Cardiopulm: Htn/cad

Front 1

What is HTN?

Back 1

>140/90 for sustained period of time
Can be diag with high systolic, diastolic, or both

Front 2

Pre-HTN

Back 2

120-139/80-89

Front 3

Stage 1 HTN

Back 3

140-159/90-99

Front 4

Stage 2 HTN

Back 4

160 and above/110 and above

Front 5

Two types of HTN classification

Back 5

1. Primary or essential HTN = 90%= unknown cause
2. Secondary HTN = treat the cause = meds, prego, endocrine issues = 10%

Front 6

Risk factors for development of HTN

Back 6

Diet, obesity, sodium, smoking, genetics, race, DM, stress, alcohol, age

Front 7

Complications caused by uncontrolled HTN

Back 7

Heart (CAD, CHF, aneurysm)
Renal failure
Liver pathology
Retinopathy
CVA
PVD
Skin issue

Front 8

2 models of HTN

Back 8

Volume model - inc fluid - inc BP
Neurogenic model - inc stress or sensitivity to stress = inc SNS. Circulating catecholamines (NT and hormones) cause other changes in inc CO, inc SVR

Front 9

BP =.......

Back 9

CO * SVR

Front 10

Potential causes of essential HTN

Back 10

Family hx
Glucose intolerance
Environmental facors (stress, diet, lack of ex)
Socioeconomic status

Front 11

Secondary apatations... hemodyamic changes that occur as HTN develops and worsens

Back 11

Medial hypertrophy
L ventricular hypertrophy
Dec baroreceptor sensitiivtyand new set point

Front 12

Medial hypertrophy

Back 12

Occurs with inc in SNS activity which causes a prolong elevaion of ANG II and inc in catecholamines leading to hypertrophy of the heart and vasculature

Front 13

Explain early (stage 1), established (stage 2), and advanced (stage 3) BP, CO, and TPR changes

Back 13

STAGE 1: Inc BP and CO, but TPR unchanged
STAGE 2: Inc BP, SVR, but normal CO b/c heart is starting to adapt as secondary adaptations begin
STAGE 3: Inc BP, SVR, but dec CO b/c not able to circulate enough blood at this point

Front 14

Exercise guidelines for HTN

Back 14

SBP > 200 or DPB > 110, get doc permission first
Stop ex if SBP > 250 or DBP > 115
Avoid valsalva, isometric, or high resistance ex (holding breath = valsalva)

Front 15

Stage 1 (early onset) response to acute exercise

Back 15

No change in exercise ability

Front 16

Stage 2 (established) response to acute ex

Back 16

Exagerrated HR response and SVR (BP)

Front 17

Stage 3 (advanced) response to acute ex

Back 17

Dec ex tolerance
Unable to achieve adequate CO level

Front 18

Can ex prevent HTN?
Can it treat HTN?

Back 18

There is a relationship between activity and lower BP
Slight dec in BP chronically (5 mmHg)

Front 19

Reasons for a person with HTN to ex

Back 19

Improved vascular fxt (inc responsiveness of vasculature to dilate/constrict and changes in walls themselves)
Post-ex hypotension (2-22 hrs after so pt must ex regularly)
Dec in exercising BP - so pt can exercise longer
Improved myocardial fxt
Dec SNS activity, changes in RAAS system

Front 20

General ex prescription for HTN

Back 20

3-5 days/week at moderate intensity (40-60% VO2 residual) for 30 minutes continuous or accumulated
Endurance supplemented with resistance ex

Front 21

Who is the RPE scale very helpful for?

Back 21

Pl where HR does not inc much
Change in SNS due to dx
Pacemakers

Front 22

What happens with BS to heart with ex?

Back 22

Inc HR = less time in ventricular diastole and less time for heart to be nourished

Front 23

Drugs for HTN

Back 23

Diuretics
Beta blockers
Vasodilators
RAAS blockers (ANG II and ACE)
Ca channel blockers

Front 24

What is atherosclerosis and what is it associated with?

Back 24

Abnormal depositing of lipids/hardening of the artery with plaque formation
Associated with vascular inflammation and thickening of teh vascular wall which causes a narrowing of the internal radius

Front 25

What are early changes with atherosclerosis associated with?

Back 25

Endothelial cells become dysfxt, which produce NO
NO causes vasodilation, is anti-inflammatory and anti-thrombotic
Without NO = vasoconstriction, platelet aggregation, infalammation, leading to vascular hypertrophy and stenosis

Front 26

Risk factors for CAD

Back 26

Family hx of CV disease
Lipid abnormalities (LDL, TGs, low HDL)
smoking
Lack of ex
High fat diet
Obesity
uncontrolled DM
Chronic stress and depressio

Front 27

s/s of CAD?

Back 27

Angina - pain, pressure, heaviness in chest, sometimes felt up toward the shoulder
SOB after periods of stress

Front 28

s/s of heart attacks in females?

Back 28

N/v
Indigestion, SOB
Anxiety and unusual fatigue
Abnormal pain
Silent heart attacks more common in women

Front 29

Diagnostic tests for CAD

Back 29

ECG/EKG
Chest x-ray
Lab tests (MI) = inc troponin tells ichemia and infarct b/c serum levels elevated for 3-12 hours
Creatine phosphokinase marker for MI 24-48 hrs post MI
High hematocrit could inc blood viscosity which would inc the work of the heart

Front 30

Balloon angioplasty

Back 30

Small balloon to push plaque back against artery wall
Stend holds artery open

Front 31

CABG

Back 31

Coronary artery bypass graft
Bypassed with a vein from the leg or internal mammary artery

Front 32

Drugs for heart problems

Back 32

Beta blockers to dec workload
Nitrates
Ca channel blockers to vasodilate
Statins to dec cholesterol
Aspirin b/c lack of antithrombotic activity (NO issue)

Front 33

Prevention of heart disease

Back 33

Health diet and ex
Improve chol level
Control DM and HTN
Quit smoking and doing drugs