MT M 5.3 Cardiovascular medical procedures/conditions

Question 1

Arrhythmias

Answer 1

Arrhythmias are a change in or loss of the regular rate and rhythm of the heartbeat. These irregularities can also be called dysrhythmias. Arrhythmias can cause the patient to feel symptoms of syncope, near syncope, dizziness, fatigue, or palpitations. Patients with arrhythmias can also be without symptoms. Arrhythmias can cause sudden cardiac death or a severe decrease in cardiac output that can damage the brain and heart

Question 2

Sinus arrhythmias

Arrhythmias

Answer 2

Sinus arrhythmias typically do not cause severe symptoms and could be a normal finding in a healthy patient.

Question 3

Sinus tachycardia

Arrhythmias

Answer 3

Sinus tachycardia is an irregularity in the heart rate where the heart rate is greater than 100 beats per minute. This is typically a normal response to exercise. Sinus tachycardia could also be the result of an infection, pain, anxiety, anemia, thyroid disease, or heart failure.

Question 4

Sinus bradycardia

Arrhythmias

Answer 4

Sinus bradycardia is defined as a heart rate less than 60 beats per minute. In healthy patients who exercise regularly, sinus bradycardia can be a normal rate. In patients with underlying heart disease or elderly patients, sinus bradycardia may indicate a problem with the SA node, or it may be a side effect of a medication.

Question 5

Atrial fibrillation

Arrhythmias

Answer 5

Atrial fibrillation is the most common chronic arrhythmia. It is an irregularly irregular heart rhythm where the electrical conduction of the heart no longer begins in the SA node, but rather the start of the electric conduction of the heart comes from many different locations throughout the atria. It is a fast arrhythmia where the atria twitch irregularly, and the ventricles then respond irregularly. Patients may feel short of breath or palpations, or they may not feel the arrhythmia at all. Patients with atrial fibrillation are at risk for developing a stroke because the atria and ventricles are not moving the blood through the heart in a coordinated way. The blood can coagulate within the heart and then travel to the brain causing a stroke.

Question 6

Ventricular tachycardia

Arrhythmias

Answer 6

Ventricular tachycardia is an arrhythmia where the contraction of the heart is initiated in the ventricles rather than the atria. It is fast, over 100 beats per minute, and is a frequent complication of a heart attack. When this rhythm is sustained, it can cause palpitations, dyspnea, or lightheadedness and can lead to death if not treated promptly. Patients may need emergent cardioversion, which is a medical procedure that is used to treat life-threatening arrhythmias.

Question 7

emergent cardioversion

Arrhythmias

Answer 7

Patients may need emergent cardioversion, which is a medical procedure that is used to treat life-threatening arrhythmias. The regular heart rate and rhythm of the heart are restored after an electric shock is applied to the heart.

Question 8

When the arrhythmia is not life-threatening

Arrhythmias

Answer 8

several options are available for treatments.
1) Sinus arrhythmias may not need to be treated directly.
2) For patients with atrial fibrillation, the goal is to either slow the heart rate down or to restore the regular rhythm of the heart, as well as reduce the risk of developing a stroke. Medications can be used to slow the heart rate down, as well as cause the blood to not clot as easily.
3) Surgical ablation destroys the parts of the atria that are sending the irregular electric signals.
4) Patients can also have a pacemaker inserted. Pacemakers are devices that can be surgically inserted into a patient’s chest cavity to stimulate the heart with electronic impulses. This can initiate a heartbeat in a patient where the SA node is not working properly.

Question 9

Coronary artery disease (CAD)

Answer 9

Coronary artery disease (CAD) is the most common type of heart disease and the number one cause of death in the United States of America. It results from atherosclerosis, which is the buildup of fatty material, or plaques, in the arteries of the heart.
Patients who are at higher risk for developing CAD have a positive family history of heart disease, male sex, abnormal blood lipids, diabetes mellitus, hypertension, physical inactivity, abdominal obesity, cigarette smoking, poor diet, and drinking too much alcohol. These underlying risk factors can be decreased through exercising regularly, eating a healthy diet, weight loss, and smoking cessation. Other risk factors for heart disease may be able to be modified through medications, such as high cholesterol.

Patients with CAD are at a higher risk for a myocardial infarction. This occurs when the plaque is large enough to cause the blood flow to decrease. The heart muscle begins to die from lack of blood flow. Figure 5.13 shows a cardiac artery with atherosclerosis leading to decreased blood flow to the heart.

Question 10

atherosclerosis

Coronary artery disease (CAD)

Answer 10

atherosclerosis, which is the buildup of fatty material, or plaques, in the arteries of the heart.

Question 11

myocardial infarction (MI)

Answer 11

A myocardial infarction (MI) is the result of obstructed blood flow to the heart muscle. This is also known as a heart attack. Patients can feel sudden chest pain at rest with sweating, weakness, and anxiety. They also may feel lightheaded, short of breath, and nauseated. One-third of patients experiencing a MI will not feel chest pain at all. A MI is a medical emergency and interventions to re-establish the blood flow to the heart should be performed quickly, otherwise sudden cardiac death may occur.

Question 12

myocardial infarction (MI)

when it happens

Answer 12

Patients should be transferred to the hospital via medic transport for frequent assessment and emergent intervention should they decline prior to arriving at the hospital. They will be assessed with blood work and an electrocardiogram. The ECG can indicate that a patient is having an MI, as well as show where the damage to the heart is occurring as the electrical conduction through the heart will change as the heart muscle dies. ECGs may show a non-ST segment elevation myocardial infarction (NSTEMI) or a ST segment elevation myocardial infarction (STEMI). These results can indicate the amount of damage the heart has sustained and may indicate the risk of additional adverse effects from the MI.

Question 13

myocardial infarction (MI)

Upon arrival to the hospital

Answer 13

patients with STEMI will undergo procedures to re-establish the blood flow to the heart. Percutaneous coronary intervention (PCI) is a procedure where a catheter is inserted into a large artery, either in the groin or the arm, and then threaded to the heart to examine the coronary arteries and discover where the blockage is located. During PCI, interventions can be made on the blockage to remove it and to keep the coronary artery open.

Question 14

Angioplasty

myocardial infarction (MI)

Answer 14

Angioplasty is a procedure where a balloon is inflated at the site of the blockage to compress the fatty plaques against the artery walls.

Question 15

Stenting

myocardial infarction (MI)

Answer 15

Stenting is another intervention that may be performed during PCI. An expandable, metal mesh is inserted into the artery to hold the artery open.

Question 16

coronary artery bypass graft (CABG)

myocardial infarction (MI)

Answer 16

If these procedures ( Angioplasty and or Stenting) are unable to be completed because the blockage is too large, another treatment option is a coronary artery bypass graft (CABG). This is a surgical procedure where veins are removed from the patient’s legs and then inserted onto the heart to provide a new route for the blood to travel to the heart.

Question 17

Hypertension

Answer 17

Hypertension is an elevated blood pressure. It is defined as the systolic blood pressure above 140 or the diastolic blood pressure above 90 on two subsequent readings on two separate doctor’s office visits. Hypertension increases a patient’s risk for developing a heart attack, heart failure, or stroke

Question 18

risk factors

Hypertension

Answer 18

for essential hypertension, which is an elevated blood pressure due to the interaction of a patient’s genetics and their environment. When hypertension is left untreated, patients are at increased risk for developing heart failure, strokes, kidney disease, and aortic dissection.

Question 19

Risk Factors for Developing Hypertension

Answer 19

Obesity, Cigarette smoking,Sleep apnea Increased use of NSAID medications, Increased salt intake Low potassium intake, Excessive alcohol use, Sedentary lifestyle
Polycythemia (abnormally increased red blood cells)

Question 20

hypertension symptoms

Answer 20

Patients with hypertension typically are without symptoms, although they may also complain of fatigue and a headache. Treatment is directed towards lifestyle modifications that can reduce the patient’s blood pressure: weight reduction, low sodium diet, increased exercise, and decreased alcohol intake. Treatment may also involve medications to decrease the patient’s blood pressure.

Question 21

Heart failure

Answer 21

Heart failure is a chronic disease that is closely associated with aging. It is the failure of one or both sides of the heart to pump the blood effectively, either to the body tissues or the lungs or both. It is a disease of aging, and most patients who are diagnosed with heart failure are over the age of 65 years old. It also is closely associated with a diagnosis of hypertension, as 75% of patients with heart failure also have diagnosed hypertension.

Heart failure can involve the right or left side of the heart

Question 22

Left-sided heart failure is also called congestive heart failure

Heart failure

Answer 22

Left-sided heart failure is also called congestive heart failure because the heart fails to move the blood from the lungs to the body tissues. Patients with left-sided heart failure will experience dyspnea and other symptoms of poor cardiac output.

Question 23

systolic dysfunction

Left-sided heart failure

Answer 23

Left-sided heart failure can be the result of systolic dysfunction, where the left ventricle is unable to contract normally,

Question 24

diastolic dysfunction

Left-sided heart failure

Answer 24

a result of diastolic dysfunction, where the left ventricle walls are unable to relax and fill with blood.

Question 25

Right-sided heart failure

Answer 25

Right-sided heart failure typically follows left-sided heart failure, as the increased pressure from the fluid backup in the lungs increases the amount of pressure in the right side of the heart, ultimately damaging the right side of the heart. The symptoms of right-sided heart failure include volume overload symptoms, such as edema of the lower extremities, liver enlargement, and distended neck veins. Heart failure is progressive, and as the disease progresses, the patient’s ejection fraction begins to decline.

Question 26

ejection fraction

Heart failure

Answer 26

The ejection fraction is a percentage of blood that is pumped out of the ventricles with each heartbeat. A typical ejection fraction is 55-70% in a healthy patient. Patients with heart failure can have an ejection fraction of less than 40%, and as the ejection fraction decreases less than 35%, the patient is at a higher risk for left-threatening conditions, such as a myocardial infarction or arrhythmia.

Question 27

Treatment of heart failure

Answer 27

Treatment of heart failure is aimed at reducing blood volume and increasing the heart’s ability to pump effectively. Multiple medications, such as diuretics that remove excess fluid from the heart and medications to treat hypertension and arrhythmias, are used to treat patients with heart failure. Implantable defibrillators may be necessary, as heart failure and the subsequent damage to the heart muscle increases the risk of life-threatening arrhythmias and sudden cardiac arrest. Finally, heart transplantation can be used in appropriate patients. This is a surgical procedure where the heart of a donor is transferred to a patient with heart failure. Patients who undergo a heart transplant successfully can have increased survival rates; however, heart transplantation is not without risks itself, including rejection of the transplanted organ or infection.

Question 28

Peripheral artery disease (PAD)

Answer 28

Peripheral artery disease (PAD) is a condition that occurs when atherosclerotic plaques build up in the arteries outside the heart. As in coronary artery disease, these plaques can restrict blood flow to various parts of the body and cause pain and dysfunction. Figure 5.18 shows arteriosclerosis that narrows the diameter of the blood vessel and restricts the blood flow through the artery. This can occur in the arteries leading to the arms, legs, feet, kidneys, and stomach.

Question 29

intermittent claudication

Peripheral artery disease (PAD)

Answer 29

Patients with blockages in the aorta or iliac arteries may complain of intermittent claudication. Claudication is where the patient experiences pain or cramping in the legs and buttocks while walking that resolves with rest.

Question 30

Peripheral artery disease (PAD)

Peripheral artery disease (PAD) other symptoms

Answer 30

PAD can lead to ischemia of the limbs or kidneys if it is left untreated. Treatment is aimed at reducing the cardiac risk factors: exercising regularly, eating a heart-healthy diet, and smoking cessation. Patients may also require blood-thinning medication to reduce the formation of clots at the site of the plaques. Patients may also undergo stenting and angioplasty in the arteries.

Question 31

Valvular disease

Answer 31

Valvular disease occurs when the valves of the heart become diseased and damaged. Any of the valves in the heart can become diseased; however, the most affected valve is the aortic valve. Valvular disease can result from aging, hypertension, a history of rheumatic fever, infections of the inner lining of the heart, or congenital heart disease.

Question 32

Regurgitation

Valvular disease

Answer 32

When the valve no longer closes completely, the valve develops regurgitation. Regurgitation is where the blood leaks back through the valve to the chamber of the heart where it came from. When the blood flow is restricted because the valve is stiff and narrowed, this is called stenosis. Prolapse is a floppy or loose valve.

Question 32

Aortic stenosis

Valvular disease

Answer 32

Aortic stenosis is the stiffening of the aortic valve due to calcium deposits that develop, like atherosclerosis. Patients with aortic stenosis develop left-sided heart failure, dyspnea, and syncope as the valve becomes narrower.

Question 33

valvuloplasty or valvoplasty

Valvular disease

Answer 33

Patients with valvular disease that is severe and causing symptoms will likely require surgical repair or replacement of the valve. A valvuloplasty or valvoplasty is a surgical repair of a valve. A valvotomy is an incision into a stenosed valve that relieves the obstruction caused by the narrowed valve. Finally, patients can undergo valvular replacement surgery where the entire valve is replaced either via a catheter through an artery or through open-heart surgery. Valves may be replaced with a metal valve or a tissue valve.