Perfusion Patho Flashcards
Cardiac Output equation
CO = SV x HR
Stroke Volume (SV)
Amount of blood pumped from the heart
Ejection Fraction
% of blood leaving heart
What can effect Preload
Stretch the blood places on ventricles when max filled
What effects preload
venous return
After load
resistance against the heart
inverse of cardiac output (low afterload high cardiac output)
Frank - starling effect
more stretch more contractility
What can affect after load
arthrosclerosis - increase afterload
Perfusion in Pregnancy
heart enlarges
increased workload
Perfusion can effect the gut giving what symptoms
N/V
Why do people cough when lungs aren’t profused according to nursing school
pulmonary edemaw
modifiable risk factors for perfusion issues
Smoking (vasoconstriction)
HTN (increased afterload)
obesity (increased strain)
Physical inactivity
Diabetes (Leads to narrowing of vessels)
Non-modifiable risk factors of perfusion issues
sex
age
famiily hx
cardiac biomarkers
Creatine kinase
CK isoenzymes
Troponin T and Troponin 1
Lipid profile for perfusion is used for
a risk assessment
BNP brain (b-type) natriuretic peptide
monitor and help dx Heart failure
Homocysteine
endothelial damage in the lining of heart
Hypertension stages
Normal <120/80
Elevated BP 120-129/<80
Stage 1: 130-139/80-89
Stage 2: >140/>90
Primary hypertension
Primary is no other reason causing HTN
Secondary Hypertension
HTN that is caused by other disease
Hypertension is the most important modifiable risk factor for
coronary heart disease
Untreated or poorly treated HTN
organ damage and athrosclerosis
stroke doubles everytime SYS doubles
retinopathy
Symptoms of HTN
usually asymptomatic need more to dx
how dx HTN
2 bp checks at least a week a part
family hx
focused medical hx
Treatment
TLC
Drug therapy
Pharm 1 line Treatment for HTN
ACE
ARB
Calcium Channel blockers
Thiazide diuretics
Black people 1st line treatment for HTN
Calcium Channel blockers or thiazide
Only use 1 (mono
Goal of therapy in general for HTN
keep BP below 130/80
Atherosclerosis
thickening or hardening of the arteries large and small
Risk factors
cholesteral
male until women reach menopause
HTN
metabolic syndrome (have a couple of these (apple shaped, cholesterol issues, diabetes)
cigarette smoking
CAD definition
- narrowing or occlusion of 1 or more coronary arteries
-Once it narrows results in angina pectoris - occlusion = MI
Etiology of CAD
Atherosclerosis with plaque within the walls cannot dilate when the myocardium demands more o2
Causes angina
ischemia to the heart
* exercise
* mental stress
* hyperthyroidism (Tachycardia)
* heart failure (myocardium thickens and increases tension)
* HTN
Angina literally means
suffocation of the chest - heart doesn’t have pain receptors (enzymes, substance P, travel to nearby pain receptors)
Types of angina
Stable (during increased effort stop and it goes away)
unstable (doesnt go away and can appear during rest)
variant/vasospastic (prinzmetals) - spasm in coronary artery causing ischemia during rest
Silent - myocardial ischemia without pain
Variant/vasospasm
can happen at the same time each day and is treated different (chronic)
Peripheral Vascular Disorders (PVD)
over arching term including vascular diseases
- DVT
- PAD
- PVD
Symptoms of PVD Arterial
Narrow artery ischemia and necrosis
cool legs
weak pulses
pain from ischemia
“VEINY” venous symptoms of PVD
V - voluptuous pulses warm legs
E - Edema from blood pooling
I - irregular shaped sores
N - no sharp pain (achy pain)
Y - yellow and brown ankles
ARTS Acronym
A - absent or weak pulses and hair
R - Round, Red sores (RUBOR!!!!!!) usually on feet heels or lateral ankles pressure sores
T - toes and feet are pale (ischemia) and black (necrosis
S - sharp pain in calf
Peripheral Artery Disease etiology
Atherosclerosis is an important cause
sAME RISK FACTORS ARE SIMILAR TO ATHEROSCLEROSIs (didn tmean to cap)
Manifestations of PAD
- Intermittent claudication (pain upon walking due to ischemia in muscle)
- paresthesia (numbness and tingling
- shiny tight and bald skin
- thickening toenails
- absent pulses
- elevation pallor
- Dependent rubor
- prolonged cap refill and cool extremities (duh)
- rest pain (really bad)
- ulceration and gangrene
When do you notice pain in PAD
at 50% occlusion
diagnosing PAD
Doppler ultrasound/ palpation of lower extremity pulses
- ankle brachial index (measure pulse)
- exercise tolerance testing
- arteriography/angiogram
-invasive, but great results
treatment of PAD
Decrease considerable cardiovascular risk
reduce symptoms
Methods to treat PAD
manage risk factors
antiplatelet
protect affected tissue
Peripheral venous disease
not getting enough blood back from extremities
Etiology of Venous disorders (3 diseases)
VTE/DVT
Incompetent valves
Vericose veins
VIrchows triad
venous stasis (physical)
endothelial injury (trauma)
being hypercoagulable (medical)
Who is at the greatest risks
people with the most riskfactors and symptoms wins
manifestations in Chronic venous insufficiens
Venous ulcers (yuk) in the gaiter area
Dx of venous
doppler (duplex something
Contrast phlebography
-venography
arterial ulcers are
deep dry and painful
complications of venous ulcers
gangrene, critical limb ischemia, infection/sepsis all can lead to amputation
