FINAL: CARDIO Flashcards
Normal blood pressure is defined as
systolic BP (SBP) < 120 mm Hg and a diastolic BP (DBP) < 80 mm Hg.
Elevated blood pressure
SBP between 120 -129 mm Hg and a DBP < 80 mm Hg.
Hypertension (stage 1)
SBP between 130-139 mm Hg and a DBP between 80-89 mm Hg.
Hypertension (stage 2)
SBP > 140 mm Hg and a DBP > 90 mm Hg
If either the SBP or DBP is outside of a range…
the higher measurement determines the classification
how to calculate cardiac output
Cardiac output= HR X Stroke volume (amount of blood ejected w/ each beat)
B-Adrenergic receptors cause
vasodilation
A-adrenergic receptors cause
vasoconstriction
define prostaglandin
lipid messenger secreted by cells right next to target cells to increase/decrease action, last around for 30 sec and die. Different ones for different systems. often affect BP depending on what the system needs.
define Nitric oxide
chemical released by vasculature that causes increased blood flow to heart. Not produced as much with age which stiffens vasculature. Can increase with nitrite rich foods (leafy greens) and exercise.
define endothelin
most potent vasoconstrictor secreted by the most inner part of the blood vessel. The receptors for it are also found on the most inner part of the blood vessel.
What is Mean Arterial Pressure (MAP)
the average pressure in a patient’s arteries during one cardiac cycle.
An MAP of ______ is necessary to perfuse the coronary arteries, brain, and kidneys
60-65
Normal MAP range
70-110
How to calculate MAP
MAP = SBP + 2(DBP)
3
90% to 95% of all cases of hypertension are classified as
Primary hypertension
Elevated BP without an identified cause
Define secondary hypertension
Secondary hypertensionis elevated BP with a specific cause that often can be identified and corrected.
Secondary hypertension can become resistant, causing cardiovascular complications if left untreated.
This type of hypertension accounts for 5% to 10% of hypertension in adults.
Secondary hypertension should be suspected in people who suddenly develop high BP, especially if it is severe. Findings that suggest secondary hypertension relate to the underlying cause.
nonmodifiable risk factors for hypertension
Age: Systolic BP rises progressively with age.
* After age 50, SBP >140 mm Hg is a more important cardiovascular risk factor than diastolic BP
Ethnicity* The incidence of hypertension is 2 times higher in blacks than in whites
Family history* History of a close blood relative (e.g., parents, sibling) with hypertension is associated with an ↑ risk for developing hypertension
Gender* Hypertension is more prevalent in men in young adulthood and early middle age
* After age 64, hypertension is more prevalent in women (See Gender Differences box on p.679)
Socioeconomic status* Hypertension is more prevalent in lower socioeconomic groups and among the less educated
modifiable risk factors for hypertension
Alcohol* Excess alcohol intake is strongly associated with hypertension
* Moderate intake of alcohol has cardioprotective properties; males should limit their daily intake of alcohol to 2 drinks per day, and 1 drink per day for females
Diabetes* Hypertension is more common in patients with diabetes
* When hypertension and diabetes coexist, complications (e.g., target organ disease) are more severe
Elevated serum lipids* ↑ Levels of cholesterol and triglycerides are primary risk factors for atherosclerosis
* Hyperlipidemia is more common in people with hypertension
Excess dietary sodium* High sodium intake can
* Contribute to hypertension in salt-sensitive patients
* Decrease the effectiveness of certain antihypertensive drugs
Obesity* Weight gain is associated with ↑ frequency of hypertension
* Risk increases with central abdominal obesity
Sedentary lifestyle* Regular physical activity can help control weight and reduce cardiovascular risk
* Physical activity may ↓ BP
Stress* People exposed to repeated stress may develop hypertension more often than others
* People who develop hypertension may respond differently to stress than those who do not develop hypertension
Tobacco use* Smoking tobacco greatly ↑ risk for CVD
* People with hypertension who smoke tobacco are at even greater risk for CVD
symptoms of hypertension
patients with hypertensive crisis may have severe headaches, dyspnea, anxiety, and nosebleeds
Fatigue, reduced activity tolerance
Dizziness
Palpitations, angina
Dyspnea
Hypertension: Diagnostic Studies
Urinalysis, creatinine clearance (Creatinine clearance reflects the glomerular filtration rate. Decreases in creatinine clearance indicate renal insufficiency.)
Serum electrolytes (, especially potassium, is essential to detect hyperaldosteronism), glucose (diabetes)
BUN and serum creatinine
Serum lipid profile
ECG
Echocardiogram
Begin measurement after the patient has rested quietly for __min.
5
Deflate the cuff at a rate of ______mmHg/sec.
2–3
Nonpharmacologic interventions to reduce and control BP
weight loss (if appropriate), a DASH diet, and potassium supplementation; regular physical activity; and limiting women to no more than 1 alcohol drink per day.
The potential impact of each lifestyle change is a 4-5 mm Hg decrease in SBP and 2-4 mm Hg decrease in DBP.
Initial therapy for hypertension
Thiazide diuretics
Calcium-channel blockers
ACE inhibitors
Angiotensin Receptor Blockers
Most hypertensive patients will need to take 2 or more medications on a long-term basis to achieve their goal BP, in addition to lifestyle changes.
Isolated systolic hypertension (ISH)
Older adults have varying degrees of impaired baroreceptor reflex mechanisms.
Consequently, orthostatic hypotension occurs often, especially in patients with ISH.
7 reasons older adults struggle to obtain normal BP
(1) loss of elasticity in large arteries from atherosclerosis, (2) increased collagen content and stiffness of the myocardium, (3) increased peripheral vascular resistance, (4) decreased adrenergic receptor sensitivity, (5) blunting of baroreceptor reflexes, (6) decreased renal function, and (7) decreased renin response to sodium and water depletion.
Pharmacological considerations for older adults
In the older adult who is taking antihypertensive drugs, absorption of some agents may be altered because of decreased blood flow to the gut. Metabolism and excretion may be prolonged.
Drugs should be started at low doses and increased slowly to reduce the chance of orthostatic hypotension. Measure BP and HR in the supine, sitting, and standing positions at every visit.
Hypertensive crisisBP is…
SBP greater than 180 mm Hg and/or DBP greater than 120 mm Hg.
May present as hypertensive encephalopathy
Treatment: Oral fast-acting or IV antihypertensives
The difference between hypertensive urgency and emergency
the presence of target organ damage and treatment
Define Angina
When the demand for myocardial O2exceeds the ability of the coronary arteries to supply the heart with O2,myocardial ischemiaoccurs.Angina, or chest pain, is the clinical manifestation of myocardial ischemia.
The most common reason for angina
significant narrowing of 1 or more coronary arteries by atherosclerosis
For ischemia to occur from an atherosclerotic plaque:
the artery is usually blocked (stenosed) 70% or more (50% or more for the left main coronary artery).
Chronic Stable Angina
Chest pain that occurs intermittently over a long period with the same pattern of onset, duration, and intensity of symptoms.
It is often provoked by physical exertion, stress, or emotional upset.
The pain of chronic stable angina usually lasts for only a few minutes. It often subsides when the precipitating factor is resolved (e.g., by resting, calming down, using sublingual nitroglycerin
Pain at rest is unusual.
Assessment of Angina
PQRST:
Precipitating events
Quality of pain
Radiation of pain
Severity of pain
Timing
1st line therapy for angina
Nitrates
Short-acting nitrates: Sublingual
Given for acute chest pain
Relieves pain in about 3 minutes
Lasts 30-60 minutes
If symptoms are improved w/ 1st dose, can repeat every 5 minutes for a max of 3 doses
**Contact EMS if symptoms haven’t resolved completely
lose potency after opening. if it doesnt tingle your tongue it might not work. can cause orthostatic hypotension. can be used prohylactically
Long-acting nitrates
Isosorbide dinitrate (Isordil)
Isosorbide mononitrate (Imdur)
reduce the frequency of angina attacks and to treat Prinzmetal’s angina. The main side effect is headache from the dilation of cerebral blood vessels. Tell patients to take acetaminophen (Tylenol) to relieve the headache.
Should not be taken with drugs for erectile dysfunction
β-Adrenergic blockers…
Decreases myocardial oxygen demand
given for relief of angina symptoms in patients with chronic stable angina. Patients who have LV dysfunction or elevated BP or had an MI should start and continue β-blockers indefinitely, unless contraindicated. These drugs decrease myocardial contractility, HR, SVR, and BP, all of which reduce the myocardial O2demand and relieve angina symptoms.
Calcium channel blockers
If β-adrenergic blockers are poorly tolerated, contraindicated, or do not control angina
Their main effects are: (1) systemic vasodilation with decreased SVR, (2) decreased myocardial contractile
Patients with chronic stable angina who have an ejection fraction (EF) of 40% or less, diabetes, hypertension, or CKD should take an…
ACE inhibitor (e.g., lisinopril [Zestril]) indefinitely
These drugs result in vasodilation and reduced blood volume. Most important, they can prevent or reverse ventricular remodeling in patients who have had an MI.
___________ is an option for people who are aspirin intolerant
Clopidogrel (Plavix)
Chest x-rays are used to…
look for cardiac enlargement, aortic calcifications, and pulmonary congestion
percutaneous coronary intervention (PCI)
a catheter with a deflated balloon tip is inserted into the blocked coronary artery. The deflated balloon is positioned inside the blockage and inflated. This compresses the plaque against the artery wall, resulting in vessel dilation and a larger vessel diameter. This procedure is calledballoon angioplasty.
Intracoronary stents are usually placed after a balloon angioplasty. Astentis an expandable mesh-like structure designed to keep the vessel open. It provides support to the arterial wall . There are 2 types of stents: bare metal (BMS) and drug-eluting (DES). A DES is coated with a drug (e.g., everolimus, zotarolimus) to reduce the risk for overgrowth of the intimal lining(neointimal hyperplasia)within the stent.
Receives antiplatelet drugs until the intimal lining grows over the stent and provides a smooth vascular surface. Aspirin must continue forever.
Acute Coronary Syndrome ECG
ST depression or T wave inversion
STEMI ECG
ST elevation
Unstable angina
Change in usual pattern
New in onset
Occurs at rest
Has a worsening pattern
Acute interventions for anginal attack
position patient upright unless contraindicated
apply supplemental O2
assess vital signs
place patient on continuous ECG monitor
obtain a 12-lead ECG
(5) provide prompt pain relief, first with NTG, followed by an IV opioid analgesic, if needed, (6) obtain cardiac biomarkers, (7) assess heart and breath sounds, and (8) obtain a chest x-ray.
(HFrEF)
LESS BLOOD LEAVING VENTRICLE (heart failure with reduced ejection fraction, NO MUSCLE THIN HEART
(HFpEF)
LESS BLOOD ENTERING VENTRICLE (heart failure with preserved ejection fraction, TOO MUCH MUSCLE CANT FILL
Cor Pulmonale
right sided heart failure due to increased vascular resistance in the lungs. Results in right ventricular hypertrophy.
Backup of blood into the right atrium and venous circulation causing JVD
Hepatomegaly, splenomegaly
Peripheral edema
Pleural effusion
INCREASED FLUID IN PLEURAL SPACE (FLUID AROUND LUNGS)
most common dysrhythmia
Atrial fibrillation, SQIGLY LINES AND IRREGULAR HEART RATE, Promotes thrombus/embolus formation, increasing risk for stroke
Chronic HF is
characterized by reduced CO and increased venous pressure
Implantable cardioverter defibrillator (ICD) ARE USED FOR
Patients with an LVEF < 35% are at significant risk for SUDDEN CARDIAC DEATH. An ICD is recommended for primary prevention of SCD in these patients.
Cardiac resynchronization therapy (CRT) ARE USED FOR
With CRT, an extra pacing lead is placed through the coronary sinus to a coronary vein of the LV. This lead coordinates right and left ventricular contractions.
Sodium may be restricted to
2 g per day.
Daily weights are important for CHF pts because
Weight gain of 3 lb (1.4 kg) over 2 days or a 3- to 5-lb (2.3 kg) gain over a week should be reported to health care provider.
Acute decompensated heart failure (ADHF) is
an increase (usually sudden) in symptoms of HF
decrease in functional status, often requiring rapid escalation of therapy and hospital admission.
ADHF is the most common cause of hospitalization for older Americans.
The presentation of ADHF typically includes symptoms and signs related to pulmonary congestion and volume overload.
Ultrafiltration, or aquapheresis, is
Used for severe Acute decompensated heart failure (ADHF) pts
when diuretics have not been effective.1 It can rapidly remove intravascular fluid volume and excess sodium from the patient’s blood while maintaining hemodynamic stability. Hemodialysis can be used for volume overload with concomitant renal failure.
The leading cause of Peripheral Vascular Disease PAD is
atherosclerosis, a gradual thickening of the intima (the innermost layer of the arterial wall) and media (middle layer of the arterial wall). This results from cholesterol and lipids deposited within the vessel walls and leads to narrowing of the artery.
compares the blood pressure measured at the ankle with the blood pressure measured at the arm
The ankle-brachial index test
ankle systolic pressure / arm systolic pressure
abnormal ankle-brachial index test range
anything below 1.0
0.5=impending gangrene
anything above 1.5 could mean severe calcification
The 3 key factors (called Virchow’s triad) that cause venous thrombosis are
(1) venous stasis, (2) damage of the endothelium (inner lining of the vein), and (3) hypercoagulability of the blood.
T/F: Anticoagulant therapy does not dissolve the clot.
T: Clot lysis begins naturally through the body’s intrinsic fibrinolytic system.
heparin-induced thrombocytopenia (HIT)
HIT is an immune reaction to heparin. It causes a severe, sudden reduction in the platelet count along with a paradoxical increase in venous or arterial thrombosis. HIT is diagnosed by measuring the presence of heparin antibodies in the blood. Treatment includes immediately stopping heparin therapy and, if further anticoagulation is needed, using a non-heparin anticoagulant (e.g., fondaparinux).
HEPARIN:
Normal aPTT:
Goal aPTT for heparin:
NORM: 30-40 seconds
GOAL: 46-70 seconds
Vena cava interruption devices
can be placed percutaneously through the right femoral or right internal jugular veins. The filter device is opened, and the spokes penetrate the vessel walls. The filters act as a “sieve-type” device, allowing filtration of clots without interruption of blood flow.
Over time, clots can clog the filter and completely block the vena cava, requiring filter removal and replacement. A filter device is recommended with acute PE or proximal VTE of the leg in patients with active bleeding or if anticoagulant therapy is contraindicated or ineffective.
Foods to avoid for pts w/ Venous Thromboembolism
leafy greens
Prolonged QT Segment
A condition affecting repolarization (relaxing) of the heart after a heartbeat, giving rise to an abnormally lengthy QT interval.
QT prolongation may occur as a result of:
certain genetic conditions
hormonal imbalances
incorrect concentrations of elecrolytes in the blood
