Final - Cardiovascular Conditions Flashcards
Modifiable Risk Factors of CAD
- Dislipidemia
- Smoking
- Hypertension
- Diabetes
- Obesity
- Thrombogenic Factors
- Sedentary Lifestyle
Non-Modifiable Risk Factors for CAD
- Family history of CAD
- Age
- Sex
Levels of Risk Associated with CAD
- Hypertension: DBP >90
- Smoking
- Serum total cholesterol level >240 mg/Dl
What does high blood pressure put you at risk for?
stroke and heart disease
leading causes of death in US
High blood pressure increases risk of:
- CAD
- Stroke
- heart failure
- PAD
- AD
- chronic kidney disease
- Dementia (vascular, Alzheimer’s)
- Mild Cognitive Deficits
Who gets hypertension?
- more common in older people
- males > females up to age 64
- females > males after age 65
- more common and severe in african americans
- positive family history
- obesity
- diabetics
For persons over age 50, what is the more important number as a CAD risk factor?
SBP rather than DBP
What does blood pressure vary with?
- strength of the heartbeat
- elasticity of the arterial walls
- volume and viscosity of the blood
- health, age, and physical condition of a person
- location of measurement
Hypertensive readings are based on the average of what?
two or more readings taken at two or more visits
Primary HTN
- AKA Essential HTN
- accounts for 95% of cases of HTN
- no universally established cause
Secondary HTN
- less common cause (5%)
- secondary to other potentially rectifiable causes
Identifiable causes of Secondary Hypertension
- sleep apnea
- drug induced or related causes
- CKD
- primary aldosteronism
- renovascular disease
- chronic steroid therapy or Cushing’s syndrome
- Pheochromocytoma
- Coarctation or the aorta
- Thyroid of Parathyroid disease
Renin Angiotensin Aldosterone System
Slide 19
Symptoms of HTN
- headache
- dizziness
- blurred vision
- shortness of breath (especially with exertion)
- chest pain
- rapid pulse, palpitations
- malaise and fatigue
- *frequently no symptoms at all
Elevated BP
120-129 / < 80
Treated with lifestyle modifications
Stage 1 HTN
130-139 / 80- 89
treated with lifestyle modification and medication for those with CVD
Stage 2 HTN
> 140 / >90
Treated with life style modification and medications
Lifestyle and diet modifications to reduce blood pressure
- weight reduction
- adopt DASH eating plan
- dietary sodium reduction
- physical activity
- moderation of alcohol reduction
Anti-hypertensive Medications
- Thiazide type diuretics
- ACE
- Beta Blockers
- Calcium channel blockers
- Angiotensin Receptor blockers
ACE inhibitors
ends in -pril
Angiotensin Receptor Blockers
end in -artan
Beta blockers
ends in -lol
Calcium channel blockers
ends in -ipine
What can thiazide type diuretics induce?
hypokalemia
Hydrocholorthiazide or Chlorthalidone
What do ACE inhibitors do?
blocks the conversion of Angiotensin I to Angiotensin II
What do calcium channel blockers do?
- slows SA node
- slows heart rate and lowers blood pressure
Types of Acute Coronary Syndromes (ACS)
- unstable angina (no permanent damage)
- MI (non ST elevation MI or ST elevation MI)
Vulnerable Plaque
contains:
- T Lymphocyes
- macrophage foam cell
- activated intimal SMC
- normal medal SMC
Angina
- occurs with activity, stress
- pain is described as pressure, squeezing, heaviness, may be associated with diaphoresis, nausea or vomiting and/or shortness of breath
- relieved with rest or nitroglycerin (relieved after 2-5 mins)
Immediate treatment for NSTEMI
- anti-ischemic
- anti-platelet/ anti-thrombotic
- invasive strategy - cardiac cath
Anti-ischemic Rx
- best rest
- nitroglycerin
- oxygen –> at least 92%
- morphine –> relaxing and vasodilating
- Beta Blocker (metoprolol)
- possibly calcium channel blocker (verapamil)
- ACE inhibitor for decreased LV function
Anti-Platelet/ Anti-thrombotic Rx
- Aspirin
- Heparin –> prevents clot from getting bigger
- Add platelet Gb IIb/IIIa receptor antagonist
STEMI Criteria
- elevated serial enzymes
- ST elevation in 2 or more leads (dont even wait for blood work to come back)
Immediate Rx for STEMI
- Anti-ischemic
- Anti-platelet/ anti-thrombotic
- invasive strategy: cardiac cath/ PCI within 90 minutes of presentation
Hospital Discharge Care
Aspirin and Anticoagulants Beta Blockers and Blood Pressure Cholesterol and Cigarettes Diet and Diabetes Education and Exercise
Candidates for Cardiac Cath
- MI
- Known CAD
- Positive stress test
- Not reach target heart rate on stress test
- possible heart failure
- structural deformities
- identified bacterial infection
Goal of Cardiac Cath (left system)
- identify location of CAD (if any) for PCA or CABG
- Measure left ventricle ejection fracture
- if needed, measure aortic valve
Risk of Cardiac Procedure
- Very rare, death, MI, stroke, renal failure
- bleeding 2-5% (biggest risk)
- allergic reaction to dye
Patient population for Percutaneous Transluminal Coronary Artery (PTCA/Stent)
- blockage greater than 70%
- pt is a candidate for CABG
- left main disease
- proximal LAD
- triple vessel disease
PTCA/ Stent Protocols
- Pts typically stay in bed for 4-6 hrs after procedure
- May resume regular activities in 4-5 days
- Pt discharged from hospital 1 day after procedure
- If received stent, discharged on anticoagulant
