CVD: HTN and CAD - Lecture #2 Flashcards
What is cardiovascular disease?
All types of disease that affect the heart or blood vessels that includes coronary heart disease/coronary artery disease
- which can cause heart attacks, stroke, heart failure and peripheral artery disease
NIH
What can the heart disease involve issue of?
The heart itself, such as arrhythmias or cardiomyopathy
- while vascular disease can inlude issues with the blood vessels such as high blood pressure or peripheral artery disease
What is the NIH definition of coronary artery disease?
Common heart condition that involves atherosclerotic plaque formation in the vessel lumen
- leads to impairment in blood flow and thus O2 delievery to the myocardium
What are some presenting sx?
- onset, progression, nature, aggravating and alleviating
- chest pain with SOB and palpitations
- fatigue
- syncope and dizziness
- social hx
- risk factors for CVD
What are some modifiable risk factors of CVD?
- cholestrol levels
- stress
- diabetes
- diet
- HTN
- weight
- activity level
- tobacco
What are some non-modifiable risk factors of CVD?
- age
- family hx
- genetics
- male > premenopausal female (equal after menopausal risk)
- race: african americans
- chronic kidney disease
- low socioeconomic status
What are the ages for men and women for non-modifiable risk factor?
overall > 65
men > 45
women > 55
What are the non-modifiable risk factors for family hx?
- cardiac event of a 1st degree male relative < 55
- cardiac event of a 1st degree female relative < 65
- 1.5-2 fold relative risk
What are we looking for when it comes to examination of CVD patients?
- general observation: posture, how they breath, ability to cough
- skin: are they bluish? are they pale or washed out? Sweating?
- Vitals: pulse, BP or SpO2
- Heart and lung sounds
- Chest wall motion and palpation
- Rhythm - EKG
- Circulation and lympathic system (that includes the Peripheral vascular system)
What are the pathologies of the CVD and vascular disease?
> 83 million Americans have one or more forms of CVD (1 in 3 adults)
- 25% of those that have HTM are undiagnosed and unaware which is the SILENT KILLER
- screening for CVD and CVD risk factors is needed for all patients
Description of the primary or essential hypertension types
- most of the population (90-95%)
- No discernible/readily identifiable cause but has to do with CV risk factors
- Biggest number of office visits of non-pregnant adults in the US
Description of the secondary hypertension types
- small % of the population
- results from another identifiable disease process (kidney disease, endocrine disorder)
What is considered normal BP?
< 120 / < 80 mmHg
What is considered elevated BP?
120-129 / < 80 mmHg
What is considered stage 1 hypertension?
130-139 / 80-89 mmHg
What is considered stage 2 hypertension?
> 140 / > 90 mmHg
What the other risk factors of hypertension?
stress, sleep apnea, the use of birth control pills, moderate alcohol use (more than 1-2 drinks/day for men - more than 1 drink/day for women)
What is HTN associated with?
Increased CVD incidence
Increased MI
Angina
CVA
HF (heart failure)
PAD (peripheral artery disease)
AAA (abdominal aortic aneurym)
How is HTN diagnosed?
- present with hypertensive emergency (> 180 / > 120)
- preasents with BP > 160 / > 100 and confirmed cardiac risk factors = highly suspicious
How are patient able to self diagnose?
If any mean home blood pressure is >130/>80 mmHg - if taken properly
- diagnosed if the mean daytime blood pressure is >130/>80 mmHg or 24 hour mean is 125/75
If out of office BP is not attained?
- HTN confirmed and should be treated if: mean BP of >130/>80 mmHg
- 3 visits over weeks to months
What is “white coat” HTN?
BP elevated while in the office but normal in general
- more common in older adults, females, non-smokers
- happens in 13-35%
- becomes important when readings are >20-10 mmHg higher than normal
- ABPM is better than HBPM to help see White Coat
What is masked HTN?
Office BP readings are normal but ABPM/HBPM is always above normal
- make sure to take accurate HBPM and own BP readings
- helps avoid unneccessary treatment
What are the effects of chronic hypertension?
due to an overload on the left ventricle
- this leads to stiff left ventricle = heart failure with decreased ejection fraction
- predisposition towards MI because the left ventricle is not able to get proper O2
What are the sx of decreased CO?
- dizziness
- dyspnea
- impaired exercise tolerance
How do we manage of HTN?
- weight loss
- aerobic exercise
- limiting sodium to < 6g/day
- Reduce alcohol
- Stop smoking . reduce sympathetic stimulation of vessels
- treat sleep apnea
Does caffeine affect HTN?
Caffeine does not produce chronic BP elevation (unless already at high risk)
What is the recommended weight loss for HTN?
each 10kg weight loss is associated with 5-10 mmHg drop in SBP
Why is aerobic exercise help with HTN management?
- sedentary normotensive people have 20-50% higher risk of getting HTN
- this causes lower HR and decreases levels of circulating catecholamines = possible reduced sympathetic tone of the vessels
Hypertension
When is pharmacotherapy suggested?
Out of office daytime BP >135 or >85 (or avg BP >140/90)
OR
Out of office day time BP >130 or >80 AND cardiac rest factors of DM, established CV disease, >65 y/o, chronic kidney disease or >10 years risk of CAD
Hypertension
What are the initial stages of medication therapy?
- thiazide diuretic
- long acting Ca channel blocker
- ACE inhibitor
- Beta Blockers
Higher BP = more drug combinations are added
Hypertension
What are some pre-hypertension management?
Risk stratification and lifestyle education
Hypertension
What are some management of elevated BP?
- risk management and lifestyle modifications
- reduction of salt and potassium supplements
- weight loss/DASH diet
- no smoking and limiting that DRANK AND DRUGS
- aerobic exercise
Hypertension
How does exercise assist with elevated BP?
Lowers BP by 5-7 mmHg
- lowers CVD risk by 30%
Hypertension
What is the aerobic ACSM guidelines for elevated BP?
5-7 days
60-80% of target heart rate or 6-11 on RPE
30-60 which can be broken uo
Rhythmic movements for larger muscle groups
- examples: walking, swimming, cycling
Hypertension
What is the resistance traning ACSM guidelines for elevated BP?
2-3 days
60-80% of 1RM
2-4 sets x 8-12 reps
Larger muscle groups
Hypertension
What is the flexibility training ACSM guidelines for elevated BP?
around 2-3 days
10-30 seconds
2-4 reps
for major muscle groups
Hypertension
Where do PTs fir in regards to hypertension treatment?
- We are screening for risk factors
- be able to take BP accurately with a baseline on everyone with 1 or more risk factors
- Monitor sx and BP readings in patients with known HTN
- Give the necessary prescription of appropriate EBP
- Education, Education, EDUCATION on lifestyle changes and risk factor management
- MD communication
What is the ratio of undiagnosed HTN?
1 in 3 adults
What are the ACSM guidelines for HTN?
- monitoring BP
- beta blockers are da goat
- look for exaggerated response to exercise at low intensities
- keep a < 220 &/or < 105
- no valsalva
- longer warm ups and cool downs
- look for post-exercise hypotension
- positive effects only happen if exercise is continued
Hypertension
What does beta blockers do to the body?
- impairs thermoregulation
- stops HR response
- BUT increases possibility of hypoglycemia
Hypotension
What is orthostatic hypotension?
Drop in the blood pressure from supine to sit or sit to stand or supine to stand