Lecture 2: CVDs Flashcards by Braden Talbert

what values classify HTN

> 130/80

some references say >140/90

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BP is a byproduct of what

CO and SVR

anything that increases CO or SVR will increase BP

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HTN risk factors

high BMI
high Na diet
inactivity
high alcohol use
excessive caffeine
smoking
genetics
>65 years old
low K levels

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describe how the RAAS works

decrease in cardiac output

decrease in renal aa perfusion

renin released from kidneys

renin forms angiotensin I

ACEs convert Ang I to Ang II in lungs, blood vessels, and kidneys

Ang II increases SVR and extracellular fluid

increase in BP

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HTN S&S

HA
visual impairments
lightheaded
syncope
fatigue
heart palpitations
nosebleeds
dyspnea
N&V
restlessness
chest pain

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what is hyperlipidemia and its implications

high blood cholesterol

increased risk for atherosclerosis, MI, and CVA

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what is cholesterol

cholesterol created and metabolized in liver

role in digestion and hormone synthesis

93% makes up cell membranes

remaining 7% circulates in blood by protein carrier

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risk factors for HDL

high saturated and trans fat diet

high BMI

smoking

diabetes

HTN

inactivity

genetics

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what is high density lipoprotein (HDL)

carries cholesterol to lover for metabolism and elimination

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what is low density lipoprotein (LDL)

builds up and creates plaque

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is very low density lipoprotein (VLDL)

carries triglycerides and adds to plaques

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what are triglycerides

another type of lipid

comes mostly from dietary fat

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ideal cholesterol levels (total, LDL, HDL, and triglycerides)

total <200

LDL <100

HDL >60

triglycerides <150

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anti-HTN meds effectiveness during exercise

anti-HTN meds lower resting BP but don’t always have the same effectiveness during exercise or with isometric activities

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risk factors for peripheral vascular disease

diabetes
smoking
HTN
CAD
CVA
age >50
males > females

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what is PAD

atherosclerosis in peripheral aa

common in uncontrolled diabetes and smokers

same pathophysiology and risk factors as CAD

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what is claudication

pain caused by reduced mm oxygenation caused by arterial occlusion in limbs

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what is critical limb ischemia and the S&S

advanced stage of PAD

severe lack of blood flow

resting claudication

pain

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PT implications for PAD

be aware of difference in intermittent and resting claudication and what it indicates

more pt edu opportunities

guided exercise training can improve claudication S&S

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what is compartment syndrome

increased pressure w/I closed osteofascial compartment resulting in local ischemia from impaired circulation

most frequently seen in anterior compartment of lower leg

typically associated with trauma

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compartment syndrome S&S

similar to VTE and critical limb ischemia

pain

firmness in compartment from increasing pressure

lack of pulse

where is compartment syndrome seen from a cardiovascular context

vascular injuries
VTE
improperly fitted or placed prosthetics
bandages
other medical devices

anything that can cause bleeding or swelling in a compartment or lack of blood flow

common with circumferential burns

fasciotomy required to relieve pressure

what is chronic venous insufficiency

veins are unable to effectively return blood to heart

venous valves become floppy and ineffective

increased venous distal pressures

burst capillaries

symptoms of venous insufficiency

worse at rest, better with activity

achy tired legs

paraesthesia

leg cramping, worse at night

edema

heavy or full feeling

varicose veins

CVI stages 0-6

stage 0 = no signs that can be seen/felt; may have tired/achy S&S stage 1= visible blood vessels, spider veins stage 2 = varicose veins >3 mm stage 3 = edema but not skin changes stage 4 = skin color/texture changes stage 5 = healed venous ulcer stage 6 = active venous ulcer

risk factors for CVI

history of DVT high BMI pregnancy inactivity smoking female prolonged dependent positon genetics

PT implications for CVI

aerobic/strength training leg elevation; sleep in bed rather than recliner/couch compression therapy; coordinated with medical provider; be aware of contraindications edu and lifestyle management

what is a VTE

venous thromboembolism refers to both DVT and PE

risk factors for Virshow's triad

hypercoaguability venous stasis endothelial injury

classic signs of DVT

unilateral pain, tenderness, swelling, warmth, redness 50% asymptomatic

factors that increase risk of DVT

prolonged immobility pregnancy birth control recent sx cancer smoking obesity venous stasis clotting disorders infection

what is a PE

blood clots lodged in pulmonary arterial circulation

classic signs of PE

sudden SOB chest pain hemoptysis O2 desaturation R heart failure

what is a segmental or saddle PE

segmental PE is clot more distal in pulmonary circulation saddle PE is clot lodged in B pulmonary arteries

how is a PE related to R heart failure

clots lodged in pulmonary circulation cause the R ventricle to have increased ejection pressure against blockage imaging will show RV dilation or dysfunction

what is an aortic aneurysm

weakening and dilation of arterial wall at least 1.5 times the normal diameter creates higher risk for rupture or dissection

type 1 aneurysm

L subclavian to renal aa

type 2 aneurysm

L subclavian to iliac bifurcation

type 3 aneurysm

mid-descending thoracic aorta to iliac bifurcation

type 4 aneurysm

sub-diaphragmatic abdominal aorta

presentation of an unruptured aneurysm

abdominal or back pain radiculopahy from compressed nn roots hoarse voice (due to aortic arch aneurysm that stretches the L recurrent laryngeal nn)

presentation of ruptured aneurysm

"tearing" acute chest pain, abdominal back, or flank pain loss or altered level of consciousness hypotension tachycardia cyanosis rapidly progressing hematoma

what is an aortic dissection

injury to intima allows blood between laters of the aortic wall forcing laters apart and jeopardizes normal blood flow to the body and organs blood between laters creates a false lumen

describe the debakey classifications of aortic dissections

type 1 = ascending to descending aorta type 2 = just the ascending aorta type 3 = arch portions and descending aorta only

stanford classifications of dissections

type A = ascending aorta involved type B = arch portions and descending aorta only

dissection presentation

tearing or acute chest/back pain acute syncope or stroke new diastolic murmur asymmetric pulse or BP malperfusion of coronary arteries sudden death is sometimes first symptom

aneurysm vs dissection

aneurysm - mostly asymptomatic - often found incidentally - abdominal more common than thoracic - thoracic has higher mortality - men > women - usually > 65 dissection - most catastrophic medical problem of aorta - type A more dangerous than B - 10-15% asymptomatic - type A is life threatening; 1-2% mortality per hour

aneurysm risk factors

HTN smoking CAD atherosclerosis high cholesterol PVD congenital connective tissue disease congenital bicuspid aortic valve pregnancy

dissection risk factors

HTN cocaine or meth use congenital bicuspid aortic valve aortic root dilation congenital connective tissues diseases familial aortic syndrome arteritis syphilis trauma