart
- Patients describe palpitations as feeling regular/irregular
- Palpitations can be caused by anxiety, atrial fibrillations, and a range of arrhythmias
What is Syncope?
Syncope: rapid loss of consciousness secondary to reduced cerebral perfusion
- Loss of consciousness is short in duration with patient recovering quickly
-Patients refer to syncope episodes as - dizzy spells, funny turn, faints, blackouts
- Ask about triggers for syncope episodes: what were you doing before the blackout?
□ Syncope associated with a sudden change in posture (moving from lying to standing) suggests postural hypotension
□ Syncope associated with exertion indicates aortic stenosis or an arrythmia
What is Oedema?
Oedema: fluid retention in various body tissues
Causes
□ Congestive heart failure
□ Medication side effects (amlodipine)
Depending on the location of edema, it has a different name
- Paled oedema - edema affecting lower limbs
- Patients complain of ankle swelling that worsens as the day goes on - as gravity draws fluid into the legs
- Patients report that their legs feel heavier than usual or their skin feels tights and uncomfortable
- Ask: have you noticed that your ankles are more swollen? Does the swelling worsen as the day goes on? - Ascites - Edema in abdomen
- Pulmonary Edema - Edema within lungs
- Patients present with shortness of breath, a rattly chest, and reduced exercise tolerance
- Typically caused by left ventricular failure - Peripheral edema
- Typically caused by right ventricular failure
What is Intermittent Claudication?
Intermittent Claudication: muscle pain that develops during mild exertion and resolves with rest
- Caused by peripheral vascular disease
- Occurs bc of inadequate perfusion to the affected muscle groups
- Patients complain of pain in a specific leg that develops during exertion and settles with rest
- Ask: how far can you walk before it develops? Does the pain go away when you rest? Have you experienced a change in sensation or weakness in the leg?
What are Systemic Symptoms?
Systemic Symptoms - ie. Fatigue, fever, weight loss/gain
- In heart failure, fatigue and weight gain
- In pericarditis - fever
- In atrial mixoma - weight loss and fatigue
What are the 5 Components of a Physical Assessment of the Cardiovascular System?
1) Vital Signs
- Take full set of vital signs & compare results with previous results
- Do they make sense given the patient’s context?
- Do they require urgent action or ongoing monitoring?
2) Inspection
- General survey - are you noticing any distress? Is the patient able to breath without difficulty? Are they diaphoretic? What is there overall colour?
- Is the shape of the chest normal? Do you notice any abnormal pulsations specifically over where the heart sits?
3) Palpitation of Pulses
- Take note of Rate, Rhythm, Strength, and compare symmetrically
- Clinical pearl: When palpating the carotid artery only palpate ONE SIDE AT A TIME!
4) Palpation of the Point of Maximal Impulse (PMI)
- In a normal sized heart, the PMI is the same spot you would assess the apical pulse, (in the 5th intercostal space and the mid-clavicular line)
- In an enlarged heart the apex extends down and laterally and is palpable in lower intercostal spaces and towards the axillae.
5) Auscultation
What are the 4 main areas to auscultate when listening to the heart?
1) Aortic valve - located at the 2nd intercostal space on the right sternal border
2) Pulmonic valve - located at the 21nd intercostal space on the left sternal border
3) Tricuspid Valve - located at the 4-5th intercostal space on the left sternal border
4) Mitral Valve - located at the 5th intercostal space mid-clavicular line
What are the 2 Sounds Heard in the Heart?
S1 - louder sound; the closure of the Tricuspid and Mitral valves
- signals the beginning of systole (contraction phase of the heart)
- best heard at the apex of the heart
- “lub” sound
S2 - softer sound; the closure of the Aortic and Pulmonic valves
- signals the beginning of diastole (relaxation phase of the heart)
- best heard at the base of the heart
- “dub” sound
What are the 2 Abnormal Heart Sounds?
- Murmurs: turbulent blood flow causing a “swooshing” or “blowing” sound.
- Bruits (brew-eee).
- caused by turbulent blood flow - but in the main arteries of the body, rather than over the heart.
- sites you can assess for bruits include: the carotids, the abdominal aorta, renal artery, iliac artery, and femoral artery.
Arteries VS. Veins
Arteries
- Transport blood away from the heart.
- Carry oxygenated blood (except in the case of the Pulmonary Artery).
- Have narrow lumens.
- Contain more muscle and elastic tissue.
- Transport blood under higher pressure than veins.
- Do not have valves (except for semi-lunar valves of the pulmonary artery and the aorta)
Veins
- Transport blood towards the heart.
- Carry de-oxygenated blood (except in the case of the Pulmonary Vein).
- Have relatively wide lumens.
- Contain less muscle and elastic tissue.
- Transport blood under lower pressure than arteries.
- Have valves throughout to prevent backflow.
What is Arterial Disease?
- development is related to atherosclerosis or a build of of plaque in the lumen of the arteries that results in decreased blood flow to the periphery.
- decreased blood flow results in decreased oxygenation to tissues and muscles.
- Risk factors: high blood pressure, high cholesterol, sedentary lifestyle, smoking etc.
- Pain associated: cramping, burning that is relieved when at rest
Symptoms of Arterial Disease?
Intermittent claudication
- intermittent claudication - pain when walking and relieved by rest.
- like angina to the calf muscle where with exertion the damaged peripheral system cannot keep up with the oxygen demands.
Ulcers
- begin at the distal ends of the limb, are dry, and “punched out” with no drainage or granulation tissue (ie. not trying to heal itself)
Cool, dry skin, with no hair growth
- Arterial disease results in a lack of oxygen and blood flow to the periphery.
- The lack of oxygen and nutrients results in cool skin on palpation, dry skin, and lack of hair growth.
Thickened nails
- lack of oxygen and nutrients thickens nail beds.
Dependent Rubor
- the leg of someone with peripheral artery disease is pale, except for when their leg is dependent (hanging down by gravity) which then causes a reddening (rubor) of the skin).
Edema
- no edema present
Pulse
- Pulses is diminished or absent
Colour
- Pale (worse if limb elevated), dusky red if limb lowered.
What is Venous Disease?
- results from the stretching of the valves found within the lumen of veins responsible for pumping blood back up to the heart.
- When the valves are stretched it causes backflow and pooling of blood in the periphery.
- Risk factor: prolonged standing (usually occupational), obesity, pregnancy, genetics.
