Common Cardiac Conditions Flashcards
What is hypertension?
Sustained high blood pressure at rest.
Related to many comorbidities and risk factors (ie. CVD, stroke/CVA, CHD, HF, PAOD).
Multiple causes, normally cannot be specific on actual cause.
-genetics and environmental factors (nutritional, stress, exercise) = epigenetics.
Types of Hypertension
Primary = no known cause, idiopathic.
Secondary = associated with another primary disease (chronic kidney disease, CVD, atherosclerosis); altered hemodynamics.
Isolated systolic hypertension = elevated SBP, but normal DBP.
Risk Factors of Hypertension
Family history
Age
Gender
Race
High sodium diet
Glucose intolerance.
Smoking
Obesity
Alcohol intake
Low potassium/calcium/magnesium in diet.
Pathophysiology of Hypertension
Increased vascular tone
Increased blood volume
Increased vascular tone and hypertension
increases resistance of cardiac output from left ventricle = increases work of the heart to push blood out to the body.
Due to changes in SNS = vasoconstriction.
Increased blood volume and hypertension
Overload of blood volume on the heart.
Increased blood volume leading to increased left ventricular blood volume at the end of diastole (filling phase).
-this then increases cardiac output and then in turn increases blood pressure.
Due to changes in renin-angiotensin-aldosterone system, inflammation, endothelial dysfunction, insulin resistance, naturetic peptide inhibition.
-all will either increase sodium retention (leads to water retention) or sodium reabsorption.
Blood Pressure Grades
Normal = <120/80
High-normal = 120-139/80-89
Grade 1 hypertension (mild) = 140-159/90-99
Grade 2 hypertension (moderate) = 160-179/100-109
Grade 3 hypertension (severe) = >180/110
Isolated systolic hypertension = >140/<90
Isolated systolic hypertension with widened pulse pressure = >160/<70
What is ischemic heart disease?
Broad term, also known as coronary artery disease (CAD) or coronary heart disease (CHD).
Result from narrowed, hardened, or blocked coronary arteries, and result in reduced blood flow or oxygen delivery to the myocardium.
Typically from atherosclerosis or arteriosclerosis.
Diagnosed through risk factors, blood tests, ECGs, echocardiograms, exercise stress tests, cardiac catheterization/angiograms.
Monitor in the clinic with HR, SO2%, RPE/RPB, ECGs
Risk Factors of Ischemic Heart Disease
Smoking
Hypertension
Insulin resistance
Low HDLs
High LDLs
Oxidative stress
Infections
How can IHD result?
Can result from inadequate blood supply to parts of myocardium.
Causes angina or myocardial infarctions.
Possibility of thrombi breaking off from plaques and causing clots or blockages of the arteries elsewhere in the body (ie. brain resulting in stroke/CVA or lungs resulting in pulmonary embolism).
What is angina?
Chest pain or discomfort.
Often results from presence of ischemia but may not result in widespread or permanent damage to the myocardium.
Tends to be exercise or intensity induced.
-only occurs with an increase in work of the heart when increased VO2 demands not met.
Can be managed with nitroglycerin spray which is a vasodilator that helps reduce symptoms.
How to measure angina symptoms?
Use angina scale.
Can be very helpful to use in clinical settings if you are working with someone who has angina or experiences angina symptoms often.
When working with someone, only want them to be at 0 and 1, if get to 2 on scale have them stop and wait for symptoms to go away before starting up again.
What is myocardial infarction?
Heart attack.
When a blockage has occured in coronary arteries that is now leading to ischemia (damage) in the myocardium.
Multiple symptoms can be present in an MI.
Needs immediate attention to reduce damage to the heart = 911, nitroglycerin spray, aspirin.
Symptoms of MI most commonly seen in men…
Discomfort or tingling in arms, back, neck, shoulder, or jaw.
Shortness of breath.
Chest pain.
Symptoms of MI most commonly seen in women…
Sudden dizziness
Heartburn like feelings
Cold sweat
Unusual tiredness
Nausea or vomiting
Can also have other symptoms that men experience.
Types of MI’s
NSTEMI = non ST elevation MI
STEMI = ST elevation MI
NSTEMI
Non ST elevation MI
Acute MI with preserved ventricular function.
Non full wall thickness MI so the entire thickness of the myocardium is not damaged, meaning some contraction function may still exist.
STEMI
ST Elevation MI
Actuve MI with impaired ventricular function.
Full wall thickness MI so entire myocardium is damaged in the area of the blockage resulting inability to function or contract.
Treatment for MI
Percutaneous coronary intervention (PCI)
-coronary angioplasty and stents
Coronary artery bypass graph (CABG)
Medications
-rate control, cholesterol control, BP control, blood thinners
Cardiac rehabilitation programs
-nutrition, education, exercise
Cardiac Arrest vs Myocardial Infarction
Myocardial Infarction (heart attack)
-mechanical issue
-blockage of coronary arteries which leads to damage of myocardium which leads to reduced function of pumping
-call 911 and give aspirin/nitroglycerin spray.
Cardiac Arrest
-electrical issue
-when heart stops beating and pumping blood due to electrical malfunction
-start CPR and call 911 as soon as possible (and use AED if have one).
What are arrhythmias?
Heart beats at an irregular or abnormal rhythm.
Monitored with electrocardiograms.
-may be done in exercise stress tests if arrhythmias are exercise induced.
-pharmaceutical stress tests are also an option.
Treatment of Arrhythmias
Depends on the arrhythmia.
Rate control = beta-blocker, pacemakers.
Ablation surgery
Blood thinners (such as warfarin) and blood pressure controlling medications.
Some Common Arrhythmias
Low concern = sinus arrhythmia, bradycardia, premature ventricular contractions (PVCs).
Moderate concern = tachycardia, atrial fibrillation (afib), supraventricular tachycardia.
High concern = atrial flutter, ventricular tachycardia, ventricular fibrillation
Benign Arrhythmias
Sinus arrhythmia
Bradycardia
Tachycardia
Atrial Arrhythmias
Atrial fibrillation
Atrial flutter
Sinus arrhythmia
irregular heart beat rhythm due to breathing
Bradycardia
slow heart rate at rest (<60bpm).
Tachycardia
fast heart rate at rest (>100bpm)
Atrial Fibrillation (afib)
Most common arrhythmia especially in those >65y/o (30%).
Can lead to stroke or heart failure if left untreated.
Controlled <100bpm; uncontrolled >100bpm.
Atria ‘fibrillate’ causing irregular and shallow beat.
ECG = irregular QRS; normal or narrow QRS; flat P-waves
Pulse = irregular, weak.
Atrial Flutter
Atria rapidly fire electrical signals causing a flutter response.
Atria contact 250-350bpm.
-AV node needs to block this to prevent ventricles from doing the same.
Can lead to more severe arrhythmias such as ventricular fibrillation is not controlled.
ECG = saw tooth looking p-waves.
Ventricle Arrhythmias
Premature ventricular contractions (PVCs).
Supraventricular tachycardia (SVT).
Ventricular tachycardia
Ventricular fibrillation
Premature Ventricular Contraction (PVCs)
Early extra beats occurring in ventricles
Supraventricular Tachycardia (SVT)
Fast heart rate due to malfunction of SA node, this causes abnormal electrical pathways in atria or from AV node.
Ventricular Tachycardia
Fast heart rate due to electrical activity starting in ventricles.
Ventricles unable to full and efficiently pump blood due to fast contraction.
Ventricular Fibrillation
Ventricles fibrillate = medical emergency; often leads to cardiac arrest.
Ventricles unable to fill and efficiently pump blood due to fast and shallow contraction.
Ischemic Heart Disease Arrhythmias
ST depression
ST elevation
ST Depression
ST segment has a depression.
Depression can be down-slopping (most severe), horizontal, or up-sloping (least severe).
ST Elevation
ST segment is elevated.
Sign of acute myocardial infarction.
Chronic Heart Failure
Broad term for several types of cardiac dysfunction resulting in inadequate cardiac output and delivery of blood to the body.
-impaired filling, impaired pumping
Creates fatigue, dyspnea (shortness of breath), and pulmonary edema (fluid retention).
Diagnosis of Chronic Heart Failure
Echocardiogram with doppler flow.
Radionuclide ventriculography.
MRI or CT Scan
Monitor in clinic…
Using HR, BP, SO2%, ECGs
Valve Conditions
Regurgitation
Stenosis
Monitored with heart murmurs, MRIs, CT scans, echocardiograms.
Regurgitation
When valve does not close properly allowing for blood to flow backwards into the heart from aorta or back into the atria from ventricles.
Most common in mitral, aortic, and tricuspid valves.
Can lead to heart failure if not fixed.
Stenosis
Narrowing or stiffening of a valve, limiting blood flow through the valve.
Often age-related or congenital.
Most common in aortic, mitral, and pulmonary valve.
Can lead to heart failure if not fixed.
Treatment of Valve Conditions
Lower blood pressure and heart rate
-medications, exercise and nutrition
Valve repair or replacement surgery
