week 12 alterations in cardiac function Flashcards
atherosclerosis
the abnormal accumulation of lipids and fibrous tissue in vessels
coronary atherosclerosis
blockages and narrowing of coronary vessels reduce blood flow to the myocardium
CAD is caused by myocardial ischemia
leading cause of death in US
heart disease
most prevalent cardiovascular disease
CAD
CAD s/s
angina pectoris
epigastric distress
radiating pain to jaw or left arm
CAD risk factors
DM peripheral arterial disease HTN smoking elevated LDL AAA
CAD prevention
diet to control cholesterol, fat exercise smoking cessation medication disease mgmt (DM, HTN)
cholesterol med groups
-statins fibrates resins (chole or cole) absorption inhibitors (Zetia) omega 3 (fish oil caps)
angina pectoris
syndrome characterized by episodes of intense pain or pressure in anterior chest
caused by insufficient coronary blood flow
worsened by emotional stress or physical exertion
stable angina
predictable, consistent
occurs with exertion
relieved by rest, NTG
unstable angina
frequency and severity of sx increased
may not be relieved with rest, NTG
intractable/refractory angina
severe incapacitating pain
variant angina
pain at rest with reversible ST-segment elevation
caused by coronary artery vasospasm
silent ischemia
objective evidence of ischemia but patient reports no pain
angina assessment
tightness, choking, heavy sensation frequently retrosternal, may radiate to neck, jaw, shoulders, back, arms (usually left) anxiety accompanies pain other sx: dyspnea, dizziness, n/v subsides with rest, NTG
angina medication
nitrates (ntg) beta blockers (-olol) calcium channel blockers (norvasc, cardizem) antiplatelets: plavix anticoags
most common chronic disease among US adults
hypertension (HTN)
hypertension increases risk for
premature death, disability
MI, CHF
stroke
CKD
hypertension definition
systolic BP > 140
diastolic BP >90
based on 2+ accurate measurements taken 1-4 weeks apart
primary/essential HTN
95% of HTN pts
no identifiable cause
secondary HTN
5% of pts
associated with renal disease, sleep apnea, pregnancy
symptoms of HTN
often asymptomatic (“silent killer”)
retinal/eye changes renal damage MI cardiac hypertrophy stroke
HTN risk factors
smoking obesity, sedentary lifestyle DM age microalbuminuria or GFR < 60
HTN assessment
retinal exam
12 lead EKG
labs
HTN medical mgmt
maintain BP < 140/90
in older adults BP < 150/90
HTN lifestyle modifications
weight reduction
DASH diet
decrease sodium intake
goals of HTN pharm therapy
decrease peripheral resistance
decrease blood volume
decrease rate/strength of myocardial contraction
stage 1 HTN medication
african-americans, pts > 60 receive calcium channel blocker or thiazide diuretic
non african-americans and pts < 60 get ACE-1 or ARB
HTN gerontologic considerations
educate pt and family on medication routine, since it may be complex
medication may be expensive
try to treat with a single drug
hypertensive emergency
BP > 180/120
must be lowered immediately to prevent damage to target organs
hypertensive urgency
BP elevated but no evidence of immediate or progressive target organ damage
hypertensive emergency treatment
reduce BP 20-25% in first hour
reduce to 160/100 within 6 hrs
gradual reduction to normal within days
IV vasodilators (sodium nitroprusside, enalaprilat, nitroglycerin)
hypertensive urgency treatment
oral agents to normalize BP over 24-48 hrs
beta blocker (labetalol)
ACE inhibitor (captopril)
alpha 2 agonist (clonidine)
left sided heart failure
left side of the heart must work harder to pump the same amount of blood; failure to properly pump out blood to the body; often reduced ejection fraction
right sided heart failure
when the left ventricle fails, increased fluid pressure is transferred back through the lungs, ultimately damaging the heart’s right side
the right side loses pumping power, blood backs up in the body’s veins causing peripheral edema
ejection fraction
percentage of how much blood the left ventricle pumps out with each contraction
between 50-70% is normal
measured by echocardiogram or MUGA
The nurse is admitting a client with frothy pink sputum. What does the nurse suspect is the primary underlying disorder of pulmonary edema?
decreased left ventricular pumping
when the demand on the heart increases, there is resistance to left ventricular filling and blood backs up into the pulmonary circulation; pulmonary edema quickly develops
