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SYSTEMIC CONDITIONS > ESSENTIAL NEED TO KNOW!!! > Flashcards

ESSENTIAL NEED TO KNOW!!! Flashcards

1
Q

VERTEBRAL ARTERY INSUFFICIENCY (VBI) - DEFINITION

A
  • VBI is when blood flow to the back of your brain reduces or stops
  • VBI affects the parts of the brain that controls balance and movement
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2
Q

VERTEBRAL ARTERY INSUFFICIENCY (VBI) - RARE TYPE

A

A rare type of VBI is transient vertebral artery insufficiency (also called Bow Hunter syndrome) and it is caused by turning/rotating the head

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3
Q

VERTEBRAL ARTERY INSUFFICIENCY (VBI) - CAUSE

A
  • Atherosclerosis commonly causes VBI
    o Atherosclerosis occurs when plaque forms from calcium and cholesterol build up in the arteries
  • Other common causes
    o Penetrating artery disease
    o Pulmonary embolism
    o Vertebral artery dissection
  • Less common causes
    o Blood disorders (coagulopathies)
    o Drug addiction
    o Fibromuscular dysplasia
    o Migraine headaches
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4
Q

VERTEBRAL ARTERY INSUFFICIENCY (VBI) - POPULATION AFFECTED

A

Men over 50

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5
Q

VERTEBRAL ARTERY INSUFFICIENCY (VBI) - RISK FACTORS

A
  • Coronary artery disease
  • Peripheral artery disease
  • Diabetes
  • Family history
  • Hypertension
  • High cholesterol
  • History of smoking
  • Obesity
  • Atherosclerosis
  • Hyperlipidemia
  • Heart conditions that cause a blocked artery also increase the risk of VBI
    o Arterial fibrillation
    o Blood clotting disorders
    o Infective endocarditis
    o Vertebral artery dissection
  • Men
  • Black people
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6
Q

VERTEBRAL ARTERY INSUFFICIENCY (VBI) - CLINICAL PRESENTATION

A
  • Balance problems - Dizziness, Vertigo
  • Confusion
  • Dysphagia
  • Ataxia
  • Double vision/loss of vision
  • Syncope
  • Loss of balance
  • Nausea and vomiting
  • Numbness in part of the body
  • Dysarthria
  • Drop attacks
  • Urinary incontinence
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7
Q

VERTEBRAL ARTERY INSUFFICIENCY (VBI) - DIAGNOSIS

A
  • Imaging – CT or MRI
  • Angiography
  • CTA or MRA
  • Echocardiogram
  • Electrocardiogram
  • Holter monitor
  • Prothrombin time (PT) and partial thromboplastin tine (PTT) blood tests
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8
Q

VERTEBRAL ARTERY INSUFFICIENCY (VBI) - TREATMENT - LIFESTYLE CHANGES

A

o Achieving a healthy weight
o Controlling cholesterol by changing diet
o Increasing exercise
o Quitting smoking

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9
Q

VERTEBRAL ARTERY INSUFFICIENCY (VBI) - TREATMENT - MEDICATIONS

A
  • Medications to help manage health problems
    o Blood clots
    o Blood pressure
    o Cholesterol
    o Diabetes
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10
Q

VERTEBRAL ARTERY INSUFFICIENCY (VBI) - TREATMENT - SURGERY

A

o Carotid endarterectomy – removing plaque from the carotid artery
o Coronary angioplasty and stent – inserts a small balloon with a stent into an artery in the heart to open it up
o Coronary artery bypass – replace a damaged blood vessel in the heart with a healthy one
o Vertebral artery reconstruction – fix the damage to the arterys that carry blood to that brain

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11
Q

VERTEBRAL ARTERY INSUFFICIENCY (VBI) - TREATMENT FOR TRANSIENT VBI

A

o Brace/collar
o Medication
o Surgery, including minimally invasive spine surgery

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12
Q

VERTEBRAL ARTERY INSUFFICIENCY (VBI) - PREVENTION

A
  • You can reduce the risk by
    o Eating a healthy diet
    o Exercising regularly
    o Keeping cholesterol under control
    o Managing other health conditions – hypertension and diabetes
    o Quite smoking
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13
Q

VERTEBRAL ARTERY INSUFFICIENCY (VBI) - PROGNOSIS

A
  • Prognosis depends on
    o Severity of brain function issues
    o Whether you have had a stroke
    o Age
    o Other health conditions
  • Serious causes may lead to disability or death
  • Most people are able to manage symptoms with medications and lifestyle changes
  • VBI has a recurrence rate of 10% to 15%
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14
Q

VERTEBRAL ARTERY INSUFFICIENCY (VBI) - LONG TERM EFFECTS

A

o DVT
o Pulmonary embolism
o Dehydration/swallowing problems
o Difficulty breathing
o Paralysis or numbness
o Gastritis
o Myocardial infarction
o Lung infections
o Bedsores
o Stroke/TIA
o Vision loss

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15
Q

ABDOMINAL AROTIC ANEURYSM (AAA) - DEFINITION

A
  • AAA is a potentially life-threatening condition
  • It’s a bulge in the main artery that supplies blood to the belly, pelvis and legs
  • The aneurysm is a weak spot in the blood vessel wall, at risk of rupturing and causing a haemorrhage
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16
Q

ABDOMINAL AROTIC ANEURYSM (AAA) - CAUSE

A
  • The following diseases can damage the blood vessel walls or cause weak spots
    o Atherosclerosis
    o Cardiovascular disease
    o Peripheral artery disease (PAD)
    o Traumatic injuries that cause tears in the artery wall
    o Smoking
    o Vasculitis
    o Genetic diseases that affect connective tissues – Marfan syndrome, Ehlers Danlos type IV
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17
Q

ABDOMINAL AROTIC ANEURYSM (AAA) - POPULATION AFFECTED

A

Men over 65

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18
Q

ABDOMINAL AROTIC ANEURYSM (AAA) - RISK FACTORS

A
  • Smoking
  • Being a woman over 70
  • Personal history of an aneurysm in another site, especially in the lower extremities
  • Family history
  • High blood pressure
  • High cholesterol
  • Obesity
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19
Q

ABDOMINAL AROTIC ANEURYSM (AAA) - CLINICAL PRESENTATION

A
  • Most people don’t have symptoms until the aneurysm is close to rupturing
  • You may experience
    o Back, leg or abdominal pain that doesn’t go away
    o Pulsing sensation in the belly
  • Signs of a ruptured AAA
    o Clammy, sweaty skin
    o Dizziness
    o Fainting
    o Fast heartbeat
    o Nausea and vomiting
    o Shortness of breath
    o Sudden, severe pain in the belly, lower back or legs
  • This is a medical emergency
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20
Q

ABDOMINAL AROTIC ANEURYSM (AAA) - DIAGNOSIS

A
  • They don’t have symptoms so healthcare providers often diagnose unruptured AAAs when performing screening exams or tests
  • These include
    o Abdominal ultrasound
    o Computed tomography angiography (CTA)
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21
Q

ABDOMINAL AROTIC ANEURYSM (AAA) - TREATMENT

A
  • Treatment depends on the size of the aneurysm
  • Aneurysms less than 5cm have a low risk of rupturing and may not need treatment right away
  • “Watchful waiting” is recommended
    o Getting ultrasounds every few months to make sure the aneurysm isn’t getting bigger
    o Making lifestyle adjustments
     Exercising
     Not smoking
     Eating a healthy diet
     Avoiding alcohol
     Maintaining a healthy weight
     Taking medication to lower blood pressure
  • Surgery
    o Open surgery – incision in the belly and a graft is sewn onto the bulging section of the aorta
    o Endovascular aneurysm repair (EVAR) – minimally invasive aneurysm repair surgery. Uses a small incision in the groin and the use of a catheter into an artery with an expandable stent to reinforce the aneurysm and prevent rupture
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22
Q

ABDOMINAL AROTIC ANEURYSM (AAA) - PREVENTION

A
  • Can’t always prevent AAA, especially is there is a family history of the condition
  • Screening is available to spot it early
  • Early detection and the right treatment may prevent the aneurysm from getting larger or rupturing
  • Can control risk factors
    o Stopping smoking
    o Exercising
    o Eating a healthy diet
    o Managing weight, blood pressure and cholesterol
    o Avoiding drinking too much alcohol
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23
Q

ABDOMINAL AROTIC ANEURYSM (AAA) - PROGNOSIS

A
  • Outlook is poor for people with an AAA that ruptures – 80% mortality rate
  • About 70% of people who have surgery before their aneurysm reptures live at least another 5 years
  • Prognosis is good for people with small AAAs detected during screening, especially if they improve their cardiovascular health risk factors
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24
Q

CERVICAL ARTERY DISSECTION (CAD) - DEFINITION

A
  • CAD happens when there is a tear in one or more layers of blood vessel tissue
  • It is a common cause of stroke in young and middle-aged adults
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25
Q

CERVICAL ARTERY DISSECTION (CAD) - CAUSE

A
  • Injury to your head or neck is the most common cause of dissection
  • Non-traumatic dissections can occur due to straining or heavy lifting in some people
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26
Q

CERVICAL ARTERY DISSECTION (CAD) - POPULATION AFFECTED

A

People ages 40 – 60

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27
Q

CERVICAL ARTERY DISSECTION (CAD) - RISK FACTORS

A
  • Connective tissue disorders
    o Ehlers-Danlos syndrome
    o Fibromuscular dysplasia
    o Marfan syndrome
    o Osteogenesis imperfecta
  • Recent illnesses
    o Gastrointestinal upset that causes frequent vomiting
    o Upper respiratory infection with persistent coughing
  • Atherosclerosis
  • Hypertension
  • Smoking
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28
Q

CERVICAL ARTERY DISSECTION (CAD) - CLINICAL PRESENTATION

A
  • Many people start noticing symptoms up to a month before receiving a CAD diagnosis
  • There are 3 main types
  • Head or neck pain
  • Horner’s syndrome
  • Stroke-like symptoms
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29
Q

CERVICAL ARTERY DISSECTION (CAD) - CLINICAL PRESENTATION - HEAD OR NECK PAIN

A

 May experience head or neck pain not related to an existing health issue
 Discomfort typically comes on suddenly and doesn’t go away
 Pain is on one side of the head (especially behind one eye) or neck and often resembles a cluster, migraine or thunderclap headache

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30
Q

CERVICAL ARTERY DISSECTION (CAD) - CLINICAL PRESENTATION - HORNER’S SYNDROME

A

 Condition that affects the involuntary function of the eyes and face
 Symptoms include:
 Drooping eyelids
 Smaller pupil in one eye
 Lack of sweating
 Typically only impacts one side of the head

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31
Q

CERVICAL ARTERY DISSECTION (CAD) - CLINICAL PRESENTATION - STROKE-LIKE SYMPTOMS

A

 CAD symptoms occur when part of the brain isn’t getting enough blood
 Ataxia
 Balance problems
 Blurred vision
 Dizziness
 Diplopia
 Limb weakness
 Dysarthria or aphasia
 Vertigo

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32
Q

CERVICAL ARTERY DISSECTION (CAD) - DIAGNOSIS

A
  • CTA
  • MRA
  • Any technique that takes specific pictures of the blood vessels
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33
Q

CERVICAL ARTERY DISSECTION (CAD) - TREATMENT

A
  • They often heal on their own
  • Medical therapies can lower the risk of blood clots that can lead to stroke
  • Antiplatelet therapy – aspirin and clopidogrel
  • Anticoagulant medications – heparin infusion or warfarin tablets
  • Rarely, stenting is necessary
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34
Q

CERVICAL ARTERY DISSECTION (CAD) - PREVENTION

A
  • Important to have monitoring from a vascular specialist
  • All people at risk for CAD should optimise their health by
    o Avoiding prolonged extreme neck positions
    o Avoiding rapid head and neck movements
    o Avoiding heavy lifting
    o Eating a heart-healthy diet
    o Exercise regularly
    o Maintaining blood pressure
    o Quitting smoking
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35
Q

CERVICAL ARTERY DISSECTION (CAD) - PROGNOSIS

A
  • They often heal on their own
  • Typically heals very well, returning the vessel to normal
  • Process usually occurs within the first 3 to 6 months
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36
Q

DEEP VEIN THROMBOSIS (DVT) - DEFINITION

A
  • Deep vein thrombosis occurs when a thrombus (blood clot) develops in veins deep in the body because the veins are injured or the blood flowing through them is too sluggish
  • The blood clots may partially or completely block blood flow through the vein
  • Most DVTs happen in the lower leg, thigh or pelvis but can also occur in other parts of the body including the arm, brain, intestines, liver or kidneys
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37
Q

DEEP VEIN THROMBOSIS (DVT) - CAUSE

A
  • Anything that prevents the blood from flowing or properly clotting can cause a blood clot
  • The main causes of DVT are damage to a vein from surgery or inflammation and damage due to infection or injury
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38
Q

DEEP VEIN THROMBOSIS (DVT) - POPULATION AFFECTED

A
  • Can occur at any age
  • Less common in children and adolescents
  • More common in those over 60
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39
Q

DEEP VEIN THROMBOSIS (DVT) - RISK FACTORS

A
  • Having an inherited condition increases the risk of blood clots
  • Having cancer and some of its treatments
  • Having a history of DVT in yourself or your family
  • Having limited blood flow in a deep vein because of an injury, surgery or immobilisation
  • Not moving for long periods of time
  • Being pregnant or recently having a baby
  • Over 40
  • Being obese
  • Autoimmune disease
    o Lupus
    o Vasculitis
    o IBD
  • Smoking
  • Having varicose veins
  • Taking birth control
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40
Q

DEEP VEIN THROMBOSIS (DVT) - CLINICAL PRESENTATION

A
  • Usually forms in the veins of your legs or arms
  • Up to 30 % of people with DVT don’t have any symptoms but sometimes the symptoms are very mild and don’t raise concern
  • Symptoms of acute DVT include
    o Swelling of the leg or arm
    o Pain or tenderness in your leg or arm
    o The area of your leg or arm that’s swollen or hurts may be warmer than usual
    o Skin that’s red or discoloured
    o The veins near your skins surface may be larger than normal
    o Abdominal pain or flank pain
    o Severe headache and/or seizures (when blood clots affect the veins of your brain)
  • Some people don’t know they have a DVT until the clot moves from their leg or arm and travels to their lung
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41
Q

DEEP VEIN THROMBOSIS (DVT) - DIAGNOSIS

A
  • Duplex venous ultrasound
  • Venography
  • MRI or MRV
  • CT
  • If someone thinks the patient may have a genetic or acquired clotting disorder you may need special blood tests
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42
Q

DEEP VEIN THROMBOSIS (DVT) - TREATMENT

A
  • Anticoagulants
  • Compression stockings
  • Elevating the affected limb at different times throughout the day
  • Sometimes more invasive treatments are requires – these are catheter based procedures
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43
Q

DEEP VEIN THROMBOSIS (DVT) - PREVENTION

A
  • After you have a DVT you will have to reduce your risk of future DVT clots by
    o Taking blood thinning medications
    o Keeping follow-up appointments
    o Making lifestyle changes such as eating healthier foods, being more active and avoiding smoking
  • If you have never had a DVT but have an increased risk of developing one you should
    o Exercise the calf muscles if you sit for a long time - stand up and walk around every 30 mins
    o Get out of bed as soon as you can if you’re sick or have had surgery
    o Take medications or use compression socks after surgery
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44
Q

DEEP VEIN THROMBOSIS (DVT) - PROGNOSIS

A
  • A DVT can take several months to a year to come apart
  • You will need blood thinner medications and keep wearing compression stockings until you are told to stop
  • May need blood tests to make sure you’re getting the right dose of blood thinners
  • You may need continued ultrasounds to make sure the clot hasn’t moved or got bigger
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45
Q

PULMONARY EMBOLISM (PE) - DEFINITION

A
  • A pulmonary embolism is a blood clot in the blood vessels of your lungs
  • This happens when a clot in another part of the body moves through the veins to your lung
  • A PE restricts blood flow tp your lungs, lowers oxygen levels in the lungs and increases blood pressure in the pulmonary arteries
46
Q

PULMONARY EMBOLISM (PE) - CAUSE

A
  • Blood pooling in a certain part of the body, usually arm or leg
  • Injury to a vein
  • Another medical condition – congestive heart failure, atrial fibrillation, heart attack, stroke
  • Increase or decrease in the bloods clotting factors
47
Q

PULMONARY EMBOLISM (PE) - POPULATION AFFECTED

A

Adults aged 70-80

48
Q

PULMONARY EMBOLISM (PE) - RISK FACTORS

A
  • Having a blood clot in the leg or DVT
  • Being inactive for long periods of time
  • Having recently had trauma or injury to a vein
  • Taking birth control pills
  • Currently smoking
  • History of heart failure or stroke
  • Being overweight
  • Are pregnant or have given birth in the previous 6 weeks
  • Received a central venous catheter through the arm or leg
  • Having cancer or receiving cancer treatments
49
Q

PULMONARY EMBOLISM (PE) - CLINICAL PRESENTATION

A
  • Symptoms vary depending on the severity of the clot
  • Some people don’t experience symptoms with a pulmonary embolism but most do
  • Sudden shortness of breath – whether you are active or at rest
  • Unexplained sharp pain in the chest, arm, shoulder, neck or jaw – pain may also be similar to the symptoms of a heart attack
  • Cough with or without bloody mucus
  • Pale, clammy or bluish skin
  • Rapid heartbeat
  • Excessive sweating
  • Feeling anxious, light headed, faint or passing out
  • Wheezing
50
Q

PULMONARY EMBOLISM (PE) - DIAGNOSIS

A
  • Blood tests – D-dimer test
  • CT angiogram
  • Ultrasound of the leg
  • A ventilation/perfusion (V/Q) scan
  • Pulmonary angiogram
  • Chest x-ray
51
Q

PULMONARY EMBOLISM (PE) - TREATMENT

A
  • Hospital stay and treatment length will vary depending on the severity of the clot
  • Main treatment is anticoagulants
  • Compression stockings
  • Thrombolytic therapy – “clot busters”
  • Surgery
52
Q

PULMONARY EMBOLISM (PE) - PREVENTION

A
  • Exercise regularly
  • Drink plenty of fluids, but limit alcohol and caffeine
  • Don’t use tobacco products
  • Avoid crossing legs
  • Don’t wear tight fitting clothing
  • Lose weight if you have overweight
  • Elevate your feet for 30 minutes twice a day
53
Q

PULMONARY EMBOLISM (PE) - PROGNOSIS

A
  • Without treatment, a PE is a very serious condition that can lead to permanent illness or death
  • With treatment, your prognosis depends on the size of the blood clot and blockages as well as overall health and how well your heart can pump blood
  • It can take months or years for a PE to go away completely
  • Repeated PE or a very large PE can lead to pulmonary hypertension in some people
54
Q

STROKE - DEFINITION

A
  • A stroke is a life-threatening condition that happens when a part of the brain doesn’t have enough blood flow
  • This most commonly happens because of a blocked artery or bleeding in the brain
55
Q

STROKE - TYPES

A
  • 2 main ways strokes can happen – ischemia and haemorrhage
  • Ischemia
    o When cells don’t get enough blood flow to supply them with oxygen.
    o This usually happens because something blocks blood vessels in the brain, cutting off blood flow.
    o This type is most common and account for about 80% of all strokes
    o Usually happens due to thrombosis, an embolism, lacunar stroke (small vessel blockage) or cryptogenic stroke (an unknown reason)
  • Haemorrhagic
    o Cause bleeding in and around the brain
    o Usually happens due to bleeding inside the brain (intracerebral) or because of bleeding into the subarachnoid space (the space between the brain and its outer covering
56
Q

STROKE - CAUSE

A
  • Ischemic
    o Atherosclerosis
    o Clotting disorders
    o Atrial fibrillation
    o Heart defects
    o Microvascular ischemic disease
  • Haemorrhagic
    o High blood pressure
    o Brain aneurysms
    o Brain tumours
    o Diseases that weaken or cause unusual changes in blood vessels in the brain, such as moyamoya disease
57
Q

STROKE - POPULATION AFFECTED

A
  • Anyone can have a stroke
  • Most common in people over 65
58
Q

STROKE - RISK FACTORS

A
  • Alcohol use disorder
  • High blood pressure
  • Hyperlipidaemia
  • Migraine headaches
  • Type 2 diabetes
  • Smoking
  • Drug misuse
59
Q

STROKE - CLINICAL PRESENTATION

A
  • Stroke symptoms often depend on the area of the brain that is affected
  • Symptoms of stroke can lead to one or more of the following:
    o One-sided weakness or paralysis
    o Difficulty with or loss of speaking ability (aphasia)
    o Slurred or garbled speaking (dysarthria)
    o Loss of muscle control on one side of the face
    o Sudden loss – partial or total – of one or more senses (vision, hearing, taste, smell and touch)
    o Diplopia
    o Ataxia
    o Dizziness or vertigo
    o Nausea and vomiting
    o Neck stiffness
    o Emotional instability and personality changes
    o Confusion or agitation
    o Seizures
    o Memory loss (amnesia)
    o Headaches (usually sudden and severe)
    o Passing out or fainting
    o Coma
60
Q

STROKE - DIAGNOSIS

A
  • Diagnosis involves a combo of neurological examination, diagnostic imaging and other tests
  • CT scan
  • Lab blood tests
  • ECG
  • MRI scan
  • EEG
61
Q

STROKE - TREATMENT

A
  • Treatment depends on many factors, the most important factor in determining treatment is what kind of stroke a person has
  • Ischemic
    o Top priority is restoring circulation to affected brain areas
    o Restoring circulation usually involves a certain medication type called thrombolytics but may also involve a catheterization procedure
    o Thrombolytic drugs (within 3 to 4.5 hours)
    o Thrombectomy (within 24 hours if there is no significant brain damage)
    o Blood pressure management
  • Haemorrhagic
    o Treatment depends on the location and severity of the bleeding
    o Reducing blood pressure is often the top priority because this will reduce the amount of bleeding and keep it from getting worse
    o Another treatment option is to improve clotting so the bleeding will stop
    o Surgery is sometimes necessary to relieve pressure on the brain from accumulated blood
  • Rehabilitation
    o Speech therapy
    o Physical therapy
    o Occupational therapy
    o Cognitive therapy
62
Q

STROKE - PREVENTION

A
  • Improve your lifestyle
  • Avoid risky lifestyle choices or make changes to your behaviours
  • Manage health conditions and risk factors
  • Reduce caffeine, alcohol, fried foods and recreational drugs
63
Q

STROKE - PROGNOSIS

A
  • Ischemic
    o The more severe an ischemic stroke is, the worse the damage
    o You are more likely to lose certain abilities, at least temporarily
    o The faster you get medical attention the effects or more likely to be temporary or less severe
  • Haemorrhagic
    o These usually cause much worse symptoms, especially when bleeding is more severe
    o Symptoms tend to get worse quickly
  • Strokes have the potential to cause death when they are severe or if they go too long without treatment
  • Outlook does depend a lot on how severe the initial stroke is
64
Q

TRANSIENT ISCHEMIC ATTACK (TIA) - DEFINITION

A
  • A TIA starts like a stroke but only lasts from several minutes up to 24 hours
  • A TIA does not kill the brain cells so there is no lasting damage to the brain
  • Also called a mini-stroke
65
Q

TRANSIENT ISCHEMIC ATTACK (TIA) - CAUSE

A
  • Happens when one of the blood vessels that supply the brain with oxygen-rich blood becomes blocked
  • In TIAs the blockage quickly resolves and the brain’s blood supply returns to normal before there is any significant damage
  • The blockage in the blood vessels responsible for most TIAs is usually caused by a blood clot that’s formed elsewhere in the body and travelled to the blood vessels supplying the brain
  • It can also be caused by pieces of fatty material or air bubbles
66
Q

TRANSIENT ISCHEMIC ATTACK (TIA) - POPULATION AFFECTED

A

Adults over 55

67
Q

TRANSIENT ISCHEMIC ATTACK (TIA) - RISK FACTORS

A
  • Older age – the risk of a stroke doubles with each decade after the age of 55 in both men and women
  • Family history
  • Being male
  • Race – black and Hispanic have a higher risk than white people
  • Hypertension
  • Physical inactivity
  • Diabetes
  • Heart disease
  • Atrial fibrillation
  • Smoking
  • High blood cholesterol levels
  • Drug abuse
  • Obesity
68
Q

TRANSIENT ISCHEMIC ATTACK (TIA) - CLINICAL PRESENTATION

A
  • Symptoms of a TIA and stroke do not differ
  • Symptoms come on suddenly
  • Difficulty seeing from one or both eyes
  • Numbness or weakness in the face, arms or legs, especially on one side
  • Severe headache
  • Difficulty walking
  • Dizziness, loss or coordination and balance
  • Difficulty speaking or understanding words
69
Q

TRANSIENT ISCHEMIC ATTACK (TIA) - DIAGNOSIS

A
  • Simple tests to check vision, muscle strength and ability to think and speak
  • CT scan
  • MRI scan
  • ECG
70
Q

TRANSIENT ISCHEMIC ATTACK (TIA) - TREATMENT

A
  • General approach to treating and preventing TIAs is the same as that used to treat and prevent strokes
  • Aspirin and clopidogrel
  • Anticoagulant drugs
  • Carotid endarterectomy – surgical removal or the plaque withing the carotid artery
  • Carotid angioplasty and stenting procedure
71
Q

TRANSIENT ISCHEMIC ATTACK (TIA) - PREVENTION

A
  • Stopping smoking
  • Monitor blood pressure
  • Monitor cholesterol
  • Eat a Mediterranean-style diet
  • Maintain a healthy weight
  • Stop drinking alcohol
  • Exercise
  • Wear your CPAP
72
Q

TRANSIENT ISCHEMIC ATTACK (TIA) - PROGNOSIS

A
  • Prognosis is good
  • A TIA usually lasts only a few minutes and doesn’t cause permeant damage
  • However a TIA is often a warning of a stroke so it is important to look at lifestyle factors to reduce risk factors
73
Q

HYPERTENSION - DEFINITION

A
  • High blood pressure
  • Blood pressure is the measurement of the pressure of blood pushing against blood vessel walls
  • Hypertension means that the pressure against the blood vessel walls in the body is consistently too high
74
Q

HYPERTENSION - BLOOD PRESSURE READINGS

A
  • Normal – under 130/80 mmHg
  • Stage 1 hypertension (mild) – 130-139 OR diastolic between 80-89 mmHg
  • Stage 2 hypertension (moderate) – 140/90 mmHg or higher
  • Hypertensive crisis (get emergency care) – 180/120 mmHg or higher
75
Q

HYPERTENSION - CAUSE

A
  • 2 types of high blood pressure
  • Primary
    o Most common
    o Aging
    o Unhealthy habits – not getting enough exercise
  • Secondary
    o Different medical problems
    o A medication you are taking
76
Q

HYPERTENSION - POPULATION AFFECTED

A

Black adults over 55

77
Q

HYPERTENSION - RISK FACTORS

A
  • Have family members who have high blood pressure, cardiovascular disease or diabetes
  • Are of African descent
  • Older than 55
  • Overweight
  • Don’t get enough exercise
  • Eat foods high in sodium
  • Smoke
  • Are a heavy drinker
78
Q

HYPERTENSION - PREGNANCY

A
  • High blood pressure complicates about 10 % of all pregnancies
  • Several different types of high blood pressure during pregnancy
  • Chronic hypertension – high blood pressure that is present before pregnancy
  • Gestational hypertension – high blood pressure in the latter part of pregnancy
  • Preeclampsia – dangerous condition that typically develops in the latter half of pregnancy and results in hypertension, protein in the urine and generalised swelling in the pregnant person. It can affect other organs in the body and cause seizures (eclampsia)
  • Chronic hypertension with superimposed preeclampsia – pregnant people who have chronic hypertension are at an increased risk for developing preeclampsia
79
Q

HYPERTENSION - CLINICAL PRESENTATION

A
  • Called the ‘silent killer’
  • Most people with hypertension are unaware of the problem because it may have no warning signs or symptoms
  • Most people have no symptoms at all
  • When symptoms do occur they can include
    o Early morning headaches
    o Nosebleeds
    o Irregular heart rhythms
    o Vision changes
    o Buzzing in ears
  • Severe hypertension can cause
    o Fatigue
    o Nausea
    o Vomiting
    o Confusion
    o Anxiety
    o Chest pain
    o Muscle tremors
80
Q

HYPERTENSION - DIAGNOSIS

A
  • Taking blood pressure with a blood pressure cuff
81
Q

HYPERTENSION - TREATMENT

A
  • Diet
    o Eat foods that are lower in fat, salt and calories
    o Use flavourings, spices and herbs to make foods tasty without using salt
    o Avoid or cut down on foods high in fat or salt
    o Increase potassium in your diet
  • Medications
    o Angiotensin-converting enzyme (ACE) inhibitors
    o Angiotensin II receptor blockers (ARBs)
    o Calcium channel blockers
    o Diuretics
82
Q

HYPERTENSION - PREVENTION

A
  • Eating a healthy diet
  • Keeping a healthy weight
  • Cutting down on salt
  • Keeping active
  • Drinking alcohol in moderation
83
Q

HYPERTENSION - PROGNOSIS

A
  • If you have primary hypertension, you will need to manage it for the rest of your life
  • If you have secondary hypertension, your blood pressure will most likely come down after you receive treatment for the medical problem that has caused it
  • You can get seriously ill of you don’t treat high blood pressure
  • You can manage blood pressure by taking certain medications
  • Exercising and eating healthy foods helps lower blood pressure
84
Q

TEMPORAL ARTERITIS - DEFINITION

A
  • Temporal arteritis is a form of vasculitis
  • Also known as giant cell arteritis or Horton’s arteritis
  • In TA, the temporal arteries (the blood vessels near the temples), which supply blood from the heart to the scalp are inflamed and constricted
85
Q

TEMPORAL ARTERITIS - CAUSE

A
  • The causes are poorly understood
  • There is no well-established trigger or risk factors
  • Once cause may be a faulty immune response
  • TA often occurs in people who have polymyalgia rheumatica
86
Q

TEMPORAL ARTERITIS - POPULATION AFFECTED

A

Women aged between 70 and 80

87
Q

TEMPORAL ARTERITIS - RISK FACTORS

A
  • Age – most cases occur between 70 and 80
  • Gender – women are 2 times more likely than men
  • People of northern European or Scandinavian descent
  • Having polymyalgia rheumatica
  • Family history
88
Q

TEMPORAL ARTERITIS - CLINICAL PRESENTATION

A
  • Most common symptom is a throbbing, continuous headache on one or both sides of the forehead
  • Fatigue
  • Fever
  • Jaw pain that may become worse after chewing
  • Tenderness at the scalp or temples
  • Vision problems
    o Double vision
    o Blurry vision
    o Transient vision loss
    o If this is not treated, it could be followed by permeant, irreversible vision loss
  • Muscles aches in the upper arms or shoulders, hips, upper thighs, lower back and buttocks
  • Loss of appetite or weight loss
89
Q

TEMPORAL ARTERITIS - DIAGNOSIS

A
  • Blood tests
    o Erythrocyte sedimentation rate
    o C-reactive protein
    o Haemoglobin level
  • Biopsy
  • MRI scan
  • PET scan
  • Ultrasound
90
Q

TEMPORAL ARTERITIS - TREATMENT

A
  • No cure
  • Can be treated with medications
  • Treatment is steroids
  • Glucocorticoids such as oral prednisone
  • Patient should not smoke, and alcohol should be kept to a minimum
91
Q

TEMPORAL ARTERITIS - PREVENTION

A
  • Eat a healthy diet
  • Exercise regularly
  • Get check ups
  • Talk to your doctor about taking aspirin daily
92
Q

TEMPORAL ARTERITIS - PROGNOSIS

A
  • Outlook is very good, unless the person has had vision loss
  • If vision loss occurs it generally cannot be reversed
  • Most complications associated with temporal arteritis are from the use of steroid drugs, not from the disease itself
93
Q

BACTERIAL MENINGITIS - DEFINITION

A
  • Acute bacterial meningitis is the most common form of meningitis
  • It can be life threatening
  • The infection can cause the tissues around the brain to swell
  • This in turn interferes with blood flow and can result in paralysis or even stroke
94
Q

BACTERIAL MENINGITIS - CAUSE

A
  • The bacteria most often responsible for bacterial meningitis are common in the environment and can also be found in the nose and respiratory system without causing any harm
  • Sometimes meningitis occurs for no reason
  • Other times it occurs after a head injury or after you have had an infection and your immune system is weakened
95
Q

BACTERIAL MENINGITIS - POPULATION AFFECTED

A

Children between 1 month and 2 years are most susceptible

96
Q

BACTERIAL MENINGITIS - RISK FACTORS IN ADULTS

A
  • Alcohol abuse
  • Have chronic nose or ear infections
  • Sustain a head injury
  • Get pneumococcal pneumonia
  • Weakened immune system
  • Have your spleen removed
  • Are on corticosteroids because of kidney failure
  • Have sickle cell disease
  • Brain or spinal surgery
  • Have a widespread blood infection
97
Q

BACTERIAL MENINGITIS - CLINICAL PRESENTATION

A
  • High fever
  • Headaches
  • An inability to lower the chin to the chest due to stiffness in the neck
  • In older children and adults
    o Confusion
    o Irritability
    o Increasing drowsiness
    o Seizures and stroke may occur
  • In young children
    o Fever may cause vomiting
    o Refusal to eat
    o Very irritable and crying
    o May be seizures
    o Swelling of the head (less common)
  • Onset of symptoms is fast, within 24 hours
98
Q

BACTERIAL MENINGITIS - DIAGNOSIS

A
  • Physical exam
    o Look for a purple or red non-blanching rash
    o Check neck stiffness
    o Exam hip and knee flexion
  • Spinal tap to decide what the cause of the meningitis is
  • Blood and urine analysis
  • Mucous from nose and throat may be analysed
99
Q

BACTERIAL MENINGITIS - TREATMENT

A
  • Antibiotics
  • Intravenous antibiotic with a corticosteroid to bring the inflammation down may be prescribed even before the test results are in
  • Replenish fluids lost from loss of appetite, sweating, vomiting and diarrhoea
100
Q

BACTERIAL MENINGITIS - PREVENTION

A
  • Seek preventative treatment if you have had close contact with someone with bacterial meningitis
  • Vaccinations
101
Q

BACTERIAL MENINGITIS - PROGNOSIS

A
  • 10% death rate from bacterial meningitis
  • Most people recover if diagnosed and treated early
  • There may be permeant damage if treatment is not started immediately
  • Seizures, mental impairment and paralysis may be life-long
102
Q

VIRAL MENINGITIS - DEFINITION

A
  • Infection and inflammation of the fluid membranes surrounding the brain and spinal cord
  • These membranes are called meninges
103
Q

VIRAL MENINGITIS - CAUSE

A
  • Common cause of meningitis
  • Usually mild and often clears on its own
  • Most cases are due to a group of viruses called enteroviruses
  • Most common in late summer and early fall
104
Q

VIRAL MENINGITIS - POPULATION AFFECTED

A

Children under 5

105
Q

VIRAL MENINGITIS - RISK FACTORS

A
  • Skipping vaccinations
  • Age
    o Most cases of viral meningitis occur in children under 5
  • Living in a community setting
    o College students living in dorms
    o Personnel on military bases
    o Children in boarding school or care facilities
  • Pregnancy
    o Increases the risk of an infection caused by listeria bacteria
    o Increased the risk of miscarriage, still birth and premature delivery
  • Weakened immune system
    o AIDS
    o Alcohol use disorder
    o Diabetes
    o Use of immunosuppressant drugs
    o Having spleen removed
106
Q

VIRAL MENINGITIS - CLINICAL PRESENTATION - OVER 2

A

o Sudden high fever
o Stiff neck
o Severe headache
o Nausea or vomiting
o Confusion
o Trouble concentrating
o Seizures
o Sleepiness or trouble waking
o Sensitivity to light
o No appetite or thirst
o Skin rash in some cases, such as in meningococcal meningitis

107
Q

VIRAL MENINGITIS - CLINICAL PRESENTATION - NEW-BORNS

A

o Nigh fever
o Constant crying
o Being very sleepy or irritable
o Trouble waking from sleep
o Being inactive or sluggish
o Not waking to eat
o Poor feeding
o Vomiting
o A bulge in the soft spot on top of the baby’s head
o Stiffness in the body and neck

108
Q

VIRAL MENINGITIS - DIAGNOSIS

A
  • Cerebral spinal fluid tap
  • Blood sample
  • Stool sample
  • Nasal or throat swan
  • CT scan
  • MRI scan
109
Q

VIRAL MENINGITIS - TREATMENT

A
  • Antivirals for certain cases of viral meningitis, like herpesvirus and influenza
  • Corticosteroids, like dexamethasone or prednisone, to reduce inflammation
  • Pain relievers
  • IV fluids to keep hydrated
110
Q

VIRAL MENINGITIS - PREVENTION

A
  • Getting vaccinated
  • Practising safe food handling
  • Washing hands
  • Cover mouth and nose when you cough or sneeze
  • Disinfect frequently touched surfaces
  • Avoid contact with others who are sick
111
Q

VIRAL MENINGITIS - PROGNOSIS

A
  • Viral meningitis can go away on its own within about a week
  • You can survive most forms of meningitis, though it is a very serious illness that requires immediate treatment
  • May have some long term effects
    o Vision or hearing loss
    o Trouble with memory or concentration
    o Epilepsy
    o Movement and balance issues
    o Behavioural issues or learning difficulties in kids
    o Arthritis
    o Organ damage
    o Loss of fingers, toes or limbs due to sepsis

SYSTEMIC CONDITIONS (13 decks)

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