Unit 3 Flashcards
formula for BP
BP = CO x PVR
PVR
peripheral vascular resistence
formula for CO
CO = SV x HR
SV
stroke volume
CO
cardiac output
normal BP
< 120 systolic
< 80 diastolic
What makes HTN the silent killer?
pts are asymptomatic while damage is done
HTN
> 120 systolic
> 80 diastolic
Tx for HTN is initialized at what values for pts ≥ and < 60 yo?
- ≥ 60 yo: > 150/90
- < 60 yo: > 140/90
categories of HTN
- essential
- secondary
etiology of essential HTN
not caused by pre-existing condition
etiology of secondary HTN
caused by pre-existing condition
gender-related HTN risk factors
- < 45 yo: men > women
- 45-65 yo: men = women
- > 65 yo: men < women
nonmodifiable risk factors for essential HTN
- > 60 yo
- postmenopausal
- family Hx
- African-American race
modifiable risk factors for essential HTN
- physical
- overweight/obese
- hyperlipidemia
- diet: ↑ intake
- Na+
- caffeine
- ETOH
- lifestyle
- inactivity
- stress
- nicotine use
risk factors for secondary HTN
- kidney dz
- primary aldosteronism
- pheochromocytoma
- Cushing’s
- coarctation of the aorta
- Brian tumors
- encephalitis
- PG
meds that increase risk of secondary HTN
- estrogen
- glucocorticoids
- mineralocorticoids
- sympathomimetics
continuous BP ↑ →
medial hyperplasia (thickening) of arterioles
↑ thickening of arterioles d/t BP →
↓ perfusion → end organ damage (heart, kidneys, brain)
damage from HTN →
- MI
- CVA
- PVD
- RF
MI
myocardial infarction
CVA
cerebrovascular accident
PVD
peripheral vascular dz
RF
renal failure
foods to improve HTN
- veggies
- fruits
- whole grains
- ↓ fat dairy products
- poultry
- fish
- legumes
- non-tropical oils
- nuts
foods to limit to improve HTN
- sweets
- sugary beverages
- red meat
- dietary Na+
exercise to improve HTN
40 min 3-4x/wk
Na+ restriction to improve HTN
- 2400 mg/day
- preferred: 1500 mg/day
medications for HTN
- diuretics
- BBs
- CCBs
- ACE inhibitors
- ARBs
CCB
Ca channel blocker
BB
beta blocker
ARB
angiotensin receptor blocker
ACE inhibitor
angiotensin-converting enzyme inhibitor
HTN urgencies
- can be managed outpatient
- managed w/ PO meds
- can be acute or chronic
HTN emergencies
- conditions w/ Sx of end organ damage
- acute evolving Sx
- expect ICU admission
- IV meds to manage at first
medical emergencies that can be caused by HTN
- acute CVA
- AKF/AKI
- CP, MI, ACS
ACS
acute cardiac syndrome
ARF
acute renal failure
ARI
acute renal injury
progression of CHD to HF
CAD → angina → MI → HF
stable angina characteristics
- predictable
- < 15 min
- relief: rest, TNG
unstable angina characteristics
- unpredictable
- > 15 min
- ↑ in occurence
- No relief with rest, TNG
Sx of CAD
almost always none
MI characteristics
- > 30 min
- ↑ cardiac enzymes
- requires immediate reperfusion therapy
types of MI
- NSTEMI
- STEMI
routine labs for suspected cardiac dz
- enzymes
- myoglobin
- CK-MB
- Troponin I or T
- lipids
- TC
- HDL
- LDL
- triglycerides
meds for long-term MI Tx
- ASA
- BB
- Ace inhibitors
- ARBs
lifestyle/education for long-term MI Tx
- ↑ activity
- no nicotine
- monitoring + Tx for
- lipids
- BP
- diet: ↓ fat and Na+
HF long-term Tx meds
- diuretics
- antihypertensives
- BBs
- ACE inhibitors
- ARBs
- CCBs
- possibly digoxin
- anticoags
extra lab for HF
BNP
BNP
B-type natriuretic peptide
lifestyle/education for HF long-term Tx
- everything for MI
- Report SOB
- Daily wt: report wt increase > 3 lbs/24 hrs
- – lipid monitoring + Tx, unless indicated
arteriosclerosis
thickening/hardening of arterial walls
atherosclerosis
- type of arteriosclerosis involving plaque formation on vessel walls
- obstructs normal blood flow
- stable or unstable
stable atherosclerosis
collagen ↓ likelihood of rupture
unstable atherosclerosis
rupture can cause more damage than in stable plaque rupture
atherosclerosis modifiable risk factors
- dyslipidemia
- lifestyle
- nicotine
- obesity
- poor diet
- inactivity
- stress
nonmodifiable risk factors for atherosclerosis
- genetic predisposition
- ethnicity
- African-American
- Hispanic
assessment for atherosclerosis
- CV assessment
- echo/doppler flow studies
- labs
CV assessment for atherosclerosis
- NVD
- extra heart sounds
- peripheral pulses
lab values in atherosclerosis
- ↓ HDL-C
- ↑ LDL-C
- ↑ triglycerides
interventions for CAD/atherosclerosis
- change modifiable risk factors
- lipid-lowering agents
groups for whom lipid-lowering meds are unsafe
- liver
- active dz
- Hx of dz
- unexplained ↑ LFTs
- reproductive
- current/possible PG
- lactation
- renal impairment
- ETOH abuse
- meds
- digoxin
- warfarin
PVD
- peripheral vascular dz
- umbrella term for
- peripheral artery dz
- peripheral venous dz (also PVD)
PAD
peripheral artery dz
peripheral artery dz incidence
- most common type of PVD
- legs > arms
etiology of PAD
- systemic atherosclerosis
- same risk factors
PAD characteristics
- chronic
- partial or total occlusion to affected extremities
inflow PAD obstruction location
- ↑ inguinal ligament
- arteries
- distal aorta
- common, internal, and external iliac arteries
inflow obstruction tissue damage
atypical
outflow obstruction location
- arteries
- femoral
- popliteal
- tibial
- ↓ superficial femoral artery
outflow obstruction tissue damage
typical
PAD stages (4)
- Stage I: asymptomatic
- Stage II: claudication
- Stage III: rest pain
- Stage IV: gangrene/necrosis