test 3 Flashcards
why is left ascending artery the widow maker
supplies to left ventricle. If left ventricle doesn’t get enough oxygen… deadly.
Major causes of CAD
atherosclerosis- cholesterol plays a major role, as well as endothelial injury causing obstruction
what does a high CRP indicate
inflammation. typically elevated in CAD patients
collateral circulation
small arteries are built around the blocked artery in CAD, but they don’t deliver much oxygen and are only temporary solution, as chronic ischemia will soon occur
non modifiable risk for CAD
age, gender, genetics, ethnicity, family history
modifiable risk factors of CAD
Lipid levels, HTN, smoking, physical inactivity, obesity, diabetes, metabolic syndrome, psychological states, substance abuse
modifiable risk factors of CAD
Lipid levels, HTN, smoking, physical inactivity, obesity, diabetes, metabolic syndrome, psychological states, substance abuse
common symptoms in CAD
edema, clubbing, chest pain with exertion, dizziness, nausea, dysrhythmias, low o2 sat
- diabetes patients may not feel chest pain or any pain as there nerves could be damaged
CAD diagnostics
Lipid panel, cholesterol, A1C, ECG, stress test, echocardiogram, chest x ray, bruits
drugs for CAD
> antihypertensives (beta blockers- lol, CCB- pine, Ace inhibitors - pril). monitor bradycardia and hypotension
> antianginals (nitroglycerine)
> lipid lowering (statins -monitor liver damage and myopathy)
> decrease cholesterol absorption - Ezetimibe (zetia)
> anticoagulants (heparin, warfarin) monitor for bleeding and thrombocytopenia (low platelets)
Coronary artery bypass graft (CABG)
take artery/vein from other place in body and attach to heart
2 wound- chest and where it was harvested
assess platelets, perfusion assessment of all organs, wound care, pain
Go into depression screening- link between getting CABG and depression
PTCA (percutaneous transluminal coronary angioplasty)
balloned catheter supresses plaque, allowing more space for blood to flow. stent may also be placed to prevent it from happening again
angina
intermittent chest pain usually occurring with the same pattern and intensity over period of time usually caused by CAD.
not enough oxygen. we want to decrease o2 demand and/or increase oxygen supply
happens when artery is 70% blocked or left main artery is 50% blocked
risk factors for angina
same as CAD, but oral contraceptives are added as well as menopausal women
short acting nitrates
dilates peripheral and coronary blood vessels
- given sublingually or by spray
can take up to 3 doses; 5 mins apart
- for angina
long acting nitrates
to reduce angina incidence
side effects- headaches, orthostatic hypotension
stable angina diagnostics
chest x ray
12 lead ecg
lab studies
echocardiogram
exercise stress test
EBCT or CCTA (test that look for plaque using IV contrast)
cardiomyapthies
diseases that directly affect myocardial structure or function
- makes it hard for blood to be delivered to body
primary: idiopathic, only partially affected muscle
secondary- caused by known primary disease
can be ischemic - MI (reduced EF), CAD
or nonischemic - dilate, hypertrophic, restrictive
ejection fraction
Percentage of blood and volume left ventricle pushes out, normal is 55% and above
preload
volume coming into ventricle
increased in hypervolemia, regurgitation of valves
diuretics can help
afterload
resistance left ventricle must overcome to push blood
increased in HTN or vasoconstriction
- creates more workload
vasodilators can help
hypertrophic cardiomyopathy
thickened left ventricular wall, becomes stiff
- contraction isn’t weakened, but filling is impaired
can be genetic, or can happen in athletes
blood backs up into lungs
dilated cardiomyopathy
enlargement of left ventricle
- most common one
poor systolic function
decreased EF
as disease progresses, atrial enlargement
blood stays in LV… worry about clots
no specific cause,,, alcohol, epstein barr, radiation
restrictive cardiomyopathy
rigid ventricular walls: impaired filling and stretch
- least common type
etiology unknown
EF may be normal
heart tissue replaced by fibrosis. could lead to HF or dysrhythmias
signs/symptoms of cardiomyopathies
angina, SOB, fatigue, HF, irreg rate, edema, pulm congestion, enlarged liver, sleepiness, cough, loss of appetite, syncope
cardiomyopathies diagnosis
chest x-ray
echocardiogram
ECG
Cardiac MRI
blood test: BNP (secreted due to stretching of ventricle) renal/liver function
cardiomyopathy meds and med management
nitrates- decrease preload bc it opens veins
diuretics- decrease fluid
ACE inhibitor- Decrease resistance in artery so L vent doesn’t have to work as hard, decreasing afterload
Beta blockers for neurohormones
antidysrhythmics
anticoagulants
reduce symptoms, slow progression, prevent clots, surgeries, meds, safety, control edema, control fatigue, manage indigestion and nutritional issues (GI is slowed). manage stress
low sodium diet, no alcohol, avoid diet pills and cold meds
what regulates valvular diseases
SNS- fight or flight- arteries constrict
hormones- epinephrine, NE, angiotensin
histamine - inflammation
what is a valvular disorder
disturbance in blood flow that eventually results in damage to tissues
the #1 cause is atherosclerosis, but can also be from raynaud’s, buerger disease, smoking, diabetes, hyperlipidemia, inflammation, HTN, obesity and age
peripheral arterial disease (PAD)
progressive narrowing and degeneration of arteries in upper and lower extremities, typically from atherosclerosis
typically goes unnoticed for a long time until symptoms appear in 60s-80s
symptoms- intermittent claudication (muscle pain that resolves w rest), paresthesia (due to lack of blood flow), thin, shiny, taunt skin, loss of hair on legs, absent or diminished peripheral pulses, pain aggravated by limb elevation, leg pain, pallor
diagnosed by doppler, ABI, angiography, duplex imaging
common sites of PAD
Iliac artery
femoral artery
popliteal artery
tibial artery
peroneal artery
PAD complications and care
complications can include poor wound healing, wound infection, tissue necrosis, ulcers, amputation
avoid HTN, stop smoking, manage hyperlipidemia and diabetes, exercise, eats fruits and veggies and low cholesterol, fat and salt
Meds-
vasodilators - ramipril (altace) : specific to PAD. improved blood flow and walking distance
antiplatelets
cilostazol and pentoxifylline- helps intermittent claudication
surgery- balloon angioplasty, bypass with vein or sympathetic graft
main goal: improve arterial perfusion
- evaluate by skin color, temp, pulse
thromboangiitis obliterans
also called Buergers, a inflammatory disorder of small/medium arteries/veins in upper or lower extremities
- common in men under 45 with history of smoking
ischemic ulceration in fingers, autoimmune markers in lab
interventions- stop smoking, avoid cold temps, walk, antibiotics if ulcers infected, sympathectomy, bypass, pain management
raynauds phenomenon
vasospastic small cutaneous arteries, common in fingers in toes in women ages 15-40.
triggered by exposure to cold, emotional upsets, tobacco and caffeine use
causes color changes of ears, nose, toes, fingers, - thick skin, brittle nails, small hole ulcers
2 phases:
vasoconstrictive- skin white then blue. feeling of coldness but skin numb
hyperemic phase- throbbing, aching, swelling . because of vessels open and blood returns quickly
wear warm clothes, avoid temp extremes, no smoking, avoid caffeine, avoid vasoconstriction meds
peripheral venous disease (PVD)
Blood isn’t returning to heart well, from incompetent valves or inadequate pumping
symptoms- cool, brown skin, edema, ulcers, pain and redness around vein, pulses may be decreased or normal. deep muscle tenderness. risk for clots.
elevate legs above heart, take anticoagulants, avoid extreme temps, monitor pulses, avoid sitting/standing for long periods
venous ulcers
type of PVD caused by venous infufficency. causes breakdown of RBC releasing hemosiderin. Fibrous tissue replaces skin.
chronic inflammation, edema, eczema, leathery skin, typically above medial malleolus (ankle), pain, wound may end up in bone causing osteomyelitis
wear compression, do wound care, good nutrition, antibiotics, pentoxifylline (wbc activation drug), skin graft
varicose veins
dilated superficial veins
primary cause- pregnancy, obesity, heart disease, family history
secondary- injury
could be congenital
may have pain after prolonged standing, itching
use compression and elevation
most common cause of HF in women
HTN
most common cause of HF in men
CAD, MI
HF risk factors
CAD, HTN, DM, age, tobacco, obesity, metabolic syndrome, valve disorders, infection.
could be congenital
HF stages
at risk
pre HF- cardiac issue but no symptoms
HF- symptoms
advanced HF- palliative care
Left sided diastolic HF
heart cant fill. chambers are thick and stiff, contracts okay so EF is fine
Blood backs into L atrium and lungs
Usually caused by HTN
left sided systolic HF
Too much stretch in chambers, they’re thin. EF is reduced. can’t pump
fluid backs into L atrium and lungs
caused by valve issues, increased afterload, CAD
Right sided HF
does not pump effectively, blood backs into body organs and tissues
most common cause is L sided HF, but can also be right ventricle infarction
compensatory mechanisms
When output goes down, HR tries to increase, lowering BP, kidneys think dehydration and increase renin to hold on to fluid, sodium and water
drugs for HF
Drugs to order- Ace inhibitors (pril) / arbs (statin), diuretics and beta blocker (lol)
Also nitrates, vasodilators, RAAS, positive inotopes like dopamine, MRA, SGLT (Sodium glucose)
Atrial natriuretic peptide (ANA), b-type natriuretic peptide (BNP)
Released due to Increased blood flow in heart
- Causes diuresis (lots of urine), vasodilation, and lowered BP
Atrial natriuretic peptide (ANA), b-type natriuretic peptide (BNP)
Released due to Increased blood flow in heart
- Causes diuresis (lots of urine), vasodilation, and lowered BP
Diagnostics for HF
*BNP, echo
Chest x-ray, ecg, nuclear imaging, cardiac cath
caring for HF
treat underlying cause
PT/OT
pacemaker
palliative care
monitor vitals
o2 therapy
semi fowlers
I&O
alternate rest w activity
monitor edema
*DAILY WEIGHTS AND RESTRICT SALT TO 2G/DAY. call Dr if gain 2lbs a day or 3-5 in week
caring for HF
treat underlying cause
PT/OT
pacemaker
palliative care
monitor vitals
o2 therapy
semi fowlers
I&O
alternate rest w activity
monitor edema
*DAILY WEIGHTS AND RESTRICT SALT TO 2G/DAY. call Dr if gain 2lbs a day or 3-5 in week
Right HF symptoms
fatigue
ascites
enlarged liver/spleen
JVD
anorexia/ GI complaints
weight gain
dependant edema
Left sided HF symtoms
paroxysmal nocturnal dyspnea
cough
crackles in lung
tachypnea
tachycardia
restlessness
fatigue
cyanosis
confusion
exertional dyspnea
Best drug to give for a patient w CAD
statin (for hyperlipidemia) because CADs most common cause is atherosclerosis
cardiac output
stroke volume and HR
Defibrillation
only for dead. For V-fib. Shocks them
cardioversion
less amount of energy to shock, can shock more dysrhythmias
Ability to initiate an impulse spontaneously and continuously
automaticity
Ability to be electrically stimulated
excitability
Ability to transmit an impulse along a membrane in an orderly manner
conductivity
Ability to respond mechanically to an impulse
contractility
ANS control of heart
parasympathetic- decreases rate of SA node, slows impulse conduction of AV node
sympathetic- increases rate of SA node, increases conduction of AV node, increases cardiac contractility
ECG
most accurate monitoring HR and rhythm. Waveforms
telemetry
continuous monitoring, machine has memory. Not as informative as ECG
counting HR on ECG
Usually 6 seconds, count QRS, multiply by 10 for 60 secs to get BPM
artifact
what is shown when not getting good reading of monitoring due to electrodes being old, not sticking, or low battery.
Patient may be shivering or have hiccups, something causing wires to move
dysrhythmias assessments
dizziness, syncope, chest pain, N/V, rate and rhythm, vitals
dysrhythmias assessments
dizziness, syncope, chest pain, N/V, rate and rhythm, vitals
What can cause nausea and vomiting with cardio issues
Blood pressure issues
what is P wave
atrial depolarization
what is QRS complex
ventricular depolarization
what is T wave
ventricular repolarization
Normal Sinus Rhythm
starts in SA node, reg rate and rhythm. rate in between 60-100
Sinus bradycardia
starts in SA node, reg rhythm, but rate is below 60
can happen if your an athlete, or in sleep, or from conditions such as Hypothermia, vagal stimulation, ocular pressure, hypothyroidism, hypoglycemia, or meds- beta blocker, CCB,
This may be normal for some people, but for others symptoms include hypotension, pale, cool skin, weakness, angina, dizziness, SOB, confusion
treated by stopping drugs that cause it, atropine or pacemaker
sinus tachycardia
starts in SA node, normal rhythm, but rate is 101-200
May be caused by sympathetic stimulation or stressors such as Exercise, pain, fever, hypotension, HF, hypovolemia, fear, hyperthyroidism
Drugs can also increase rate- such as caffeine, cold meds, etc
symptoms include dizziness, dyspnea, hypotension, angina possibly
treatment depends on cause. Beta blockers, vagal maneuver
Premature Atrial Contraction (PACs)
starts somewhere in the atrium but not the AV node, irregular rhythm, rate varies.
Can happen whenever, may not be a issue if it only happens occasionally. It distorts P waves.
Can be caused by stress, fatigue, tobacco, alcohol, hypoxia, electrolyte imbalances, diseases such as hyperthyroidism, CAD
Patient will feel palpitation or heart skipping a beat
treatment is for more serious dysrhythmias, B blockers
Atrial Flutter
starts in single ectopic focus in right atrium. There is not a P wave, and it looks as a saw tooth pattern. The atrial rate is 200-350, and vent rate is around 150, a ratio of 2:1.
It is associated with a disease, such as HTN, CAD, mitral valve disorder.
Clotting is common, so patients need to be on anticoagulant.
Treatment can be pharmacological agents, electrical cardioversion, or radiofrequency ablation (burning)
Atrial Fibrillation
loss of effective atrial contraction. Atrial rate can be 350-600. vent. rate varies
controlled Afib- under 100
uncontrolled or rapid Afib- over 100. action need taken.
P wave is all over the place, chaotic waves.
This usually occurs secondary to a prior heart issue. It is the most common dysrhythmia. It can occur from other issues as well such as hyperkalemia or after cardio surgery
with AFib, there is decrease in CO and increase of risk for stroke
Goals- oxygenate (despite pulse ox), anticoagulation, try to get back to normal rhythm.
what does thyroid gland do
secrete thyroxine (T4), triiodothyronine (T3), regulates energy metabolism, growth and development
issues are more common in women (age 20-40) and smokers
goiter
enlarged thyroid; may result in over or underactive thyroid
may be caused by lack of iodine
surgery can remove
autoimmune disorder that affects thyroid causing hypothroidism
hashimoto thyroiditis
autoimmune disease causing hyperthyroid
graves disease
hypothyroidism
fatigue, memory impairment, depression, myxedema, weight gain, constipation, dry skin, slowed heart rate, enlarged thyroid, shaggy hair, low sex drive
hyperthyroidism
nervousness, weight loss, diarrhea, hunger, fragile fingernails, warm skin, broken hair, enlarged thyroid, increased HR, muscle cramps, exophthalmos
diagnosed by TSH levels under .4, if TSH low, it hyperthyroidism, if it’s high than its hypo
thyroid storm
severe health crisis when large amount of hormones released, causing severe tachycardia, death
treatment of hyperthyroidism
block effects of excess hormones or suppress over secretion
antithyroid- propylthiouracil and methimazole
radioactive iodine
beta blockers
thyroidectomy
high calorie diet for weight loss
- Don’t stop meds abruptly
primary hypothyroidism causes
destruction of thyroid tissue or defective hormone synthesis
secondary hypothyroidism causes
pituitary disease w decreased TSH secretion or hypothalamic dysfunction with decreased TRH secretion
what causes myxedema
sugar molecules under skin, causing puffiness
levothyroxine
synthetic hormone for hypothyroidism, starts with low dose and increased every 4-6 weeks.
Must take for the rest of life
- better to take on empty stomach
parathyroid
4 glands that sit behind the thyroid
- makes PTH to regulate body’s blood level of calcium and phosphorus
excess PTH associated with high calcium- constipation, kidney stones, muscle weakness
inadequate PTH associated with low calcium- numbness, tingling, tetany
what does adrenal gland produce and secrete
glucocorticoids- cortisol is stress hormone
androgens (sex hormone)
mineralocorticoids- aldosterone regulates Na and K
cushing syndrome
from chronic exposure to excess glucocorticoids, usually from steroids, or ACTH secreting pituitary adenoma
may have moon face, acne, excessive hair growth, increased body hair, weight gain, slow wound healing, buffalo hump, thin extremities due to fat being in stomach and back, purple striae
diagnosed CT or MRI
treatment depends on cause- surgery, or decrease steroid dose
correct hypertension and hyperglycemia
correct hypokalemia
high protein diet
avoid exposure to extreme temps, infections and emotional (causes increased cortisol)
addison’s disease
lack of cortisol and aldosterone
symptoms- bronze skin, changes in hair distribution, GI disturbances, weakness, hypoglycemia, postural hypotension, weight loss
symptoms don’t typically show until 90% of adrenal cortex is destroyed
diagnosed by ACTH stimulation
women will need androgen replacement as well as cortisol and aldosterone because they get their aldosterone from adrenal, men get it from testi
issues of long term steroids
osteoporosis, insomnia, anger, muscle weakness, protein depletion, increased glucose, delayed wound healing
make sure to gradually stop steroid
