Objective 3: cardiovascular alterations Flashcards by Kaitlyn Dominie

To provide oxygenated blood and nutrients to vital
organs/tissues.
Without adequate pressure to force perfusion, tissue and
organ injury can result

cardiovascular/peripheral vascular system

How well did you know this?

Not at all

Perfectly

what are the measurements for adequate pressure and perfusion?

SBP > 90mm Hg
MAP > 60 mmHg

How well did you know this?

Not at all

Perfectly

CK and CK-MB; Troponin T and I; myoglobin - levels rise from heart damage

cardiac biomarkers

How well did you know this?

Not at all

Perfectly

cholesterol, triglycerides, lipoproteins (12 hr fast)

lipid profile

How well did you know this?

Not at all

Perfectly

helps regulate BP &
fluid volume; increased with heart failure

brain natriuretic peptide

How well did you know this?

Not at all

Perfectly

produced in the liver; levels will rise in
response to inflammation

C-ractive protein

How well did you know this?

Not at all

Perfectly

amino acid in your blood. You get it mostly
from eating meat. High levels of it are linked to early
development of heart disease

homocysteine

How well did you know this?

Not at all

Perfectly

shows electrical currents; detects abnormal rhythms, and
can sometimes detect heart muscle damage

ECG

How well did you know this?

Not at all

Perfectly

uses an X-ray machine and a computer to create
3-dimensional pictures of the heart. Sometimes a dye is injected
into a vein so that your heart arteries can be seen as well

cardiac CT scan

How well did you know this?

Not at all

Perfectly

client wears a small, portable, battery-powered
ECG machine to record heartbeats over a period of 24 to 48 hours
during normal activities. At the end of the time period, the
information is read and evaluated.

holter monitor

How well did you know this?

Not at all

Perfectly

evaluates CV response to stress;
complications can be life threatening. Often done with ECG

cardiac stress testing

How well did you know this?

Not at all

Perfectly

treadmill exercise/bicycle to increase HR

exercise stress testing

How well did you know this?

Not at all

Perfectly

vasodilating agents are used to
mimic effects of exercise on CV system; used with physically
disabled or deconditioned persons

pharmacologic stress testing

How well did you know this?

Not at all

Perfectly

u/s to measure ejection fraction and examine size,
shape & motion of cardiac structures, also its pumping function. Ejection
fraction 60-65% is normal

echocardiogram

How well did you know this?

Not at all

Perfectly

uses a small transducer through
mouth into esophagus nearer to the heart. It allows a closer look at the
heart’s structure and function. It also shows any abnormal tissue around
your heart valves, if blood is leaking backward through a valve, and if
blood clots are present in your heart chambers

transesophageal echocardiogram

How well did you know this?

Not at all

Perfectly

used to distinguish atrial from ventricular
tachycardias when other methods are inconclusive; serious dysrhythmias

electrophysiologic testing

How well did you know this?

Not at all

Perfectly

a small
catheter guided through the large artery in your upper leg, or sometimes
your wrist or arm, into your heart. Dye is given through the catheter and
moving X-ray pictures are made as the dye travels through your heart.
This comprehensive test shows; narrowing in the arteries, heart chamber
size, how well your heart pumps, and how well the valves open and
close, as well as a measurement of the pressures within the heart
chambers and arteries.

cardiac catherization

How well did you know this?

Not at all

Perfectly

is the force produced by the volume of
blood in arterial walls

Blood pressure

How well did you know this?

Not at all

Perfectly

what is BP an indicator of?

The ability of arteries to stretch and fill with blood
The efficiency of the heart as a pump
The volume of circulating blood

How well did you know this?

Not at all

Perfectly

what is BP affected by?

Age, body size, diet, activity, gender, time of day, emotions,
pain, position and disease.
Fluctuations occur so it is important to obtain several
measurements for comparison

How well did you know this?

Not at all

Perfectly

is a chronic condition in which the blood pressure in the
arteries is elevated above normal.
* is a risk factor for coronary heart disease, stroke, peripheral artery disease,
and renal failure.
* Systolic blood pressure equal to or greater than 140 mm Hg and a diastolic
pressure equal to or greater than 90 mm Hg over a sustained period.
* Based on the average of two or more blood pressure measurements taken in
two or more visits with the health care provider after an initial screening

hypertension

How well did you know this?

Not at all

Perfectly

Elevated BP that develops during evaluation by medical
personnel –who traditionally have worn white coat. Likely result of anxiety. Clients are
advised to do regular BP check either at home or with assistance and bring record to
physician

white-coat hypertension

How well did you know this?

Not at all

Perfectly

what are the 2 types of HTN?

primary
secondary

How well did you know this?

Not at all

Perfectly

is HTN with no identifiable cause but
implicated factors include:
* 90-95% of population
* Heredity
* Increased sympathetic neural activity
* Age

primary HTN

How well did you know this?

Not at all

Perfectly

has an identifiable underlying cause and is less common than primary HTN. * 5-10% of population

secondary HTN

* The rate of the rise of BP is more important than the absolute value in determining the need for emergency treatment. * Prompt recognition and management is essential to decrease threat to organ function and life!

hypertensive crises

occurs when * BP > 180/120 mmHg * must be treated and lowered immediately to prevent further damage to organs

hypertensive emergency

is defined as severely elevated BP with no evidence of target organ damage. *Develops over days to weeks *Client requires close monitoring of BP and CV status *ASSESS FOR POTENTIAL EVIDENCE OF TARGET ORGAN DAMAGE. *The blood pressure must be lowered within a few hours

hypertensive urgency

occurs when the major blood vessels that supply the heart become damaged or diseased. * Inflammation and plaque formation in the coronary arteries is most common cause (atherosclerosis). As this plaque builds up, the arteries are narrowed which decreases blood flow. * If blood flow is compromised enough, angina pectoris (chest pain) occurs. * If a full blockage occurs, a myocardial infarction (MI or heart attack) will occur.

coronary artery disease

* A loss of elasticity and artery hardening that accompanies the aging process. * Arteries lose elasticity, are more rigid * arterial vessels fail to stretch causing less O2 rich blood to be delivered to the organs

arteriosclerosis

* Artery lumens fill with fatty, cholesterol plaque deposits * reducing the amount of O2 rich blood reaching organs. * This is a more modifiable contributor to vascular disease than _______________

atherosclerosis

chest pain caused by myocardial ischemia

angina pectoris

This is a sum of your blood's cholesterol content. Below 5.2 mmol/L desirable, Above 6.2 mmol/L is considered high

total cholsterol

"good" cholesterol because it helps carry away LDL cholesterol, keeping arteries open and your blood flowing more freely. Above 1.5 mmol/L is best; Below 1 mmol/L is poor

HDL cholesterol

"bad" cholesterol. Too much of it in your blood causes the buildup of fatty deposits (plaques) in your arteries (atherosclerosis), which reduces blood flow. These plaques sometimes rupture and can lead to a heart attack or stroke. 2.6-3.3 mmol/L for clients without CAD, Below 1.8 mmol/L for client with symptomatic CAD; Above 4.9 mmol/L is considered very high.

LDL cholesterol

When you eat, your body converts calories it doesn't need into triglycerides, which are stored in fat cells. High triglyceride levels are associated with several factors, including being overweight, eating too many sweets or drinking too much alcohol, smoking, being sedentary, or having diabetes with elevated blood sugar levels. Below 1.7 mmol/L is desirable; Above 5.6 mmol/L is considered very high

triglycerides

* Pain: pressure, fullness, burning or tightness in your chest, crushing or searing pain that lasts for more than a few minutes and increases with exertion. * May be associate with shortness of breath, cold sweats, dizziness or weakness, nausea or vomiting. * Since this is visceral pain, radiation of cardiac pain is common to any of the following sites: back, neck, jaw, shoulders, and one or both arms

cardiac pain

* Pain: Typically sharp and unilateral * Increases with point tenderness or coughing- this is somatic pain which increases with movement of the thorax * Sore throat may be present as associated with excessive coughing

pleuritic pain

* A syndrome characterized by episodes of paroxysmal pain or pressure in the anterior chest caused by insufficient coronary blood flow * Physical exertion or emotional stress increases myocardial oxygen demand, and the coronary vessels are unable to supply sufficient blood flow to meet the oxygen demand

angina pectoris

what are the types of angina pectoris?

chronic stable unstable intractable variant nocturnal silent ischemia

Predictable and consistent pain initiated by exertion and responds to rest or nitroglycerine. Same pattern of onset, duration & intensity of symptoms

chronic stable angina

Persistent and unpredictable, even during rest. Doesn’t respond to nitroglycerine. Requires medical intervention

unstable angina

severe and incapacitating chest pain; unrelenting pain

intractable angina

pain at rest, often with reversible electrocardiogram (shows the heart's electrical activity) changes. Seen in clients with a history of migraine headaches and Raynaud’s phenomenon

variant angina

Occurs only at night but not necessarily during sleep. May occur in the absence of significant coronary atherosclerosis or coronary spasm. More common in women

nocturnal angina

Objective evidence (EKG changes) but patient does not report symptoms; no pain

silent ischemia

* Spectrum of conditions which describes the reduction of blood flow to the heart muscle (myocardium) . * When ischemia is prolonged and is not immediately reversible, acute coronary syndrome (ACS) develops.

acute coronary syndrome

a change in the pattern of angina symptoms, without signs of an MI

unstable angina

an MI identified by BW, without the typical ECG changes

non-ST-elevation MI

an MI identified by BW and produces typical ECG changes. SERIOUS

ST-elevation MI

* Infarct, or tissue death, occurs when: An area of heart tissue dies (necrosis) from reduced oxygen supply. * Result of prolonged occlusion (blockage) of the coronary arterial blood flow (RCA, LAD & LCx). * Larger necrotic area = more serious damage * classified based on the area affected and the depth of the damage to the heart muscle

Myocardial infarction

* CK-MM (skeletal muscle), CK-MB (heart muscle), CK-BB (brain tissue). * CK-MB is found mainly in cardiac cells and increases with damage. * Increases in a few hours and peaks within 24 hours. * Sensitivity and specificity are not as high as for troponin levels. * Currently replaced by troponin levels

creatine kinase

s found in cardiac and skeletal muscle. * It is released rapidly, within 1-3 hours after an MI. * has high sensitivity in that it occurs quickly, but poor specificity to the heart alone. It may be useful for the early detection of myocardial infarction. * If it is not present – MI may be ruled out

myoglobin

* bleeding (from puncture and from getting heparin during procedure), * damage to coronary artery (occurs mainly in the procedure room), * infection (invasive procedure), * clot formation in stent after procedure (called restenosis, client must ensure to take required medication post procedure to the period of time prescribed (usually ASA and Plavix), * abnormal heart rhythms (Post procedure vitals and site checks are required as ordered)

post cardiac catheterization/stenting procedure risks

heart failure

characterized by a weakened heart muscle, and the EF is severely reduced (55-70%). * Inability of heart to pump blood related to impaired contraction, increased afterload, mechanical abnormality (valve disease) * most common type * Caused by left ventricular hypertrophy from chronic systemic HTN, aortic stenosis, hypertrophic cardiomyopathy

systolic HF

characterized by a stiffened non-compliant heart muscle. EF is normal. * Insufficient blood volume pumped related to reduced filling during diastole (preserved systolic function- normal EF) * Characterized by high filling pressures and venous engorgement * caused by Left ventricular hypertrophy from chronic hypertension, Aortic stenosis, Hypertrophic cardiomyopathy

diastolic heart failure

Imaging of tissues, organs and BV; estimation of velocity. Can use doppler

ultrasonography

Images of arteries/occlusions in lower limbs as blood flows; contrast agent. Can be done with CT or MRI

angiography

compares the BP in the client’s ankle with the BP in the arm. The ratio represents the reduction in blood flow between the 2 sites. ABI range of 0.90 to 1.40 is considered normal. Mild to moderate if the ABI is between 0.41 and 0.90, and severe if an ABI is less than 0.40

ankle-brachial index

a more invasive procedure that involves guiding a catheter through an artery in your groin to the affected area and injecting the dye that way. Although invasive, this type of angiography allows for simultaneous diagnosis and treatment. After finding the narrowed area of a blood vessel, your doctor can then widen it by inserting and expanding a tiny balloon or by administering medication that improves blood flow.

catheter angiography

A sample of your blood can be used to measure cholesterol and triglycerides and to check for diabetes.

blood tests

refers to diseases of the blood vessels outside the heart and brain. * It’s often a narrowing of the vessels that carry blood to the legs, arms, stomach or kidneys. * Can affect arteries or veins * reduced blood flow through the peripheral blood vessels. * This causes decreased perfusion and oxygenation of the peripheral tissues. * This decrease may lead to ischemia, malnourished tissues and tissue death.

peripheral vascular disease

* Atherosclerosis is the leading cause * So patients are likely to have CAD * The gradual thickening of the layers of the arterial wall cause narrowing of the lumen, or stenosis, thrombosis blockage, aneurysm, ulceration and rupture. * These changes starve organs and tissues of necessary blood flow and the components it carries. * Commonly affects arteries of neck, abdomen, and extremities

peripheral arterial disease

* Reduction in arterial circulation caused by brief spasms of the arteries and arterioles in fingers (most common), toes, nose, ears, or chin * Spasms last about 15 minutes * Cause: no explainable reason, or secondary to connective tissue disease; impaired release of prostaglandins * Post spasm, vessels dilate widely

non-atherosclerotic PAD

aggregates of platelets attached to vein that have a tail-like appendage containing fibrin, WBC, RBC

venous thrombi

is a condition where the flow of blood through the veins is inadequate, causing blood to pool in the legs. * May be consequence of varicose veins or valve damage from previous thrombosis. * Blood cannot return to heart, due to valve damage. * Volume accumulates. * Fluid leaves veins and enters the interstitial spaces due to increased pressure in vessels. * Results in localized edema, fluid-filled space becomes shiny and hard. Skin is leathery in appearance

venous insufficiency

tissue swelling related to obstruction of lymphatic flow (unable to drain unabsorbed plasma from the interstitial spaces).

lymphedema

congenital ® hypoplasia of the lymphatic system if the lower extremities (females age 15-25)

primary lymphedema

acquired obstruction ® axillary node dissection for breast cancer or chronic inflammation of the lymph vessels

secondary lymphedema

occur when part of an artery wall weakens, allowing it to widen abnormally or balloon out, and may rupture causing hemorrhage and death. * Commonly involves aorta (aortic arch, thoracic, abdominal)

aneurysms

what are the types of aneurysms

saccular fusiform dissecting

projects only from one side of the vessel. Pouch-like

saccular aneurysms

he entire arterial segment becomes dilated. Circumferential and uniform in shape

fusiform aneurysms

the inner layer of the vessel tears and a hematoma forms and may rupture. Can be in ascending or descending aorta; acute or chronic

dissecting aneurysm

A weakening in the wall of a cerebral blood vessel Usually occur in the circle of Willis (ring of arteries that supply the brain) Defect is congenital or secondary to hypertension and atherosclerosis Can cause cranial nerve deficits Many have no warning prior to its rupture

cerebral aneurysms