Objective 3: cardiovascular alterations Flashcards
- 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
what are the measurements for adequate pressure and perfusion?
SBP > 90mm Hg
MAP > 60 mmHg
CK and CK-MB; Troponin T and I; myoglobin - levels rise from heart damage
cardiac biomarkers
cholesterol, triglycerides, lipoproteins (12 hr fast)
lipid profile
helps regulate BP &
fluid volume; increased with heart failure
brain natriuretic peptide
produced in the liver; levels will rise in
response to inflammation
C-ractive protein
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
shows electrical currents; detects abnormal rhythms, and
can sometimes detect heart muscle damage
ECG
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
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
evaluates CV response to stress;
complications can be life threatening. Often done with ECG
cardiac stress testing
treadmill exercise/bicycle to increase HR
exercise stress testing
vasodilating agents are used to
mimic effects of exercise on CV system; used with physically
disabled or deconditioned persons
pharmacologic stress testing
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
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
used to distinguish atrial from ventricular
tachycardias when other methods are inconclusive; serious dysrhythmias
electrophysiologic testing
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
is the force produced by the volume of
blood in arterial walls
Blood pressure
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
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
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
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
what are the 2 types of HTN?
primary
secondary
is HTN with no identifiable cause but
implicated factors include:
* 90-95% of population
* Heredity
* Increased sympathetic neural activity
* Age
primary HTN
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
- 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)
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
