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89 Cards in this Set
- Front
- Back
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What occurs in the heart valves as aging occurs?
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calcification, especially in mitral and aortic
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What occurs in the conduction system with aging?
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pacemaker cells decrease in number, conduction time increases, fibrous tissue and fat in the SA node increases
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What occurs in the baroreceptors with age?
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become less sensitive
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What occurs in the left ventricle with age?
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size increases, becomes stiff and less compliant, decreased speed of early diastolic filling by 50%
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What occurs in large arteries/ aorta with aging?
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thickens and becomes stiffer, less compliant, systeolic BP increases to compensate, systemic vascular resistance increases to cause left ventricular hypertrophy
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What is CHD
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affects the arteries that provide blood, o2 and nutrients to the myocardium
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What are 3 basic processes of atherosclerosis?
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overgrowth of intimal smooth muscle cells with accumulation of macrophages and T cells, formulation of connective tissue matrics in the vessel intima, accumulation of lipids (especially cholesterol) in teh connective tissue
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What are the stages of atherosclerosis?
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fatty streatk, fibrous plaque, and a complicated lesion
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Fatty streak
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an accumulation in the arterial intima of an artery (foam cells and intercellular lipids)
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Fibrous plaque
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Proliferative lesion in which a fibrous cap covers a lipid core
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Complicated lesion
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can manifest by calcification, hemorrahage, ulceration (rupture) thrombosis
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2 branches of the Left coronary artery
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left anterior descending and circumflex
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What is the electrophysiology function of the coronary function
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automaticity, excitability, conductivity, refractoriness
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What is the conduction function of the coronary function
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SA node, AV node, Bundle of His, Purkinje fibers
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Diastole
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2/3 of the cardiac cycle; relaxing and filling of the atria and ventricles
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Systole
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the contraction and emptying of the atria and ventricles
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CO
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HR X SV
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What is the amount of CO
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4-7 liters/minute
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What is cardiac index
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CO divided body surface area
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What are some mechanical properties of the heart
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CO, CI, HR, SV, preload, afterload, contractility
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When do women usually develop heart disease
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later in life
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What are some modifiable risk factors for heart disease
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smoking, physical inactivity, type A personality, obesity, diabetes, hypertension, hyperlipidemia
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What are some things to assess (health problems) to help identify heart disease
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chest pain, dyspnea, fatigue, palpitations, syncope, weight gain, extreme pain
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What is one of the first complains of heart disease?
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fatigue
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What are some physical assessments done to help determine heart disease
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general appearance (usually pale), integumentary system (skin color, temperature), extremities (long term) clubbing, edema, capillary filling
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What may a person's skin with heart disease look like?
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gray, cool, clammy, diaphoretic
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What is the desirable total cholesterol level?
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less than 200
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Borderline High cholesterol level
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200-239
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High cholesterol level
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above 240
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What is the low HDL leve
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below 40
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High HDL level
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above or equal to 60
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How can you increase good cholesterol (HDL)
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extercise, lose weight, consume SOME alcohol
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What is optimal LDL cholesterol level
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less than 100
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What is near optimal/above optimal LDL cholesterol level
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100-129
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Borderline high LDL cholesterol level
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130-159
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High LDL level
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160-189
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Very high LDL level
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above or equal to 190
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What is the LDL goal in people with CHD risk level
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less than 100
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What is the LDL goall in people with 2+ risk levels?
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less than 130
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What is the LDL goal in people with zero to one risk facter
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less than 160
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What are some interventions for elevated cholesterol levels?
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diet modification, smoking cessation, complimentary therapies, drug therapy, gene therapy
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What is the number one intervention for high cholesterol?
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diet modification
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What is the step one diet?
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less than 30% fat
less than 10% sat. fat less than 10% poly unsat. fat 10-15% monounsaturated fat less than 300 mg of cholesterol a day |
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When do you use step 2 diet?
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when step one not working
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Step Two Diet
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limited sat fats to less than 7% of total fat and limit cholesterol to less than 200 mg/day
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What are 3 types of medications you can use for after diet modification for high cholesterol?
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statins, bile acid binding resins, nicotinic acid
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HOw long are statins taken and why?
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lifelong; because if you take off, cholesterol will bounce back
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What do statins do?
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limit cholesterol production
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What is an extreme occurence with statins
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rhabdomyolisis
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What do statins do percentage wise?
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reduce LDL 18-55% and TG 7-30% and raise HDL 5-15%
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What are major side effects of statins?
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myopathy, increased liver enzymes
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What are contraindications for statins?
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never use with liver disease! or with erythromycin or cyclosporins
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What are the therapeutic benefits of statins?
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reduced major coronary events, reduced CHD mortality, reduced coronary procedures, reduced stroke, reduced total mortality
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When do you take statins
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at bedtime
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What should you avoid with statins?
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prolonged exposure to UV light
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What needs to be monitored with statins?
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CPK levels (creatinine phosphokinase)
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What will be a sign that statins are causing muscle breakdown
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muscle pain and dark tea colored urine
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When should you reevaluate statins
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montly
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How are BABR's used?
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as an adjunt to statins to lower LDLs
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How do BABRs work?
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bind bile acid in the body
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What are 2 BABRs?
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Questran, Cholestid
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What are the major actions of BABRs?
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Reduce LDL, Raise HDL, and may increase TG
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What are some side effects of bile acid binding resins?
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GI distress/ constipation, decreased absorption of other drugs
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When is BABRs contraindicated?
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if raised TG especially if over 400
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What is important with BABRs?
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timing: give one hour before or 4 hr after other meds
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What are some drug interactions with BABRs?
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anticoagulants and fat soluble vitamins
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What are the major benefits of BABRs
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reduce major coronary events, reduce CHD mortality
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What are some parts of client teaching for BABRs
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Take at mealtime, mix powder with fluids, monitor cholesterol and triglyceride levels frequently, increase fluid and fiber, take a stool softener
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What are the major actiosn of nicotinic acid?
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lower LDL, lower TG, raises HDL
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What are some side effects of nicotinic acid?
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flushing, hyperglycemia, hyperuricemia, upper GI distress, hepatotoxicity
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What are some contraindications with nicotinic acid?
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liver disease, severe gout, peptic ulcer
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What is a concern for taking nicotinic acid?
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DIABETES due to hyperglycemia as a s/e
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What do you do when dosing nicotinic acid?
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start with lower dose (like 500) and then go up to 1,000
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What is some teaching to do with nicotinic acid?
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do not take with hot beverages, take with food and/or with aspirin, give 1 hr before or 4-6 hours after BABRs, monitor lipid levels, monitor liver functions, monitor CBC and PT levels, monitor diabetic patients, report visual disturbances, report muscle pain/weakness
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What are examples of fibric acids?
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gemfibrozil, fenofibrate, clofibrate
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What are the actions of fibric acids?
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lower LDL (with normal TG), may raise LDL (with high TG), lower TG, raise HDL
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What are the side effects of fibric acids?
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dyspepsia, gallstones, myopathy
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What are contraindications for fibric acids?
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severe hepatic or renal disease
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What are some tests for CHD/ cholesterol levels?
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EKG, Stress test
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What are the types of stress test
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traditional, thallium, persantine
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What is persantine stress test?
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heart gets exercise without treadmill "chemical exercise"
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Why do we use thallium with a stress test?
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accuracy
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What should you tell a person about a stress test
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wear proper attire, comfortable walking shoes, start low and slow, don't have to go the whole time, eat a light meal, stay away from alcohol, smoking, or caffeine!
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What are 2 types of EKG
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resting, ambulatory
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What is stress test used for?
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to evaluate CV response to exercise
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What are some parts of stress testing prep?
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consent, plenty of rest the night before, light meal 2 hours prior, avoid alcohol, caffiene, nicotine the day of the test, proper attire, instruct practitioner if develope SOB, chest pain, or dizziness, resting EKG prior to exercise
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Why do you do a resting EKG before exercise?
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to see any differences
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What is a stress test procedure
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starts from less and then advances
BP and HR are monitored at different points in the test |
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How long does the client continue a stress test?
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until predetermined HR is reached and maintained, pt. experiences chest pain, fatigue, extreme dyspnea, vertigo, hypotension, and ventricular arrhythmias, or until signiificant ST seg depression occurs
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