Lecture 9: Cardiac complications Flashcards
d
You don’t need a cardiopulmonary issue to treat cardiopulmonary
Obesity = BMI of
> 30 kg/m^3
weight (kg)/Height(m2)
x 701 to convert to inches
over wt bmi
> 25
BMI = very genetic/environmentally linked
waist circumference for obesity
* men
* women
men = >40 inches
women = >35 inches
waist to hip ratio obesity
* men
* women
1.0
0.8
obesity = linked to mental health problems
obesity = corrleated w/ depression
males impacted more by obesity in the realm of fertility
dont need to know classes of obesity, just know 30+ = obesity
25+ = over wt
know the waist measurements
tx for obesity
PT implications
CV risk factors, phsyiological response to exercise, BP elevated at first, must include endurance training; moderate intensity to truely make an impacted on body composition
brain natruietic peptide (BNP) and N-terminal pro-BNP levels (screening tool for LV dysfunction) are inversely propertional to BMI, regardless of the presence of severity of HF
* thus BNP levels are decreased in obese individuals even when the LV end-diastolic pressure is elevated, and their levels are less likely to be useful for diagnosis and monitoring of LV dysfunction - so BNP stops being a good screening tool for obese - less useful in monitoring LV dysfunction
not must know medications - this will come back in multisystems
last 2 used for anxiety/depression as well
Diabetes mellitus
* metabolic disorder or disorder of endocrine system
* primarily diagnosed from lab values
* Type 1 = genetic, environmental (virus); immune system attacks pancreas - virus can lead to this
* Type 2: cells resist the action of insulin; pancreas cant produce enough insulin and glucose builds up
EX helps muscles become more sensitive to insulin
Lab values
* Hva1c or hemoglobin a1c - gives you a track record of glucose use over time
* fasting glucose = gives you snapshot of that day
Diabetes mellitus
NIDDM - non-insulin depdent DM - may turn into insulin depdnents if not involved
* turns into insulin depdent
* typically T2DM
* pancreas decreases in size
IDDM - Insulin depdent DM
leads to other metabolic problems: kidneys, eyes, cholesterol, neuropathies
increased blood viscosity; decreased BF; glucose damages nerves - which is why we get peripheral neuropathy
What should fasting blood glucose be?
100 or less
what hba1c is at increased risk of diabetes?
5.7-6.4%
which hba1c is diabetes?
> 6.5%
long term compliations of diabetes mellitus:
* retinopathy, neuropathy, cad, cardiac muscle dysfunction, autonomic neuropathy
what pt education can you provide for someone w/ an hba1c of 6.0%?
* so this is high but not diabeteic value
*
DM life expectancy
type 1 - 15% die before 40 due to cad
type 2 = 10 years off life expectancy
may have issues w/ ketones like diabetic ketoacidosis
ACE inhibitors for diabetes - reduce morbidity/mortality, lowers BPm prevents kidney dysfunction; primarily prescribed
* primarily described for someone who has hypertension/diabetes - so if they have diabetes w/ the hypertension this is the one were going to use - not just diaretics
beta blockers - for BP; hypoglycemic response to ex
* MOA: block sympathetic response
* if pt has diabetes and is on a beta blocker you won’t get the same response to ex because of hypoglycemia - they will not show the common symptoms of hypoglycemia because of the beta blockers - so monitor blood glucose levels more carefully
Metabolic syndrome
* what is it?
* how many risk factors needed? what are they
Group of risk factors that raise risk for heart disease, diabetes, and stroke
Endocrine organ dysfunction, also called inslin resistance
Individuals may have DM and other disorders
Need three of more of these to have metabolic syndrome:
* increased waist circumference
* elevated triglycerides
* reduced HDL
* elevated BP
* elevtaed fasting glucose
anginia equilivant = anything other than chest pain that occurs
sob my indciate myocardial ischemia
remember sympathetic ns impacted
c???
asymptomatic stages 1/2
diagnosis through lab values
* diagnosed by microalbuminuria and glomerular filtration rate
stage 5 = when you start seeing all the physical symptoms
* severe diet restrictions including limiting protein because liver cant filter it out
showing how interlinked kidney disease is w/ cad
dialisis = stage 4/5
ra = autoimmune = dont ex w/ flare ups
systemic lupus erythematosus = chronic pain/lymphedema
scleroderma = hardening of connective tissue (think skin becoming restrictive)
* restrictive lung disiease
* happens throughout bdoy = cvd problems
Hemochromatosis
Disorser of iron metabolism that leads to iron deposits in various organs
* CVP implication = cardiomyopathy and arrythmias
Sarcoidosis
chronic inflammatory diease w/ granulomas in multiple organs
* CVP implication = ventricular tachy, cardiomyopathies; all only 10% of pts
Amyloidosis
overproduction of certain proteins leading to deposits of amyloid fibrils in various organs
* CVP implications: cardiomyopathy (rest or dilated), atrial arrhythmias, orthostatic hypotension, bradycardia, tachy, MI, and sudden death
these impact cardiopulmonary system
POTS
diagnosed via a tilt table
dehibiliating because you get OH pretty randomly (w/ changing in positions)
diagnosed when theres no other identifiable causes of symptoms
need symptoms at least 6 months to be diagnosed
symptoms:
* HR > 30 bpm within 5-10 minutes of quite standing or upright tilt
* absence of OH
* frequent symptoms that occur w/ standing
gold standard for diagnosis = tilt table test
if you have pots you likely have one of these
mast cell activation disorder = basically you’re allergic to everything they all turn on
3
reduced circulating rbc mass relative to an individuals gender adn age
* fatigue and weakness, diminshed ex tolerance, exertional dyspnea, and palpatations; pallor; angina
anemia
would do hematocrit
structurally abnormal hb resulting in rbcs that become crescent - or sickle shaped during deoxygenation
sickle cell disease
multiple organs are affected, leading to progressive systemic vasculopathy and chronic organ failure
* vaso-occlusive crisis
cant bind to o2 so they become stuck
lymphomas and other malignancies = impaired immune function, anemia, thrombocytopenia
HIV = virus/infection
* leads to aquired immune deficiency syndrome means body starts to attack itself
HAART = tx
* minimized viral replication
complications due to immune deficiency = body attacks itself = fluid buildup = pulmonary hypertension/myocarditits
Bleomycin = main drug she wants us to know
* pulmonary toxicity = 20% of pts
cardiotoxixity = due to some anti biotics
anytime we get radiation around abdominal cavity, radiation fibrosis, radiation induced pulmonary toxicity, acute radiation pneumonitits, late radiation fibrosis
all these means is that when you have scaring from radiation = scaring = restrictive lung disease
* think lung cancer/breast cancer - anything that ristricts abdominal cavity
late radaition fibrosis = restricive lung disease down the road due to the previous radaition they intook
vlvular banormalitites = due to the radaition
* cannot dilinaite between healthy and cancer cell
Radiation inducated or accelerated CAD and MI
* may be silent due to radiation-induced nerve damage
* so cardiac symptoms not present ebcause nerves are there (no agngia) - need to look at angina equivilants
biological agents developed from body elements
have side effects
a
