Flashcards in Hypotension & PAD Deck (80)
What is the equation for pulse pressure?
- Systole - Diastole
-ex: PP= 120-80 = 40
What is an abnormal pulse pressure? What does it indicate?
Greater than 50-60mmHg
- this is known as Wide Pulse Pressure
- often indicates Isolate Systolic Hypertension (most common in elderly)
What are the numbers for hypotension in adults?
BP less than 90/60
What are symptoms of hypotension?
- lightheadedness (pre-syncope)
- fainting (syncope)
- blurry vision
- possibly confusion
What are 3 possible causes of hypotension?
- dehydration (especially elderly)
- standing for long periods
Severe hypotension &/or shock can be indicative of what?
Multisystem organ hypoperfusion
What could cause severe hypotension/shock?
- Sudden loss of large amount of blood
- Allergic reaction (severe)
- Myocardial infarction
Explain Orthostatic Hypotension.
greater than a 20 mmHg fall in SBP and/or 10mmHg DBP within 3 mins of going from supine to upright position
aka- postural hypotension
(most common in elderly)
= an abnormal finding
** some authors include an elevation in pulse rate as part of the criteria
What are some possible causes of orthostatic hypotension?
- prolonged bed rest
- autonomic nervous system dysfunction (decreased baroreceptor sensitivity)
- cardiovascular disorders
What is normal HR? bradycardia? tachycardia?
Bradycardia= less than 60
Tachycardia= greater than 100
What is the regular rhythm of pulse called?
What does a normal pulse imply of the heart?
normal pacemaker function of the SA node (no variation from beat to beat- evenly spaced)
What is arrhythmia? How is it elevated?
Irregular pulse (beats are uneven)
EKG test will support finding
What are the 2 types of arrhythmias and what are their subtypes?
(has a definitive pattern)
- physiologic sinus arrhythmia
- bigeminal pulse
- trigeminal pulse
Irregularly- irregular (no pattern)
- atrial fibrillation
Explain physiological sinus arrhythmias.
- typical for younger fit individuals
- corresponds to breathing
- asymptomatic pulse abnormalities are usually benign
Explain bigeminal pulse.
coupled rhythm of beats in pairs
- first beat= sinus beat
- second= premature, usually ventricular beat
Explain trigeminal pulse.
coupled rhythm of beats in triplets followed bya pause
- often benign in young, healthy people
- may indicate conduction problem in elderly patients with heart disease
Combination of ______ and ______ is suggestive of a pathological arrhytmia
Palpitations & pre-syncope
If you discover that your patient has an irregularly-irregular heart beat what is your next step?
suggests atrial fibrillation
- rapid, unsynchronized contraction of heart muscle fibers
** find out if they know they have a-fib first
- requires urgent EKG evaluation if patient did not previously have known a-fib
Explain atrial fibrillation
Can lead to stroke or death
- increased risk of blood clot formation when unsynchronized atria
- it if travels to brain (embolus) = stroke
** afib causes 15% of strokes
What are the 3 types of a-fib?
Lone episode- young & healthy patients. may be due to stress, alcohol, or stimulant
Paroxysmal= a sudden attack- intermittent episodes that last minutes to hours
Chronic, sustained - requires long term anti-coagulant and rate control medication
Match the medical terms for the listed grading pulse amplitudes:
- 0 (not palpable)
- 1 (barely palpable)
- 3 (full or increased)
What is peripheral arterial disease and what does it indicate?
- stenosis, occlusion, or aneurysm in the limb arteries or aorta
- indicates high risk for cardiovascular morbidity or mortality
- with PAD= 6x increased risk of heart attack
Is PAD the leading cause of artherosclerosis?
- usually occlusions in the large & medium sized vessels
How does atherosclerosis start and progress?
as a fatty streak= LDL deposition in walls
- progresses with chronic inflammation
What are the modifiable risks of PAD?
Smoking & diabetes
- also includes hypertension & hyperlipidemia
What is the Non-Modifiable risk of PAD?
age over 60
(sometimes also includes being African-American)
What is the pathophysiology of PAD?
plaque build-up leads to narrowed arteries= decreased blood supply= poor oxygen delivery= ischemia (painful)
- especially when exercising (due to tissue demand)
PAD= oxygen supply & demand mismatch
What is the symptom of PAD?
Main symptom= INTERMITTENT CLAUDICATION = exercise induced extremity pain (due to ischemia)
most common location= calf