Week 2 Cardiovascular Conditions Flashcards
Heart failure
the heart cannot pump enough blood for your body’s needs, causing inadequate perfusion.
Generally a dysfunction of the left ventricle (systolic and diastolic HF)
Measured by decreased cardiac output
Cardiac output
total amount of blood pumped per minute (ave. 5L/min). CO = stroke volume (amount of blood pumped out every beat) x heart rate (bpm).
Systolic Heart Failure
Systolic heart failure (HFrEF)- heart muscles (left ventricle) cannot contract with enough force to empty/pump enough blood into circulation (to body and lungs). (big chambers, thin muscles)
Diastolic heart failure
Diastolic heart failure (HFpEF)- the heart’s main pumping chamber (left ventricle) becomes stiff and unable to fill the heart with blood properly to eject blood into circulation (thick muscles and small chambers).
Left & Right Sided HF
Left & Right Sided heart failure - heart failure can isolate to a specific side of the heart, typically starting with the left and moving to the right
Left side - blood comes in from the lungs and pumps out to the body → not contracting well to body → fluid build up in lungs (pulmonary oedema/congestive heart failure)
Right side - blood comes from body and pumps to the lungs → not contracting well to lungs → fluid build/congestion up in the body (feet, legs, abdomen). General causes COPD, ARDS, chronic respiratory conditions
Clinical manifestations - hypertension, oedema, crackles, dyspnoea, congestion, orthopnea, fatigue, weakness, weight gain
Stroke
Occurs when blood supply to part of the brain is blocked or reduced, reducing oxygen (ischemic 85%) or a blood vessel in the brain bursts (haemorrhagic 15%)
Symptoms: damaged brain cells due to oxygen deprivation → drooping face, weakness in mobility, difficulty speaking, changes to vision, loss of balance, confusion, memory loss, FAST (Face, Arms, Speech, Time)
Risk factors: high blood pressure, smoking, high cholesterol, inactivity, unhealthy diet, high alcohol intake, poor diabetes control
Stroke rehabilitation and medication can be used to treat stroke
Ischemic Stroke
Ischemic Stroke - generally caused by buildup of fatty material inside the blood vessels, leading to a clot/blockage → death of brain tissue
Transient Ischaemic Attack (TIA) - goes away within 24 hours but still must go hospital
Ischemic embolism - blood clot comes generally travels from the heart or cholesterol to brain
Ischemic thrombosis - blood clot arises in the blood vessel in the brain (no travelling) also known as atherosclerosis.
Watershed stroke - cerebral hypoperfusion (low blood flow to brain)
Haemorrhagic Stroke
Hemorrhagic Stroke - blood vessel in the brain bursts, leading to swelling → may require surgery
Angina
A type of chest pain caused by reduced blood flow to the heart (myocardial ischemia). Transient ischemia of the heart without permanent damage (increases risk of heart attacks)
Symptoms: squeezing pain or heaviness in the chest, neck, jaw, arms, shoulders, back (stomach area for elderly after meals), (women may experiencing burning or tenderness instead of pain)
Causes: narrowing of 1 or more coronary arteries in the heart due to fixed obstruction by cholesterol plaques or vascular spasms. Can also be caused by anaemia.
Acute Myocardial Infarction
AMI - heart muscle cells are permanently damaged due to obstruction of coronary artery
Stable vs Unstable angina
Stable angina - caused by a fixed obstruction (plaque), predictable, familiar pain patterns, prompted by physical exertion, emotional stress, cold temperatures, heavy meals, NOT at rest, generally subsides with rest, responds well to medications
Unstable angina - unpredictable even at rest, changed pain patterns, more severe, does not respond to rest or medication, often precedes a heart attack, ECG shows ST-segment depression during attacks, stress test is taken
Heart Failure - early vs late treatment
EARLY:
Exercise
Dietary changes (reducing sodium intake)
Medications e.g., Ace-inhibitors (perindopril, ramipril), Beta-blockers (MF metoprolol), Hydralazine and nitrates
LATE:
Diuretics (frusemide)
Calcium channel blockers
Digoxin
Ace-inhibitors and beta-blockers
Heart Failure - role of the nurse
Patient education: regarding the condition, the need for lifestyle modifications (exercise/dietary changes), signs and symptoms of heart failure, signs of an exacerbation, importance of medication adherence, when/where to seek medical attention
Emotional support: to patients and their families, help them manage their condition, navigate challenges that may arise, provide calm and reassuring source of advice and support
Medication administration and support: adhere to regimes, monitor for side effects
Care coordination: multidisciplinary team, advocate for patient
Assessment and monitoring: vital signs, fluid status (strict FBC for input/output/daily weights), symptoms, venepuncture (to test for changes in kidney function, electrolyte imbalance), ECG, review chest x-ray, pitting oedema, bloods to monitor potassium (if on diuretics)
