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?
