Cardiovascular diseases Flashcards
(27 cards)
What are the cardiovascular diseases?
- Congestive heart failure
- Pulmonary oedema
- Pulmonary embolism
- Peripheral vascular disease`
What is CHF
A syndrome characterised by impairment in the heart’s pump function
M > F, leading cause of cardiac death in North America, Most frequent cardiac Dx for hospital admissions
What are the types of CHF
Left-sided heart failure, Right-sided heart failure, Biventricular heart failure
What CHF type causes pulmonary oedema?
Left-sided heart failure (L ventricle can’t pump blood out, blood backs up into L atrium and pulmonary vein and eventually into the lungs
What happens with R-sided heart failure? (Cor-pulmonarie)
Backup of fluid from the R atrium into the venous system and excessive fluid in the veins (peripheral/pitting oedema and jugular distention)
For biventricular heart failure, which ventricle backs up first and which backup second?
L ventricle backs up first, R ventricle backs up afterwards
CVD risk factors
Cardiac muscle dysfunction, cardiac dysrhythmias, cardiomyopathies, long-term CAD, hypertension, valve abnormalities, pericardial pathology
L-sided HF signs and symptoms
Pulmonary oedema, Paroxysmal noctural dyspnea, orthopnea (don’t lie them flat on back), dyspnea, fatigue, weakness
R-sided HF signs and symptoms
Peripheral/pitting oedema, jugular vein distention, fluid weight gain, ascites, weakness, dyspnea, fatigue, weakness
What sleeping or resting position should someone with L-sided heart failure be in
Don’t put into supine, slightly head-elevated position (reduce fluid surface area at alveoli)
CHF interventions
Positioning to reduce orthopnea (slight incline resting/30degrees)
Relaxed breathing exercises (diaphragmatic breathing)
Supplemental O2
Graded increased ambulation
Graded exercise
Cardiac rehab program
What is pulmonary oedema?
An abnormal amount of fluid inside the lungs (fluid moves from pulmonary capillaries -> interstitial space -> alveolar space)
Pulmonary oedema pathophysiology and aetiology
Increased capillary membrane permeability
Increase hydrostatic pressure
Decreased capillary osmotic pressure
Lymphatic insufficiency
What are the 2 types of pulmonary oedema?
- Cardiogenic pulmonary oedema (high pressure/increased hydrostatic pressure = backflow of blood in system due to kidney, heart muscle, or valve damage)
- LHF - Non-cardiogenic pulmonary oedema (low pressure/increased permeability = increased permeability of pulmonary capillaries)
- ARDs
Are secretion clearance techniques useful for pulmonary oedema?
No, because it is fluid and not secretions. Better managed with medication (diuretics)
Pulmonary Oedema clinical presentation
- Inspection: increased WOB, cyanosis, ORTHOPNEA, cough with PINK FROTHY SPUTUM (cardiogenic), SWELLING IN LOWER EXTREMITIES if severe, dyspnea
- Palpation: increased tactile fremitus
- Percussion: dull
- Auscultation: decreased BS, fine inspiratory crackles
- ABGs decreased O2
- CXR: cardiomegaly, enlarged pulmonary vessels
Pulmonary embolism
A blood clot that has been lodged in a pulmonary artery, commonly associated with DVT in the lower extremities (life-threatening)
Pulmonary embolism pathophysiology
- PE obstructs blood flow to an area of the lung
- If blood flow to the lung is completely blocked, it can lead to infarction and necrosis of lung tissue
- Very large embolism can lead to increased pulmonary artery resistance -> increase workload of right ventricle -> RHF
Pulmonary embolism risk factors
IMMOBILISATION (i.e post op)
Secondary things that increase coagulation (ie. oral contraceptives, cancer, polycythemia)
Other: CHF, Hx of DVT, obesity, pregnancy, stroke, trauma, varicose veins
Clinical presentation of pulmonary embolism
- Inspection: acute onset of dyspnea, increased RR, CHEST PAIN, may have cough with BLOODY SPUTUM (hemoptysis)
- ABGs: decreased O2, decreased CO2, increased pH
- CXR: infarcted area of lung appears white (rare)
Dx using CT scan or V/Q scan
Interventions for pulmonary embolism
- Prophylactic post op: anti-coagulant medication (not in PT scope), bed exercises, early mobilisation, compression stockings (preventative)
- If PE or DVT is suspected or confirmed
- Discontinue exercise and mobilisation until further notice
- notify the nurse or surgeon
- document
- anti-coagulant medication
- Thrombolytic medication
What is peripheral vascular disease?
Disorders of the blood vessels of the body (arteries and veins)
Primarily due to atherosclerosis
Significant narrowing of vessels must occur before there is enough occlusion of blood flow to produce symptoms
Signs and symptoms peripheral vascular disease?
Leg pain (intermittent claudication), coldness in affected leg, decreased pulses in lower leg, decreased mobility and function of limb due to pain, possible numbness, possible pain and paleness of leg with elevation (Buerger’s test), decreased hair growth, skin breakdown, ulceration, gangrene
What does intermittent claudication mean?
Pain or cramping in the leg or buttock area (especially calves) as a result of poor circulation.
Increased pain with activity from increased energy demands on the muscle, which has poor circulation
Decreased pain at rest
Must differentiate between intermittent claudication and neurogenic claudication
