Risk factors for CAD - Modifiable: - - Smoking -? - - Blood pressure? - - Cholesterol? Non-modifiable - what are the three?

smoking 1+ packs a day BP - >160 cholesterol - >240 non-modifiable - family Hx of heart disease - Age - Gender (men > women til age 60)

CV - things in red Flashcards by Daniel Picard

Conduction system: the ____ node is the _________ of the heart, which conducts to the ____ node, through the bundle of his, to the lt and rt bundles branches, diffuses through the ventricle walls via the Purkinje fibers; takes all of _____.

SA - sinoatrial - pacemaker
AV - atrioventricular node
0.12 seconds

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HTN:
- systolic BP ?
- DBP?
How many measurements?

systolic 140 or higher
diastolic 90 or higher
either or for HTN
Need more than one measurement

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Dietary HTN management?

DASH - dietary approaches to stop HTN - low fat dairy and lots of fruits and veggies - recommended to combine with low sodium too

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Effects of aging on the heart:

Amount of _____ in the heart increases and the amount of ______ decreases
Decreased ______ and heart rate
cardiac valves become _____ and _____ due to _____ accumulation, valve incompetence or stenosis = _____
number of pacemaker cells in the ___ node decreases causing?
decreased ________ NS control of CV system
Arterial blood vessels thicken and become less elastic causing an increase in _____.

collagen ↑; elastin ↓
contractility ↓
thicker, stiffer - lipid accumulation
valve incompetence and stenosis = murmur
SA pacemakers ↓ –> bradycardia, heart block
↓sympathetic input
↑BP - arterial walls thicken and become less elastic

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Congenital heart defects:

Survival rate - ___% of infants born with complex heart defects reached adulthood

90%

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Pericarditis - Dx

- Symptoms - most important one?

Pain decreases when patient leans forward

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Women and CAD:

Heart disease kills more Canadian women than all forms of _____ combined
It is the #__ cause of death in women over ___
_____ deaths in women than men
Women manifest CAD __ years later than men due to the cardioprotective effects of natural ______, which are lost after ______
higher mortality and complications with CABG surgery, because they have ______ arteries, are ______, and are referred ______
These three things are powerful predictors of CAD in wome

cancer
1, >55
more
10, estrogen, menopause
smaller, older, later
diabetes, smoking, decreased estrogen levels

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Risk factors for CAD

Modifiable:
- Smoking -?
- Blood pressure?
- Cholesterol?

Non-modifiable
- what are the three?

smoking 1+ packs a day
BP - >160
cholesterol - >240

non-modifiable

family Hx of heart disease
Age
Gender (men > women til age 60)

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Angina pectoris

Stable angina - no permanent damage is done to the heart muscle. Predictable and typically relieved with ______

rest

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Medications for angina pectoris:

Anticoagulants/Antiplatelet - prevent platelet aggregation - benefit is what?

Improves blood flow

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Acute coronary syndrome (MI)

- Severe, _______ chest pain not relieved by rest or nitrates

immobilizing

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MI Assessment

GI - ?
Integument?
Neuro?
Psychological

GI - will VOMIT and be NAUSEOUS - if there is food, they will vomit

Integumentary - pale, cool, clammy, DIAPHORETIC - sweating buckets

Neuro - ANXIOUS

Psychogolical - FEELING OF IMPENDING DOOM

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Diagnostic studies - non-invasive
- Albumin cobalt - binding test
Blood studies (name):
- cardiospecific enzyme >3-5% indicates MI
- Contractile proteins released following MI
- cholsterol, TGs, lipoproteins

Cobalt binds to damaged tissue and confirms location of infarct

CK-MB
Troponin T and I (i)
Serum lipids

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MI treatment acronym?

MONA
M - morphine for pain
O - oxygen per nasal cannula 2-4L/min
N - nitrates
A - aspirin

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MI treatment - real important one?

Cardiac catheterization

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What is required after cardiac catheterization?

Pressure dressing

Bed rest post-procedure

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What effect on a client and their family’s QOL would symptoms of CHF have?

Very high level of stress for the patient and family

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Interprofessional treatment for CHF:

Acute:
-Drugs - number one drug for heart failure patients?

Chronic:
- Diet??

Digitalis - Digoxin

Sodium restricted diet

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A cardiac glycoside, slows and strengthens the heart

Digoxin

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When is digoxin held?

If pulse < 50

What are signs and symptoms of digitalis toxicity?

Bradycardia/tachycardia, pulse deficit, dysrhythmias

NV, diarrhea and abdominal pain

What is a cardinal sign of pulmonary edema?

Pink, frothy sputum

Life-threatening arrythmia, Dx when there is a run of 3 or more PVCs. Decreased CO and can carry on the this.

Vtac –> Vfib

Treatment of VTAC?

Drug therapy (e.g. IV lidocaine), CARDIOVERSION

VFIb treatment?

CARDIOVERSION, CPR, drug therapy (IV epi)

Describe whether left or right sided heart failure: A: - SOBOE - Orthopnea - Dry congested cough - Bibasilar crackles - Oligouria B: - JVD - Edema (dependent) - Hepatomegaly - Ascites - Anorexia

A - left | B - right

A client with heart failure is concerned about decreased urinary output. What would you tell the client regarding the cause of their decreased output? A - You are dying so your body is shutting down. B - Your chest pain caused a negative feedback loop to your bladder to tell it to stop producing urine. C - Decreased cardiac output which results in decreased urinary output. D - I’m sure if you tried hard enough you could have a better urine output.

Frothy blood-tinged sputum would indicate which of the following? A - Spinal cord trauma B - Fat embolism C - Right sided heart failure D - Left sided heart failure

D - specifically pulmonary edema

Progressive narrowing and degeneration of the arteries of neck, abdomen or extremities.

PAD

What is the major cause of PAD?

Atherosclerosis

PAD: - __ years of age or older; earlier age with ____ - Clinical manifestations occur when there is between __-___% vessel occlusion

50+; DM | 60-75%

Risk factors for PAD: - Non-modifiable? - Modifiable?

non-mod - age, gender, genetics Modifiable - smoking (nicotine), HTN, diet, obesity, sedentary lifestyle, stress, DM

Arterial leg ulcer characteristics: - Painful - _______ _______ - ABPI?

intermittent claudication | ABPI < 0.8 - if <0.4 - critical ischemia

How is ABPI calculated?

Ankle systolic / greatest systolic pressure in arm

Aneurysms: - Outpouchings or _____ of the blood vessel wall - ______ most common vessel - usually caused by ______ and ______ - AAA major risk factors are ____, age over ___, and _____ use - classified as _____ or ______ - Sign - pulsating swelling that produces a blowing ____ on auscultation (______)

``` dilations aorta HTN, atherosclerosis males, 65+, tobacco true, false murmur (bruit) ```

Where is an AAA located? | What is the treatment?

Location: below the kidneys, above femoral artery bifurcation Surgeon puts pt on heart-lung machine and completes a bifurcation graft

Buerger's disease: - Rare, non-atherosclerotic, segmental ________ disorder - Cause?

inflammatory | TOBACCO SMOKE

Episodic vasospastic disorder of small cutaneous arteries.

Raynaud's phenomenon

Raynaud;s phenomenon - cause? - Primarily affects this demographic - Association with ______ diseases (e.g. RA, SLE) - Colour change of fingers and toes, ears, nose to this - Attacks brought on by _____ or ______ stimuli

``` cause unknown women 15-40 yrs collagen white, blue, red cold, emotional ```

What is the treatment for Raynaud's phenomenon?

Loose, WARM clothing, no nicotine, caffeine or vasoconstrictive drugs Calcium channel blockers

What is the recipe for disaster for developing DVT called?

Virchow's triad: - Venous stasis - Damaged endothelium of vein - Hypercoagulability of blood

DVT: | - Women at greater risk due to this?

If on estrogen, smoke and over 35 y.o.

Describe varicose veins

Valves become dysfunctional in the perforating vein - get backflow and tortuous, extended veins

Venous insufficiency pathology: - _________ which blocks outflow. DVT - _______ incompetence, permitting retrograde backflow - _______ muscle pump failure, which results in incomplete emptying

obstruction valvulvar calf

Differentiate venous vs. arterial ulcers:

Arterial: - painful, mostly toes and malleolus - skin shiny, taut, lack of hair - cold - ABPI < 0.8 - punched out Venous: - normal ABPI - often painless - large, irregular shape, often in gaiter area (above ankle, below knee) - inverted champagne bottle (lipodermatosclerosis) - buckets of exudate

Most important thing for management of venous ulcers?

COMPRESSION - cornerstone of prevention - NEVER use without doing ABPI first

Compression bandaging precautions | - always document this?

PATIENT TEACHING PROVIDED TO PT AND FAMILY

Support/Compression stockings: - For ________ - ordered once ______ is controlled - mild to high compression - prescribed by? - replaced at this frequency - removed at _____ and reapplied in the _____

``` prevention edema MD, NP, ET, WCS q3-6 months bedtime, morning ```