Exam 2 Review Flashcards
fibrillation
irregular fast heart rate, can lead to blood clots
thrombus
stationary clot attached to vessel wall
coronary thrombus
thrombus in blood vessel of the heart
embolus
moving clot
can thrombus go to embolus?
yes from the pressure of blood
congestive heart failure
heart muscles don’t pump as well as they should - inadequate blood to organs
stable angina
chest pain, stress or exercise
embolism
obstruction of artery
arteriosclerosis
stiffening or hardening of blood vessels
atherosclerosis
narrowing from plaque build up
metabolic syndrome
waist circumference - 31 in Asian Americans
high triglyceride
how HDL
elevated BP
elevated fasting glucose
unstable angina
no pattern of pain or at rest, lasts longer, rest and medication don’t relieve
sign of heart attack
variant angina
pain at rest, temporary artery spasm, younger women under 50, smaller lumen
management for Angina drugs
nitrate
beta blocker
Calcium channel blocker
anti platelet drugs
what do you look for patient evaluation
co-morbidity (2 or more diseases at same time), company atherosclerosis - diabetes, high lipid, hypothyroid, vascular disease
reduce risk of angina
lower LDL to less than 100
ischemia
no tissue death - causes reduction of blood flow
infarction
prolonged cessation of blood flow (blood flow reaches zero) causes tissue death
why is presence of cardiac enzymes a major sign of infarction
when the cells are dying they can’t hold the structure and release content to other areas - cells are dying if you can detect them
heart attack in men
pain in chest
lightheadedness, nausea, vomiting
jaw, neck, back pain
discomfort or pain in arm or shoulder
shortness of breath
heart attack in women
flu like
pressure, squeezing, fullness or pain in chest
pain or discomfort in arms, back, jaw, stomach
shortness of breath
cold sweat, nausea, vomit, lightheaded
chest pain or discomfort
male patterns of heart attack
obstruction in coronary vessel
male heart attack diagnostic
stress test, coronary angiography
male heart attack treatment
angioplasty, bypass surgery, statins
female heart attack patterns
microvascular coronary dysfunction, inflammation
female heart attack diagnostic
stress test, functional vascular imaging, cardiac MR, IVUS
female heart attack treatment
anti-hypertensive, anti inflammatory, statins
women ____ men ___
women erode, men explode
most common area for infarction and most lethal
left anterior descending artery
widow maker - kills
Clotting process
- monocytes go to area of injury in blood vessel
- covered to macrophages that engulf fat and turn to foam cells
- foam cells die and deposit under endothelium
smooth muscles go to top to form fibrous cap - when cap ruptures it exposes atheroma and stimulate coagulation forming coronary thrombus
- can obstruct artery that lead to AMI
million hearts initiative
focus, coordinate, enhance cardiovascular disease prevention activities
life’s simple 7
get active
control cholesterol
eat better
manage blood pressure
lose weight
reduce blood sugar
stop smoking
go red for women
raise awareness about heart disease and stroke in women. take charge of heart, red as symbol to untie women
transmural
death tissue on layers of the heart
sub endocardial
death of tissue is located just underneath the endocardial layer
AMI complications - 7
- Arrhythmias - AF, VF, heart block
- heart failure
- intracardiac thrombi
- pericarditis
- papillary muscle dysfunction
- ventricular aneurysm
- cardiac rupture - worst
hypertension nickname
silent killer because you don’t know it’s going to happen until it happens
diagnostic of hypertension?
blood pressure measurements
primary hypertension
no known cause
secondary hypertension
there is a known cause
isolated systolic hypertension
same effects as primary and secondary
rise in systolic
lower diastolic
what percentage of people will develop hypertension in the next 4 years with a BP of 120-139/80-89
50%
hypertension urgency
asymptomatic for signs
hypertensive emergency
shows signs and symptoms
complications of hypertension
CVD mortality and morbidity
increase systolic and diastolic BP
older than 50 have increase in systolic and pulse pressure - predictor of complications than diastolic
inaccurate BP readings-7
talking or active listening - adds 10
full bladder - adds 10
unsupported back and feet -adds 6
crossed legs - addes 2-8
unsupported arm - adds 10
cuff over clothing - add 5-50
cuff too small - add 2-10
lifestyle modifications
reduce weight - highest BP reduction
increase aerobic physical activity - average SBP reduction 4-9
moderation in alcohol, 2 for men, 1 women
restrict sodium 1.5-2.4 g/day 2 if with CHF and kidney disease
modify eating plan - dash 8-14 SBP reduction
dash diet
high fruit, vegetable, low fat dairy
low total fat, saturated, cholesterol
stroke risk factors
age
gender
family history
high blood cholesterol
high blood pressure
physical inactivity
obesity and overweight
smoking
diabetes
TIA (transient ischemic attack)
less than 24 hour stroke, symptoms resolve, not permanent damage
s/s of TIA
loss of sensation in arm or leg, opposite side of body
temporary reduction of brain supply
think or speaking
short speech
partial loss of vision
causes of TIA
platelets, blood clot, fatty material calcium on carotid artery
ischemic stroke
blockage of blood vessel supplying Brian by embolus or thrombus
- clot from fatty deposit
- can cause cerebral thrombosis
- cerebral embolism
cerebral embolism
blood clot in another part of the circulatory system which breaks loose from an artery or the heart and travels to the brain where the blood vessels are too small to pass it
- causes obstruction of blood flow in brain - lack of oxygen
hemorrhagic stroke
rupture of blood vessel with bleeding into or around the brain
- causes by weak vessels that rupture
- compression on brain tissue where blood is
- pressure damage to brain cells inhibits proper function of brain tissue
- 20% of strokes are more serious and frequently fatal, extensive damage to brain tissue, pre-existing hypertension
- both last more than 24 Hours
strokes in right hemisphere of brain -7
impair judgement
short term memory
one-sided neglect
spatial and perceptual abilities
loss of sensation, reflex changes
controlling emotions
dysarthria
stroke in left hemisphere of brain
aphasia - partial loss or total loss of ability to communicate verbally or writing
highly specific problems
difficulty learning new information, login, problem solving
prevention treatment
reduce risk factors
immediate treatment after stroke
acute or while stroke is evolving - dissolve blood clot or stop bleeding
post - stroke rehabilitation
reduce stroke damage
overcome disabilities
how to prevent stroke
lifestyle modifications
treat risk factors
stress
drugs
surgery - carotid endarterectomy - 50% narrowing
FAST
face drooping
arm weakness
speech difficulties
time to call 911
BEFAST
balance
eyesight changes
facial drooping
arm weakness
speech difficulty
time to call 911
dementia
neurocognitive disorder that impairs intellectual function, interfere with daily activity
dementia is NOT..
disease itself but group of symptoms
causes damage to brain cells
types of dementia
Alzheimer’s disease - MC in U.S
vascular dementia
Lewy body dementia
frontotemporal dementia
parkinson’s
Lewy body dementia
rigidity and bradykinesia
visual - bizarre hallucinations
tremor - rarely
frontotemporal dementia
personality change
compulsive behavior
preserved visuospatial function
s/s dementia
clinical picture varies greatly
2 core mental functions significantly impaired
impairments
memory impairment
aphasia - language
fluent/receptive aphasia - comprehension, word meaning
PPA - primary progressive aphasia
apraxia - motor disorder, purposeful movement
agnosia - perceptual disorder, identifying
impaired executive function
Is Alzheimer’s characterized by early loss of long term memory and one other cognitive function
No
just 2 cognitive functions being impaired
6 R’s
reassess
reconsider
re-channel/re-direct
reassure
review
restrict
reassess
situation needs, interventions
reconsider
strategies based on condition
re-channel/re-direct
negative energy or action, guide behavior
reassure
support and comfort
review
care plan and interventions
restrict
limit actives
guidelines for caretakers-8
safety first
music brings joy
routines are good
speak simply
understand feelings not words
don’t urge to correct
communicate w/ touch
ask for support
agitation
respond simply, reasonable, kind statement - don’t be angry
aggression
underlying reason, agreeable, feelings and validate
apathy- lack of interest
keep them engaged
apraxia
remember it’s not stubbornness or willfulness
repetition/perseveration
be patient and repeat back
confusion/disorientation/ memory loss
don’t remind them they’re losing their memory
hallucination/delusion
no action necessary if not harmful,
medication, validation, social contact
suspicions, delusions, paranoia
validate feelings
sundowning
reduce stimulation, good lighting
wandering
constant supervision
lock, gate, alarm
alzheimer’s is a type of…
dementia
specific brain disease that accounts fro 60-80% of dementia cases
dementia
general term for symptoms like decline in memory, reasoning, other thinking skills
Alzheimers disease and senile dementia
○ Acquired, persistent, progressive impairment of intellectual function
○ Cortex of brain shrivels and damages area that involve thinking, remembering, and planning
○ Cerebrospinal fluid fill ventricle
○ Hippocampus shrink a lot
○ #7 cause of death in U.S. and only top 10 cause of death we can’t prevent, slow, or cure
Increased 146% from 2000 to 2018
signs of Alzheimer’s
poor judgement and decision making
can’t manage budget
losing track of date or season
difficulty having conversation
misplacing things and not able to retrace steps
pre-clinical Alzheimer’s
plaques and tangles spread in cortex in brain areas - learning, memory, thinking, planning
MCI mild cognitive impairment
more plaque and tangle
serious thinking/memory problems that interfere with work or social
change in personality or behavior
trouble recognizing friends and family
dementia
may last 1-5 years..?
most of the cortex seriously damaged, brain shrinks dramatically because of widespread cell death
loss of speech, appetite, weight, bladder, bowel control
total dependance
dementia risk factors
age
family
lack of social engagement
low educational level (apolipoprotein E detected in late AD)
MCI
traumatic brain injury
CVD risk factors
dementia diagnosis
medical history
mental status testing - mini cog (clock test)
physical and neurological exam
lab test - blood test and brain imaging
brain scan - CT or MRI to tule out stroke or tumor and PET scan
biopsy/autopsy
diagnosis to REALLY remember
mental status testing - mini cog (clock test)
biopsy/autopsy - only way to be 100% certain of AD
perfectly hidden depression - 10 things
- perfectionist
- excessive sense of responsibility
- worry a lot, avoid situations where control isn’t possible
- focus on task, accomplishment to have value
- sincere concern about others, allow few to world
- dismiss hurt or abuse from past
- accompanying mental health issue - anxiety
- count blessing as foundation
- emotional difficulty in personal relationships
- professional success
s/s of depression
SIGECAPS
○ S- sleep changes - increase day, decrease night
○ I- interest loss (apathy)
○ G- guilt
○ E- energy loss
○ C- cognition/concentration reduced
○ A- appetite, decreased usually
○ P- psychomotor agitation (anxiety)/retardation (lethargic)
S- suicide preoccupation
cognitive distortions - 8
○ Catastrophizing - assume the worst
○ Overgeneralization - what happened once to all experiences
○ Jump to conclusions
○ Label - self label
○ Should statement
○ Filter thinking - negative side of things
○ Black and white thinking - one way or another with no in between
○ Emotional reasoning - true based on how you feel
Personalization and blame - too personally and blame self
cognitive reconstruction effects
lower BP
reduce risk of heart disease
strengthen immune system to resist infection and disease
lower stress level
calm down
avoid stomach problems, insomnia, back pain
happier and more optomistic about future
strategies for cognitive reconstruction - 8
○ Remove should though
○ Acknowledge feelings
○ Thought diary
○ Recognize thought pattern and ANTS
○ Put thought on trial - challenge ANTS
○ Take break from ANTS
○ Focus on strengths, make small steps
- Coping with criticism and rejection
more strategies
§ Eat well, sleep, active
§ Gratitude- count blessings
§ Social connections
§ do something nice for self
§ Mindfulness
§ Set self up for success - be realistic
§ Share feelings
- Seek professional support
benign tumor
slow growth rate
growth character - expansion
tumor spread - localized
cell differentiation - well differentiated cells
- oma to cells of origin
malignant tumor
rapid growth rate
growth character - infiltration
tumor spread - metastasis by bloodstream or lymphatic channels
cell differentiation - poorly differentiated cells
type of lump in breast - fibrocyst, fibroadenoma, malignant tumor
gene mutations
BRCA 1 and BRCA 2
BRCA 1
mutated tumor suppressor gene
60-80% chance of BC
45% chance of ovarian cancer
increase risk of uterine cancer
BRCA 2
mutated tumor suppressor gene
50-70% chance of BC
10-20% chance of ovarian chancer
s/s of breast cancer
lump, change in size/shape, duct discharge
lump painless, hard and uneven or soft and tender
spread through blood and lymphatics - tissue
breast cancer locations
upper right - 60
lower right - 15
upper left - 15
lower left - 5
nipple -5
staging
describes extent and spread from original site - size, location, spread
- prognosis and treatment options
different staging systems
AJCC
TNM staging
tumor size
node involvement
metastasis
in situ
localized
ductal carcinoma in situ
lobular carcinoma in situ
infiltrating
invasive ductal carcinoma
50-75 hard tumor, irregular shape, abnormal cells in milk ducts
invasive lobular carcinoma - firm tumor likely ER+ and HER2 negative
ER+
tumor uses estrogen to grow
HER2
human epidermal growth factor, if negative, not a lot of protein HER - slower growth in contrast to positive, treated with Herceptin
TNBC
10-15% of BC, cells don’t have estrogen or progesterone receptors
breast cancer risk factors
age
race
biological susceptibility
personal and family history
early menarche, late menopause
not breastfeeding
poor diet
physical inactivity
alcohol
contraceptive
hormone therapy
reproductive history
DES - nonsteroidal estrogen med
dense breast
has more fibrous and glandular tissue rather than fatty tissue
- hard to tell in mammogram if there is BC
- non-dense, fatty, low density, high density
stage 0
noninvasive, carcinoma in situ
stage 1
breast cancer
1-2 cm, no lymph nodes involved
stage 2
invasive breast cancer
2-5 cm, axillary LN on same side as BC
stage 3
locally advanced breast cancer
greater than 2 inches in diameter
extensive axillary LN, spread to other LN or tissue
stage 4
metastatic breast cancer
recurrent
breast surgery
simple/total mastectomy
halted radical mastectomy
modified radical mastectomy with axillary lymph node dissection
breast conserving surgery
simple or total mastectomy
remove entire breast -
leave behind axillary lymph node and chest muscle
Halsted radical mastectomy
entire breast, all LN, chest muscles, and additional fat and skin
modified radical mastectomy with axillary lymph node dissection
entire breast and all ALN dissection but leave chest muscles
breast conserving surgery
*Lumpectomy - remove only tumor and small rim of normal tissue around, most of breast left in place
partial mastectomy
lymph node dissection
mammogram
up to 2 years can detect breast cancer - 2 years earlier than manual
infectious agent
micro-organism capable of causing disease or illness
bacteria, fungi, parasite, prions
reservoir
place where infectious agents live, grow, reproduce
- people, water, food
portal of exit
agent leaves reservoir
- blood, secretion, excretion, skin
mode of transmission
spread from reservoir to host
- physical contact, droplet, airborne
portal of entry
how it enter susceptible host
- mucous membrane, respiratory system, digestive system, broken skin
susceptible host
have traits that affect susceptibility and severity
- immune deficiency, diabetes, burn, surgery, age
direct contact
body to body
transmission: personal contact
prevention: wash hand, mask, condom
indirect contact
object or surface
○ Transmission: not washing handing between patients, instruments contaminated
- Prevention: sterilizing instruments, disinfect surfaces
droplet
large >5 um projected up to 5 feet
○ Transmission - air, sneezing, cough, talk
- Prevention: cover mouth, mask, physical distance
airborne
airborne particle
○ Transmission - ventilation
- Prevention - masks, PPE, hospital negative pressure room
vehicle
single contaminated source to multiple
○ Transmission: point source - food borne
○ Common source - E. coli outbreak in meat facility
- Prevention: safety and disinfection standards
vector
born by insect or animal
○ Transmission: animal or insect bite
- Prevention: barriers, sprays
CDC guidelines on hand washing
alcohol based preferred to soap when not dirty
20 seconds
miss the thumbs, fingertips, between fingers
hand washing
alcohol based hand sanitizers do not cause antibiotic resistance
- alcohol based contain 60-95% alcohol that are most effective at denaturing proteins
mean arterial pressure
2x diastolic + systolic / 3
normal MAP
70-110
what is MAP
average pressure in the arteries during one cardiac cycle
better indicator of perfusion to vital organs than systolic pressure
stroke
clot block or vessel rupture
stroke belt
southeast United States
arb
block angiotensin II receptors
decrease SVR,SV
ace inhibitors
inhibits ace
decrease SVR, SV
alpha blockers
block alpha receptors
decrease SVR
beta blockers
block beta receptors
decrease HR, SV
Calcium channel blockers
block calcium channels, decrease SVR
diuretics
facilitate diuretics
decrease SV
Renin -angiotensin - aldosterone system (picture) - regulates BP
○ Angiotensinogen released from the liver to blood
○ Enzyme reaction from renin in kidney to turn to angiotensin 1
○ Enzyme reaction from ACE to Angiotensin 2
○ Stimulate to adrenal cortex to aldosterone
○ Stimulate salt uptake
Drug block - ACE inhibitors
WISE study
women, ischemia, symptom, evaluation
- understand heart disease in women
- address the gender gap
- different symptoms
angina & AMI sensation
both not pain but tightness, squeezing, burning, pressing, choking, aching, bursting, gas indigestion, discomfort
angina and AMI location
80-90% behind mid sternum, precordial
angina and AMI radiation
left shoulder and upper arm, elbow, forearm, wrist, 4-5 fingers
angina duration
less than 30 min
AMI duration
more than 30 min
angina and AMI timing
most common is lifting that strains thoracic or arm muscle, rapid walk uphill, morning or after strong emotion, sexual activity, vasospasm
