- EKG - Treadmill exercise testing with EKG - Treadmill medication e.g Thallium - Cardiac Catheterization

Cardiovascular pt. 2 Flashcards by Devon Palmer

Disease caused by impaired blood vessels

Disease states: angina, MI, cardiac dysrhythmias, conduction defects, congestive heart failure, sudden death

Number one cause of death in U.Sin both males and females

Etiology: Atherosclerosis

Coronary Artery Disease (CAD)

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CAD does not usually present symptoms until there is about ___ occlusion of the artery due to development of collateral circulation

70%

Rapid developing atherosclerosis does not allow time for development of atherosclerosis and therefore death of tissue can develop

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Diagnosis of CAD

EKG
Treadmill exercise testing with EKG
Treadmill medication e.g Thallium
Cardiac Catheterization

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5 classes of Lipoproteins:

VLDL - Triglycerides
LDL - cholesterol
HDL's
IDL - Intermediate density lipoproteins
Chylomicrons

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Main carrier of cholesterol

Cholesterol is deposited in the intima layer of the coronary arteries and other arteries as “fatty streaks”

LDL’s

< 100 - Optimal
>160 - High

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“Good Guys”

Synthesized in the liver and facilitate the transport of cholesterol from atherosclerotic plaques to the liver where it is excreted

HDL

inhibits cellular uptake of LDL
Higher in women than in men until menopause

<40 - low
>60 High

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Risk Factors for Hyperlipidemia

Metabolic Syndrome: Abdominal Obesity, HTN, low HDL, insulin resistance, hyperglycemia (need 3/5 for dx)
Smoking
Increased age (after 40)
Increased homocysteine levels
Total high cholesterol level
C-Reactive Protein

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____ lowers cholesterol level (LDL) (Pharm)

Statins

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Atherosclerosis: Mech of Development

Ppt slide 81

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______ is substernal/radiating chest pain to the left arm which occurs with a predictable pattern for a predictable length of time

Result of ischemia to heart muscle, anaerobic metabolism releasing lactic acid which irritates nerve endings

Angina Pectoris

< 5 minutes
Pain is burning, squeezing, and doesn’t increase in intensity
-Strong emotion, exercise, or exposure to cold

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Stable Angina

Stable Plaque

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> 15-20 minutes and nonpredictable in nature

Patho: probably triggered by changes to unstable plaque

Unstable Angina

Treatment: Cardiac Cath, IV nitroglycerine, PTCA (Percutaneous Transluminal Coronary Angioplasty)

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Death (necrosis) of cardiac tissue due to prolonged ischemia lasting about 40 minutes

Death is usually caused by ventricular fibrillation of the heart

Myocardial infarction

Patho: Atherosclerotic plaque disrupts and blood vessels ruptures or acute coronary thrombosis occurs

Scar areas cannot contract or conduct action potentials

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After 20-40 minutes of no perfusion, 3 zones of tissue damage

Necrosis
Area of Injury
Ischemia

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Non - ST Elevation MI

Troponin/CK-MB released showing that there is myocardial damage

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ST Elevation MI (STEMI)

Shows ST elevation on EKG in addition to troponin release

0-1 is normal troponin levels
- Troponin T or I > 1 is positive in 1-3 hours

___ occlusion is the worst prognosis for immediate death

LAD (Left Anterior Descending Artery)

Occurs when pumping action of the heart is impaired and there is accompanying congestion of body tissues and lung tissues

Occurs when the heart is unable to compensate for the demands placed on it

Congestive Heart Failure

Etiology: MI, HTN, Volume overload

Reduced ejection fraction, decreased CO and decreased renal blood flow leads to increased sodium and water retention and increased venous return to heart

Inappropriate myocardial hypertrophy and remodeling - increase in muscle mass, chamber dilation, and impaired systolic and/or diastolic function lead to further pump dysfunction and hemodynamic overload

Patho for CHF

Right Sided Failure results in

Congestion in the liver
JVD
Dependent Edema
Ascites
Fatigue

Left sided failure

Crackles
Dyspnea
Cyanosis
Tachycardia
Fatigue

Most common in elderly
No cure and prognosis is generally poor
considered to be a chronic, progressive disease

CHF

Chest X-ray is gold standard to show cardiomegaly

Treatment of CHF

*restrict sodium intake and increase potassium intake

Diuretics
Digoxin - cardiac glycoside to increase cardiac contractility
-Vasodilators
-Mechanical support - used for end-stage heart failure

Arterial Diseases of the Extremeities

Atherosclerotic Occlusive Disease (arterial insufficiency)
Raynaud’s Disease
Aneurysms

Atherosclerosis in an extremity with 50% narrowing before symptomalogy develops *Intermittent claudication with walking (calf muscle has highest O2 consumption)

Atherosclerotic Occlusive Disease *cool temp, limb color blanch when elevated deep red when dependent Disease progresses - pain more severe at rest (rest pain)

S/Sx of Arterial insufficiency

- Pulses diminished or absent - Loss of hair on toes, feet, nails thickened and ridged - Arterial ulcers are painful and deep, and circular (tips of toes, heel or other pressure areas) - Edema is minimal unless kept in dependent position to minimize pain

Treatment of Arterial insufficiency

Femoropopiteal Bypass Graft Surgery: Using saphenous vein to bypass the occluded area ***Engage in walking to the point of claudication to develop collateral circulation

Intense vasospasm of the arteries and arterioles in the fingers Cooling of body parts and also strong emotional responses causes a sympathetic-mediated reduction in digital blood flow

Raynaud's Disease Avoid exposure to cold, vasodilators, calcium channel blocker, may cause gangrene

Abnormal localized dilation of a blood vessel usually occurring in the aorta and brain Area is weakened and grows larger due to the pressure exerted by the blood in the vessel; over 5 cm are especially prone to rupture Weakness is due to congenital defects, infection, atherosclerosis

Aneurysms -HTN is risk factor in dissecting aneurysms

Diseases of Venous Circulation

- Chronic Venous Insufficiency | - Venous Thrombosis

Valves of the legs are unable to close properly and retrograde blood flow occurs. Muscle pumps are also ineffective and other smaller veins increases pressures Signs and symptoms are of impaired blood flow

Chronic Venous Insufficiency

S/Sx of Chronic Venous Insufficiency

- No ischemia as in arterial insufficiency - tissue congestion, edema - brown discoloration of skin due to hemosiderin deposits - lymph insuff - venous or stasis ulcers - medially over ankle and lower leg w/ minimal pain and irregular borders - varicose veins

Presence of a thrombus in the vein with an inflammatory response occurring. There is venous stasis, increased blood viscosity, and vessel wall injury

Deep Vein Thrombosis Risk Factors: Bedrest, prolonged immobility, MI, CHF, pregnancy, childbirth, oral contractives, dehydration, cancer, IV's Complication: pulmonary embolism

S/Sx of DVT

- Swelling - Dorsiflexion causes pain (Homan's sign) - Fever - General Malaise - Redness - Increased WBC, ESR - Calf pain, deep pain muscle tenderness

Prevention, Dx, Treatment

- Leg exercises when immobile, early ambulation, SCD's - Anticoagulation therapy - Keep entire leg elevated at 15-20 to prevent stasis