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126 Cards in this Set
- Front
- Back
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Risk factors for arteriosclerosis
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*Aging
*Smoking *diabetes *Hypertension *dyslipidemia *Estrogen withdrawal (prememopausal women 6x less likely to get artscler.) *Homocysteine *Infection/inflammation *sedentary lifestyle **** what happens- (endothelial dysfx - vasoconstriction, platelet adhesion, proliferation of cells around that) |
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Alcohol in general
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Decrease platelet aggregation
(those don't drink at all or drink too much have most cardiovascular issues) *women w/ personal hx of breast cancer should not be drinking (w family hx - unclear) ***Chlamydia pneumoniae (not trichomatus) - bacterium found in all plaques 85% can find this (doc was laughed at) Cause or effect of plaque |
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C reactive protein
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Crp levels high = damage to vessel walls
Same with dyslipidemia |
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Risk factors for metabolic syndrome
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Metabolic syndrome - profile that leads toward cardiovascular disease
*atherogenic dyslipidemia *elevated blood pressure *elevated blood glucose *prothrombotic state (cytokines + sticky platelets) *pro inflammatory state *abdominal obesity - fat around organs |
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Personality type and arteriosclerosis
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Type A ppl have more HT disease
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Sx with arteriosclerosis
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None until blood flow impeded and tissue is dying
Triglyceride levels - below or = 150 total cholesterol - below or = 200 adl - greater than = 40 LDL - less than / = smaller and denses the molecule of ldl the more risk u have (apolipoproteins - prt of LDL A1 -96-176. B - 43-128 Want more a1 + less b Crp want less than 1 - but less than 3 ok highly sensitive, cardiac crp (measure inflammation) Homocysteine shold be less than 3 Thrombocytes - 140- 440 thousand |
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Statins
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Block formation of cholesterol in liver
(LDL - becomes atherogenic when exposed to air and light) cholesterol left out at night |
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Magnesium
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+ most imp nutrient of ht
\\\smooth muscle dilation Too much can also cause arrhythmia |
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Niacin is
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Hepatotoxic
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Chromium
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Regulating blood glucose levels also raises hdl levels
1mg a day |
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If on statins or red yeast rice
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Take coq10 at same time
Because if blocking cholesterol synthesis then blocking coq10 |
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If Chinese herbal formulas are impacting blood pressure
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Think licorice - gan cao
Has pseudoaldosterone effect |
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H.a + hypertension - think...
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Stroke potential (hypertension most imp risk factor for stroke)
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Nosebleeds in elderly
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Hypertension
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Normal blood pressure
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120/80
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For hypertensives most common cause of death
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Coronary artery disease
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For hypertension sodium/day
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150mg a day
Sodium causes block in blood pressure |
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Potassium
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Mushrooms, avocados, drk leafy greens, potato skins, cantelope, dried fruit
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Low vit D levels effect ---
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Hypertension
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Hctz
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Hydrochlorothyrozide (joe says use dandelion leaf)
Diuretic--- hctz can cause gout in sm ppl |
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Ace inhibitors - b careful of...
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Causes potassium retention in kds (extra potassium may cause an arrhythmia)
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Women HT attack looks like
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Mid to upper back pain + fatigue
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If angina changes
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Very back sign - could have MI within 3 mo (1/3)
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Nitroglycerin
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Powerful vasodilator
(not specific to HT so can cause h.a. Etc) |
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2 greatest risks / coronary thrombosis can cause...
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Unstable angina
MI |
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Plaque formation d/t
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Injury to epithelium
If ruptures - frm more pressure/ inflammation ::: Occlusion as try to repair |
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Chelation therapy
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Takess minerals out of everywhere so become xu
But EDTA - chemical that removes congestion from plaque ---must check kd fx + continue to check *Folic acid (2.5mg) b6 (25 mg), b12 ( 500micrograms) can reverse arteriosclerosis 7grand----approx |
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Angioplasty / rotoreuter risks
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Rpture of vessel - already thin + damaged
Piece plaque break off (ESP. Risky with carotid artery) 30% recurring Stint is put in... |
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CABG
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Coranary artery bypass graft
*usu great saphenous vein removed, clamped - disconnect HT to lung machine * tiepieces around block) Other twists + turns Then may become blocked *Great decrease in mental acuity + memory Red blood vessels damaged as go thru HT Lu machine (damages oxygen carrying capacity) * want surgical team to have been working together longer - so they can do it faster |
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MI =
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Infarction + necrosis of tissue
Thrombus in vessels supplying myocardium 1.5 million MIs a yr Ventricular fibrillation - not contacting nicely to get blood out (blood cells pool in HT and back up) *2/3 of px experience sx 3 wks prior - usu. Angina "not feeling right" |
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Blood testing for MI
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Creatine kinase CK - will go up quite high (48 hrs)
LDH will slowly rise *look @ troponin (substance secreted from muscles when they die) elevated within minutes of having an MI (stay elevated for 10 days after MI) Troponin specific to cardiac muscle |
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Differential diagnosis for chest pain/ diff. Breathing/ potential MI
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Pneumonia, pulmonary embolism, esophageal spasm, gb disease, aortic dissection, renal stone, many gi disorders, hiatal hernia, chrst muscle tightness, Gerd, costal chondritis, - could be many many things
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HT disease # 1 bit factor
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Inflammation
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Px history for heart disease
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I. History
A. family 1. MI, high BP, AS B. tobacco, alcohol, recreational drug use C. physical activity D. stress E. increased BP F. Ht disease 1. rheumatic fever, Ht murmurs G. chest pain 1. OPQRST 2. pressure, squeezing a. clenched fist in center of sternum 3. worse with exertion, better with rest 4. radiation commonly to left jaw, neck, shoulder, arm H. chest pressure, tightness, heaviness I. dyspnea 1. orthopnea 2. paroxysmal nocturnal dyspnea (PND) 3. dry cough 4. leg edema J. palpitations 1. perception of Ht action K. rapid or irregular Ht beat L. lightheadedness, fainting, weakness, fatigue M. circulation 1. cold hands or feet 2. leg cramps 3. phlebitis 4. varicose veins N. past EKG |
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Pulmonary signs from CHF
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Left side of heart
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Systemic/LV Sx from CHF
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Right side of heart (hepatic artery from inf. Vena cava) + sup vena cava also filled up with fluid (swollen neck)
Exertional fatigue one of first signs/ cough could be early sign too /// pitting ankle edema later later sign ///usu sx of cold |
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Orthopnia
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Diff lying down at night -
Paroxysmal nocturnal dyspnea - wake up out of breath (differentiate GERD) |
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Sleep apnea can lead to... And can look like...
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Ht failure, hypertension, CHF
(ppl with HT failure will have tachycardia + Rales in basilar part of lungs) |
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CHF tests
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Always do ekg to rule out other things
Chest xray (more vascular markings) Echocardiogram - size of ventricle / ventricular wall, ejection fraction (65-70%) Bnp brain natriuretic protein HT fibers not contracting properly, the bnp goes up (to retain more water - bnp shld be less than 100) |
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With heart failure - avoid
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Salt and alcohol
Px must do some exercise even with exertional dyspnea |
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Diuretics + ace inhibitors
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*Take presure off, deal with water but doesnt address failing heart
*Ace inhibitors - cause retention of potassium (careful they dont take more) - *magnesium oritate - study 38% improvement (possibly most imp nutrient for HT) *potassium- fluid balance *coq10 - gingivitis, HT disease (found in High levels in myocardium) *fish oil - study 1 gram a day / mortality rate went down significantly *argenine - cause vasodilation *Seems those with HF have low vitD *thiamin - promote energy production by cells *Hawthorne- vasodilator *infra red sauna - good adjunct tx for pretty much everything |
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Cor pulmonale
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Right ventriular involvement secondary to lung disease COPD
(HT failur - starts on left side - backs up right side eventually) - exertional dyspnea (and syncope - fainting) |
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Cardiomyopathy
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Nt dt coronary artery d, valvular disorder, or genetic disorder
Arises in myocardium itself - looks a lot like HT failure, ventricles dilated Hypertrophic - genetic Restrictive - autoimmune conn Hemochromotosis - excess iron - significant - stored in tissues (ESP LV) eventually effects all tissues including HT - oxidative / damaging Cocaine - spasms of coronary arteries - |
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Pregnancy related cardiac myopathy
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Dilated type - looks just like HT failure (reflex in neck, dyspnea, pitting adema) most common
Hypertrophic type - genetic - thickening of ventricular wall (more murmers/ syncope) Restrictive - Arrythmias - hard to contract regularly (PSS) *mag, coq10, selenium (if ventricular problem 200 micrograms a day - careful tho - toxic) good for retroviral diseae (interferes with rna in these) toxicity- brittle nails, peeling nails, garlic breath * induced in animals thru copper xu |
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Arrythmias
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Abmnormality in contraction of HT
Palpitation - awareness of HT beat Cause not enough blood to tissues (feeling faint/ dizziness) Jugular vein - can see a rise frm the backup Main tx - tell them its benign and don't worry (once rule out worries :-) ectopic beats (other than sa node) - radiofrequency ablation Beta blockers -serious side fx Defibrillators / look @ food sensitivities (like with GERD could be stimulation of vagus nerve) |
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Valvular disease definition
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Mechanical lesion in one of the valves of the HT
*stenosis / chamber behind stenotic valve must wrk harder + hypertrophies *incompetence / chambers behind + in front of incompetent valve bear an extra load, extra volume of xue * mitral valve (50% of px) Rheumatic fever most common cause metal valve disease + all valve disease in general *Aortic valve disease second most common - 35% (left side of HT most susceptible) |
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Valvular disease sxs + sns
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*very long course - decades
*poss fatigue, dizziness, syncope, dyspnea *various murmers in various positions * (clot formation if blood in atrium for too long - if happens to be right atrium / pulmonary embolism - sudden severe dyspnea + Arrythmias) Hawthorne - peripheral dilation |
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Endocarditis
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Inflam of inner lining of HT
Microbial infection of endocardium Murmurs, petechiae Valves become incompetent or stenotic Abe - acute bacterial endocar Staph, streph, pneumococcus, Sbe - sub acute bact endocarditis Usu valve is already abnormal - now have bacteremia (in bloodstream) - bacteria lodges on abnormal valve - bactereremia asymptomatic Dental disease - bacteremia GI disorders - colonoscopy, digital rectal exam DRE will cause bacteremia |
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Endocarditis key sxs
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* petechiae over cardiac trunk
* painful erythmatous subcutaneous nodules at tips of finger * clubbing of fingers - oxygenation of tissues - suspect in anyone with fever + murmur ALWYS fatal if untreated |
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PulSe pressure
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Diff (systolic minus diastolic)
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Aortic aneurism
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Anurysm - "dilation" of any vessel
"local dilation of the aorta" Arteriosclerosis most common cause- also Hypertension, ciggies |
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Aortic aneurism sxs + sns
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Asymptomatic until compressing somethig else
1/4 in thorax - abdominal aorta 75% of aortic aneurisms are abdominal Deep boring steady visceral pain Very very severe low back pain |
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Thoracic aorta aneurism Presents with...
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Mid to upper back pain 25% of
Poss other sx depending on what aneurism is pressing / diff swallowing, breathing, hoarseness, Hypertension **** big risk factor ***abrupt excruciating ripping pain |
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When to have surgery with aneurism
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5cm wide or greater
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Peripheral arteriole disease
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All sx come from ischemia.... If at rest don't require as much - when exercising get sx
Intermittant claudication - Xu of blood supplying exercising muscles (post calf muscles - ache, hurt, cramp whenever they walk) |
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Peripheral arteriole disease pulses...
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Dorsalis pedis and Achilles pulse (post...) Decreased or absent pulses
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cardiovascular sys hx
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I. History
A. family 1. MI, high BP, AS B. tobacco, alcohol, recreational drug use C. physical activity D. stress E. increased BP F. Ht disease 1. rheumatic fever, Ht murmurs G. chest pain 1. OPQRST 2. pressure, squeezing a. clenched fist in center of sternum 3. worse with exertion, better with rest 4. radiation commonly to left jaw, neck, shoulder, arm H. chest pressure, tightness, heaviness I. dyspnea 1. orthopnea 2. paroxysmal nocturnal dyspnea (PND) 3. dry cough 4. leg edema J. palpitations 1. perception of Ht action K. rapid or irregular Ht beat L. lightheadedness, fainting, weakness, fatigue M. circulation 1. cold hands or feet 2. leg cramps 3. phlebitis 4. varicose veins N. past EKG |
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cardio physical exam: vital signs + peripheral pulses
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A. vital signs
1. BP: 120/80 a. CO - systole b. peripheral resistance - diastole c. elastic recoil of aorta and large arteries d. blood volume e. blood viscosity 2. HR:60–100 3. RR:12–20(9–16) 4. T B. peripheral pulses 1. rate, symmetry, bruits 2. radial, carotid, femoral, popliteal, posterior tibial, dorsalis pedis |
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cardio physical exam: auscultation
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1. possibly the most demanding skill
2. lungs first - congestion, rubs 3. orderly a. aortic, pulmonic, tricuspid, mitral b. reflection of heart sounds i.. ii.. iii. iv. aortic - R 2nd ICS close to sternum pulmonic - L 2nd ICS close to sternum tricuspid - L 5th ICS close to sternum mitral - L 5th ICS midclavicular line 4. 1st sound - S1 a. intensity, pitch, duration, timing, splitting 5. 2nd sound - S2 a. as above b. breathe through nose c. inspiratory splitting III. IV . 6. systole a. extra sounds, murmurs i. timing, intensity, pitch 7. diastole a. extra sounds, murmurs 8. for all murmurs, listen for the following characteristics a. duration b. timing i. early, mid, late c. location i. interspace ii. # cm from midline d. radiation e. intensity i. grades 1-6 f. pitch i. high, medium, low g. quality i. blowing, rumbling, harsh, musical 9. use diaphragm then bell |
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cardio physical exam: jugular venous pressure
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C. jugular venous pressure
1. competency and compliance of right Ht 2. patient at 45O 3. see venous column - waves - in internal jugular vein; behind SCM a. N just below clavicles 4. briefly elevated by pressure of hand on abdomen a. hepatojugular reflux 5. should return to N in a few seconds even with continued pressure on abdomen 6. if not - cardiomyopathy, Ht failure, right ventricular problem |
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cardio physical exam: inspection + palpation
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D. inspection
1. patient should lie for remainder of examination 2. tangential lighting to detect pulsations E. palpation 1. orderly a. aortic, pulmonic, tricuspid, mitral, epigastric 2. thrills a. loud murmurs b. vibrations - use ball of hand 3. pulsations a. pads of fingers b. apical - PMI i. 5th ICS midclavicular line c. epigastric i. aortic width |
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cardio labs
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A. lipids
1. triglycerides 2. cholesterol a. HDL, LDL,apolipoproteins 3. homocysteine 4. CRP B. cardiac enzymes 1. CK, LDH C. specialized testing depending on presumptive diagnosis |
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cardio imaging
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A. radiology
1. PA, lateral 2. size, shape, lung vasculature B. echocardiography 1. ultrasound 2. valvular disease 3. cardiac chambers 4. congenital Ht disease 5. coronary artery disease 6. cardiomyopathy 7. cardiac masses 8. pericardial effusion 9. aortic disease C. ultra-fast CT scan 1. coronary vessels D. MRI 1. vessels 2. masses 3. other structures with contrast agents, ECG |
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cardio special studies
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A. electrocardiogram
1. record of Ht electrical activity 2. no exam of a cardiac patient is complete without a chest x-ray and an ECG 3. standard 12 lead 4. exercise ECG (stress test, treadmill test) a. stress echocardiogram b. myocardial perfusion scintigraphy i. radionuclide imaging ii. technetium (thallium) scan 5. Rapid Interpretation of EKG’ s by Dubin B. angiocardiography 1. visualization of chambers, vessels by x-ray after injection of contrast material C. venography 1. as above D. cardiac catheterization 1. diagnosis and therapy E. cannulation 1. arterial and venous 2.monitoring,measurements F. doppler ultrasonography 1. blood flow G. plethysmography 1. peripheral venous blood flow |
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cardio emergencies
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A. chest pain
1. severe with SOB - immediate ER referral 2. complex a. any acute chest pain needs primary evaluation B. aneurysm 1. dilation of a blood vessel, especially aorta or peripheral artery 2. pain 3. specific testing - physical, imaging 4. immediate ER referral if suspected 5. danger is from rupture C. myocardial infarction (MI) 1. ischemic myocardial necrosis from sudden reduction in coronary blood flow 2. deep, substernal pain 3. restless, anxious, pale 4. thready pulse 5. die of ventricular fibrillation before reaching hospital 6. EKG, cardiac enzymes 7. call 911 a. need rapid dx and tx b. 50% of deaths from MI occur within 3-4 hours of onset of clinical syndrome D. deep vein thrombosis (DVT) 1. not emergency but needs evaluation and monitoring as soon as possible 2. possible pulmonary embolism |
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atherosclerosis definition
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A. the presence of irregularly distributed lipid deposits in arterial intima
1. the arterial wall becomes thickened and loses elasticity 2. arteriosclerosis is general term for any process that causes the above to occur a. commonly called hardening of the arteries B. leading cause of morbidity and mortality in US & West 1. AS Ht disease and stroke #1 killer 2. 33% of all deaths C. between 35-44, 6x > in white men than white women D. increase in postmenopausal women to match men |
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atherosclerosis etiology
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E. etiology
1. age 2. male gender 3. family hx of early AS 4. elevated TC or LDL; elevated TC/HDL ratio 5. decreased HDL 6. cigarette smoking 7. DM 8. hypertension 9. other potential etiologies a. low or excess alcohol intake b. Chlamydia pneumoniae c. increased CRP d. high levels of small, dense LDL e. high lp(a) f. hyperhomocysteinemia g. hyperinsulinemia h. hypertriglyceridemia i. obesity, metabolic syndrome j. low intake of fruits and vegetables k. sedentary lifestyle l. personality: type A, depressive, anxious, socioeconomic m. renal insufficiency n. prothrombotic |
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atherosclerosis sxs + sns
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1. none until critical level of stenosis
2. sx from decreased blood flow to an area a. thrombosis, embolism, aneurysm, CVA, MI |
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atherosclerosis labs
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1. serum lipids
a. triglycerides, cholesterol, HDL, LDL b. apolipoprotein A & B 2. lipoprotein (a) 3. CRP 4. homocysteine 5. thrombocytes |
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atherosclerosis imaging
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1. doppler ultrasonography
2. angiography |
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atherosclerosis tx
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J. treatment
1. prevention 2. diet a. whole foods i. vegetables, fruits, whole grains, nuts, seeds, legumes ii. fish, olive oil, onions, garlic - Mediterranean diet iii. moderate use of eggs, alcohol, organic free ranged beef, chicken, turkey b. Ornish, Pritikin, or modified Atkins diets in some cases c. avoid: refined sugar, refined grains, over-cooked food, fried foods, trans fatty acids, chlorinated water 3. EP A: 2-3 gm/d 4. vit. C: 2-10 gm/d 5. Mg: 300-600 mg/d 6. niacin: time release 500-1200mg/d 7. folic acid (2.5 mg/d), vit. B6 (25 mg/d), vit. B12 (250 mcg/d) 8. Cr - 200-1,000 mcg/d 9. pantethine - 1200 mg/d 10. carnitine - 3 gm/d 11. exercise a. 30-60 minutes of moderate activity daily 12. meditation 13. avoid tobacco use |
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hypertension definition
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A. elevation of systolic and/or diastolic BP
1. pre-hypertension a. 120-139/80-89 2. stage 1 hypertension a. 140-159/90-99 3. stage 2 hypertension a. greater than or equal to 160/100 B. increase with age - in West 1. 2/3 of people over 65 2. 90% risk of developing HTN if normal at 55 3. apparently no age related hypertension in non industrialized areas 4. hypertension increases dramatically when move to developed area C. incidence 1. more in blacks - 32% of adults - than whites - 23% of adults a. 50% all males and 60% all females over age 65 in U.S. if both isolated systolic and diastolic 2. 85-95% primary (essential) - unknown etiology 3. 5-10% secondary to renal disease 4. 1-2% other curable conditions |
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hypertension etiology
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1. COxTPR
2. primary a. blood volume b. increased CO c. increased peripheral vascular resistance d. sympathetic nervous system stimulation e. renin-angiotensin-aldosterone 5. secondary a. renal disease b. pheochromocytoma c. Cushing’ s syndrome d. hypo or hyperthyroid e. coarctation of aorta f. oral contraceptives g. corticosteroids h. cocaine i. licorice j. alcohol abuse k. cigarette smoking l. excess sodium intake |
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hypertension sxs + sns
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1. asx until complications develop
2. dizziness, HA, flushed face, fatigue, epistaxis, anxiety 3. complications a. left ventricular failure b. AS Ht disease c. retinal diseases d. CVA e. renal failure |
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hypertension diagnosis
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F. dx
1. measure twice (once sitting, once standing) on three separate occasions and take the average of the three readings 2. exclude secondary causes |
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hypertension prognosis
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1. untreated have risk for left ventricular failure, MI, CVA, renal failure
2. most important risk factor for stroke 3. one of 3 most important for CAD (cigarette smoking, dyslipidemia) 4. CAD most common cause of death for hypertensives 5. mortality related to systolic |
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hypertension tx
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H. treatment
1. similar to AS, especially diet 2. Na restriction to 1500 mg/d 3. avoid food sensitivities 4. weight loss 5. exercise 6. meditation 7. stress reduction 8. potassium, especially dietary 9. Ca/Mg: 1,000mg/500mg 10. CoQ10 200 mg/d 11. vit. D 1 2. heavy metal treatment 13. drug tx a. diuretics b. beta-blockers c. Ca channel blockers d. angiotensin converting enzyme inhibitor |
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coronary artery disease definition
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A. impairment of blood flow in the coronary arteries
1. AS in vessels surrounding Ht 2. coronary artery spasm B. complications are angina pectoris, MI C. angina pectoris 1. chest discomfort or pressure due to myocardial ischemia brought on by exertion and relieved by rest or sublingual nitroglycerin D. 1/3 of all deaths in developed countries |
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coronary artery disease sxs + sns
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1. variable discomfort
a. from a vague ache to an intense crushing sensation 2. substernal 3. radiation to left shoulder and down inside of left arm to fingers 4. also radiates to back, throat, jaw, teeth 5. worse with physical activity, better with rest 6. worse if exertion after a meal or in cold weather 7. frequency varies 8. sx characteristic for each individual a. any change in pattern is serious and may indicate an impending MI – unstable angina – 30% have MI within 3 months of onset 9. often no sns 10. may have increased HR & BP during attack |
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coronary artery disease dx
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F. dx
1. clinical, based on classic pattern 2. better with nitroglycerin |
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coronary artery disease testing
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G. testing
1. ECG 2. CT scan 3. exercise testing a. stress ECG b. myocardial perfusion scintigraphy 4. coronary arteriography |
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coronary artery disease prognosis
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H. prognosis
1. unstable angina, MI biggest risks 2. age, extent of coronary disease, severity, vent function major influences on prognosis 3. left main coronary artery lesions worst 4. # coronary vessels involved |
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coronary artery disease tx
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I. treatment
1. diet similar to AS 2. smoking cessation 3. weight loss 3. exercise 4. Mg 5. arginine 1gm tid 6. tx HTN, dyslipidemia, DM 7. IV chelation therapy 8. drug tx a. sublingual nitroglycerin for tx and prophylaxis b. beta blockers c. Ca channel blockers d. angioplasty e. coronary arterial bypass surgery |
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myocardial infarction MI definition
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A. ischemic myocardial necrosis due to abrupt decrease in coronary blood flow
B. greater than 90% have thrombus that occludes artery that supplies affected myocardium C. cocaine users - coronary artery spasm, MI D. epidemiology 1. 1.5 million in US yearly 2. 500,000 deaths a. half before reaching hospital E. acute rupture of thrombus 1. greater than 50% have thrombotic vessel occlusion less than 40% |
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myocardial infarction MI sxs + sns
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1. 2/3 experience prodromal sx for days or weeks before MI 2. worsening angina
3. SOB 4. fatigue 5. 1st acute MI sx a. deep substernal visceral pain - pressure or aching - often radiating to back, jaw, or left arm 6. 20% acute MI silent 7. restless, anxious, diaphoretic 8. cyanosis with cool skin 9. thready pulse, arrhythmia 10. muffled heart sounds |
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myocardial infarction MI labs, dx, tx, + prognosis
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F. lab
1. ECG 2. troponins 3. increased ESR & WBC in 12 hours due to tissue necrosis 4. CK-MB inc within 6 hrs a. increase for 48 hrs 5. LDH G. dx 1. hx 2. ECG 3. troponins 4. serial enzyme changes a. CK-MB b. LDH 5. consider MI if chest pain in all men over 30 and women over 40 6. differential a. H. treatment 1. 911 pneumonia, pulmonary embolism, pericarditis, rib fx, costochondral separation, esophageal spasm, chest muscle tightness, hiatal hernia, peptic ulcer, GB disease, aortic dissection, renal stone, many GI disorders I. prognosis 1. 30% overall mortality rate 2. quiet bed rest for 1st day 3. discharged from hospital in 3 days a. depression common by 3rd day 4. stool softeners to avoid straining 5. complications a. b. c. ED, arrhythmias, heart failure 6. physical activity gradually increased over 6 wks 7. lifestyle changes a.smoking cessation b. weight loss c.balance of work and play |
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heart failure CHF definition
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A. also called congestive heart failure (CHF)
B. abnormal mechanical performance of the heart C. results in inadequate CO to meet body’s needs D. an end stage for many cardiac disorders |
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heart failure CHF etiology
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E. etiology
1. anything that affects left ventricular function by either increasing CO or decreasing myocardial function 2. decreased function: valvular disease, CAD, myocardial disease 3. increased CO – HTN, anemia, thyrotoxicosis, pg, liver disease |
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heart failure CHF sxs + sns
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G. sxs
1. pulmonary sns and sxs from LHF 2. liver sns and sxs from RHF 3. fatigue on exertion 4. exertional dyspnea 5. cold intolerance 6. paroxysmal nocturnal dyspnea 7. nocturia 8. cough with blood tinged sputum 9. sense of suffocation with extreme dyspnea, cyanosis, tachypnea,& sns anxiety, pallor, diaphoresis may incite acute pulmonary edema 10. fullness in neck and abdomen 11. ankle swelling 12. cyanosis 13. tachycardia 14. wheezes and rales in lungs 15. diffuse PMI 16. pitting ankle edema 17. enlarged, tender liver 18. NYHA classification |
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heart failure CHF testing
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H. testing
1. no specific ECG changes 2. chest x-ray a. b. c. pulmonary venous congestion increased vascular markings enlarged cardiac silhouette 3. echocardiography a. EF – ejection fraction 4. BNP – brain natriuretic protein 5. CBC 6. CMP |
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heart failure CHF
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I. treatment
1. control underlying disease processes 2. avoid salt and alcohol 3. rest 4. diuretics 5. ACE inhibitors 6. nutrition a. Ca 1 gm/d b. Mg 600 mg/d c. K d. Coenzyme Q 10 100-300 mg/d e. carnitine 500 gm TID f. taurine 1 gm TID g. arginine 1 - 3 gm TID h. crataegus i. IR sauna |
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cor pulmonale definition + etiology
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A. right ventricular enlargement secondary to lung disease
B. produces pulmonary arterial hypertension C. etiology 1. COPD 2. pulmonary embolism |
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cor pulmonale sxs + sns
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D. sxs & sns
1. suspect in anyone with COPD 2. exertional dyspnea or exertional syncope 3. angina |
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cor pulmonale testing + tx
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E. testing
1. chest x-ray 2. ECG 3. echocardiogram F. treatment 1. tx lung disease and heart failure |
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cardiomyopathy definition
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A. a primary myocardial disorder
1. not the result of coronary artery disease, valvular disorders, or congenital cardiac disorders B. classifications 1. dilated (congestive) a. HF with ventricular dilation & systolic dysfunction 2. hypertrophic a. ventricular hypertrophy with diastolic dysfunction 3. restrictive a. ventricular non-compliance |
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cardiomyopathy etiology
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C. etiology
1. dilated a. ischemic myopathy, infections, metabolicdisorders, drugs, toxins, neoplasms, connective tissue disorders, pg, stress 2. hypertrophic a. genetic 3. restrictive a. PSS, hemochromatosis, neoplasms |
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cardiomyopathy sxs + sns
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D. sxs & sns
1. dilated – like HF a. fatigue, exertional dyspnea b. hepatojugular reflux c. pitting edema d. arrhythmias 2. hypertrophic a. syncope b. murmurs c. arrhythmias 3. restrictive a. arrhythmias b. exertional dyspnea c. orthopnea d. pitting edema |
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cardiomyopathy dx + prognosis
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E. diagnosis
1. hx&pxexam 2. chest x-ray 3. ECG 4. echocardiogram F. prognosis 1. dilated a. 20% mortality in 1st year, 10% per year thereafter 2. hypertrophic – 1 -3% annual mortality a. worse with early onset b. sudden death 3. restrictive a. 70% annual mortality |
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arrhythmias definition
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A. abnormalities in the normal rhythmic contraction of the heart
B. palpitations 1. awareness of the heartbeat C. hemodynamic upset 1. sustained bradycardias or tachycardias 2. serious, possibly life threatening 3. dizziness, syncope |
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arrhythmias diagnosis
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D. diagnosis
1. hx 2. peripheral pulses 3. jugular venous pulse 4. ECG 5. Holter 24 hour ECG monitoring |
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arrhythmias tx
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E. treatment
1. reassurance a. most arrhythmias benign b. must determine severity and type 2. drug tx 3. implantable defrillators 4. radiofrequency (RF) ablation 5. food sensitivities |
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valvular disease definition
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A. mechanical lesion in one of the valves of the heart
B. stenosis 1. chamber behind stenotic valve must work harder and hypertrophies C. incompetence 1. chambers behind and in front of the incompetent valve bear an extra load, an extra volume of blood with each heartbeat D. mitral valve disease most common of all valvular disease - over 50% 1. rheumatic fever most common cause of mitral valve disease and all valve disease in general E. aortic valve disease second most common valvular disease - about 35% |
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valvular disease sxs + sns
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1. very long course - decades 2. possibly fatigue, dizziness, syncope, dyspnea
3. various murmurs in various positions |
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valvular disease testing
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1. chest x-ray
2. ECG 3. echocardiogram 4. cardiac catheterization |
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valvular disease tx
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1. drugs to slow heart rate
2. peripheral vasodilators to decrease resistance 3. valve replacement |
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endocarditis definition
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A. microbial infection of endocardium
B. fever, murmurs, petechiae, emboli,vegetations, valvular incompetence or obstruction, myocardial abscess, mycotic aneurysm C. ABE most commonly from staph, Group A beta hemolytic strep, pneumococcus, gonococcus D. SBE from strep 1. often on abN valves from asx bacteremia from infected gums, GI, or GU |
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endocarditis sxs + sns
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1. SBE (frm strep) has insidious onset
2. ABE (frm staph/grpA)has similar sx but rapid onset 3. low grade fever, chills 4. nightsweats 5. fatigue 6. weight loss 7. arthralgias 8. cardiac murmurs 9. tachycardia 10. petechiae over upper trunk 11. painful erythematous subcutaneous nodules at tips of fingers - & sns Osler’s nodes 12. splinter hemorrhages under nails 13. clubbing of fingers 14. emboli - stroke, MI, hematuria 15. encephalopathy, brain abscess |
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endocarditis lab + tx
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F. lab
1. suspect in anyone with fever and murmur 2. immediate blood culture 3. echocardiogram H. treatment 1. always fatal if untreated 2. antibiotic prophylaxis a. for patients with valvular disease or other predisposition to IE i. IV drug use, dx procedures with vascular lines, elderly b. oral procedures i. high risk patients - previous IE, congenital Ht disease, prosthetic valves c. GI, GU infections d. cardiac valvular surgery 3. tx a. IV antibiotics |
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aortic aneurysm definition + etiology
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A. local dilation of the aorta
1. can occur in a peripheral artery B. etiology 1. atherosclerosis most common cause 2. risk factors a. cigarette smoking b. hypertension c. 3x more common in males 3. familial 4. trauma 5. arteritis 6. syphilis 7. Marfan’ s syndrome |
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aortic aneurysm sxs + sns
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sxs & sns
1. depends on location - all may be asx 2. abdominal aorta a. 75% of all aortic aneurysms a. 90% inferior to renal arteries b. deep, boring, steady, visceral pain c. wide abdominal aorta on palpation d. rupture is highly lethal i. ii. iii. excruciating pain in abdomen and back rapid hypovolemic shock and death surgical emergency, 50% death 3. thoracic aorta a. 25% of all aortic aneurysms b. back pain c. other sx related to which structures affected d. cough, wheezing, hemoptysis, dysphagia, hoarseness e. dissecting aneurysm D. diagnosis 1. x-ray i. tear in intima, rupture ii. commonly in ascending aorta and descending thoracic aorta iii. hypertension major risk factor iv. abrupt, excruciating, ripping pain |
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aortic aneurysm diagnosis + tx
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D. diagnosis
1. x-ray 2. ultrasonography 3. CT scan 4. MRI E. treatment 1. 100% mortality without tx 2. surgical repair a. 50% mortality b. 30% mortality if stenting can be done c. 65% mortality for thoracic |
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peripheral AS disease definition
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A. occlusion of blood supply to extremities due to atheromas
B. underlying atherosclerosis and its risk/etiologic factors |
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peripheral AS disease sns + sxs
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1. sx from chronic tissue ischemia
2. intermittent claudication a. deficient blood supply in exercising muscle b. pain, ache, cramp, tiredness in calf on walking c. relieved in 1 - 5 minutes by rest d. then can walk same distance until sx return e. worse walking uphill f. never sx at rest 3. pain at rest signifies worsening disease a. severe, unrelenting pain worse on elevation b. difficulty sleeping 4. decreased or absent pulses 5. severe ischemia - painful, cold, numb limb dry, scaly skin with poor nail and hair growth 7. toe, heel, leg ulcers |
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peripheral AS disease testing + tx
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D. testing
1. ankle-brachial index <0.9 2. Doppler ultrasonography 3. arteriography E. treatment 1. walking 1 hour/d a. walk until sx, rest, walk again 2. no tobacco 3. elevate head of bed while sleeping 4. hydrotherapy 5. percutaneous transluminal angioplasty 6. reconstructive surgery 7. amputation |
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thromboangiitis obliterans definition
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A. Buerger’ s Disease
B. obliterative disease with inflammatory changes in small and medium sized arteries and veins C. mostly in men aged 20-40 who smoke cigarettes D. 5% in women E. none in non-smokers F. inflammation and thrombosis of involved vessels |
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thromboangiitis obliterans sxs + sns
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1. gradual onset in most distal vessels of upper and lower extremities and progressing proximally
2. arterial ischemia and superficial phlebitis 3. coldness, numbness, tingling, burning 4. Raynaud’ s phenomenon 5. intermittent claudication 6. persistent pain as inc ischemia 7. xs sweating and cyanosis of affected limb 8. ulceration, gangrene 9. dec or absent pedal arteries in most cases 10. 60% have sns in wrist arteries 11. pallor on elevation, rubor on dependency |
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thromboangiitis obliterans diagnosis + tx
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H. diagnosis
1. clinical 2. arteriography I. treatment 1. stop smoking a. disease will always progress if not 2. like peripheral AS disease |
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raynauds disease definition
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A. spasm of arterioles of digits with pallor and cyanosis
1. occasionally in nose and tongue |
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raynauds disease etiology
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"spasm of arterioles of digits with pallor and cyanosis"
B. etiology 1. primary – 80% a. idiopathic 2. secondary – 20% a. primarily connective tissue disorders b. small % from wide variety of other possible disorders |
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raynauds disease sxs + sns
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1. from vasospasm of digital arteries and arterioles
2. from exposure to cold or emotional upsets 3. pallor, cyanosis, redness 4. burning pain 5. paresthesias 6. only distal to mp joints 7. ulcers on tips of digits |
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raynauds disease tx
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1. stop smoking
2. biofeedback 3. stress reduction 4. EPO 2gm TID 5. Mg 600-800 mg/d 6. niacin 300 mg TID 7. food sensitivities 8. thyroid hormone replacement when needed |
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venous thrombosis def + etiology
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A. thrombophlebitis, phlebitis
B. presence of a thrombus in a vein C. patients complain due to thrombophlebitis, DVT, chronic venous insufficiency D. etiology 1. injury to the vein 2. hypercoagulability a. malignant tumors, oral contraceptives, thrombophlebitis 3. stasis a. postoperative b. postpartum c. prolonged bed rest d. heart failure e. stroke f. trauma g. long traveling with legs dependent |
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venous thrombosis sxs + sns
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1. DVT asx often at first
a. tenderness, pain, edema, warmth, skin discoloration, prominent superficial veins b. hard, palpable cord (difficult in DVT of calf veins) c. DVT of calf may have no sx at first because 3 veins drain lower leg d. soreness on standing or walking relieved by rest with leg elevated 6. superficial thrombophlebitis a. linear indurated cord b. pain, tenderness, erythema, warmth 7. chronic venous insufficiency a. edema, dilated superficial veins b. fullness, aching tiredness or no sx c. worse standing, walking; better with rest, leg elevation d. usually hx of previous DVT e. stasis syndrome over time causing (skin pigmentation increases, stasis dermatitis, + stasis ulceration) |
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venous thrombosis diagnosis
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clinical
doppler ultrasound |
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venous thrombosis prognosis + tx
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G. prognosis
1. DVT may cause chronic venous insufficiency or pulmonary embolism H. treatment 1. superficial thrombophlebitis a. warm compresses b. usually resolves within 2 weeks 2. DVT a. bed rest usually in hospital b. heparinization c. coumadin d. compression stocking 3. vitamin C, E; bromelain; garlic 4. hydrotherapy |
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varicose veins ALL
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A. dilated, tortuous, superficial veins with incompetent valves
B. etiology 1. valvular incompetence 2. family history 3. vein wall weakness 4. increased pressure C. sxs & sns 1. fatigue, achiness, warmth of legs D. diagnosis 1. clinical E. treatment 1. compression hosiery 2. ablation 3. surgery 4. horse chestnut seed: escin - 50 mg BID |
