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Questions and Answers
What are the classifications of aortic aneurysms?
Which of the following is NOT a risk factor for aortic aneurysms?
What is the primary characteristic of Deep Vein Thrombosis (DVT)?
Which management options are included for aortic aneurysms?
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What are the components of Virchow's triad related to thrombosis?
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What is the main consequence if a plaque in the coronary arteries ruptures?
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Which symptom is typically associated with angina in women?
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What is the primary goal of general management for coronary artery disease?
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Which of the following is NOT a diagnostic test for coronary artery disease?
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In the context of coronary artery disease, which factor does NOT contribute to its development?
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Which clinical manifestation is associated with right-sided heart failure?
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What is a common cause of left-sided heart failure?
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Which diagnostic test measures the ejection fraction of the heart?
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Which medication class is primarily used to reduce fluid overload in heart failure patients?
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Which of the following is NOT a clinical manifestation of right-sided heart failure?
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What does a low ejection fraction specifically indicate?
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Which symptom is indicative of critical limb ischemia?
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Which treatment is commonly used for managing peripheral artery disease (PAD)?
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Which of the following changes can occur in arteries but not in veins?
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What is the normal range for the ankle-brachial index (ABI)?
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Which of the following are effects of aging on the cardiovascular system?
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What is a common etiology of myocardial infarction (MI)?
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Which of the following is NOT considered a risk factor for hypertension?
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What is one of the initial goals of treatment for myocardial infarction?
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What is one of the mechanisms that can lead to hypertension?
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Which symptom is commonly associated with myocardial infarction?
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Which blood pressure category indicates hypertension?
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What is one of the indications for administering thrombolytic therapy?
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Which statement regarding hypertension is correct?
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What is the primary effect of atherosclerosis on blood vessels?
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Which condition is characterized by incompetent valves leading to venous hypertension?
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What is a common complication associated with hypercoagulability?
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Which of the following treatments would be appropriate for managing a blood clot?
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Which sign is NOT typically associated with chronic venous insufficiency?
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What is the role of pneumatic compression devices in prevention?
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Which of the following factors increases the risk of developing hypercoagulability?
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What differentiates venous ulcers from arterial ulcers?
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What is a common symptom of post-thrombotic syndrome?
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Study Notes
Aging Effects on the CV System
- Blood vessels lose elasticity, have a decreased response to the Autonomic Nervous System (ANS), and have less sensitivity to baroreceptors
- Systolic blood pressure increases (widening pulse pressure) and there is an increase in connective tissue in the Sinoatrial (SA) and Atrioventricular (AV) nodes
- Heart valves stiffen, atria and ventricles thicken
- Cardiac reserve decreases (heart can’t pump enough blood to meet the body’s needs)
Hypertension
- Primary/Essential hypertension has an unknown cause
- Secondary hypertension has a known cause, such as narrowing of renal arteries, atherosclerosis, certain medications, pregnancy, and coarctation of the aorta (narrowing)
- Hypertension can lead to vasoconstriction and fluid retention
- Risk factors for hypertension include age, gender, race, cigarette smoking, obesity, excessive alcohol intake, diabetes, vitamin D insufficiency, and salt sensitivity
- Hypertension can impact organs including: the heart, brain, and kidneys
- Treatment includes weight reduction, a DASH diet (low salt, low fat), medications (diuretics, beta blockers, ACE inhibitors, ARBs, Ca Channel blockers, vasodilators), smoking cessation, and limiting alcohol intake
Myocardial Infarction (MI)
- Blood flow to the heart is blocked, causing myocardium (heart muscle) necrosis (death)
- Plaque rupture or thrombosis (blood clot formation) can completely occlude an artery
- Most common cause is atherosclerosis
- Common symptoms are chest pain, indigestion, nausea, cool, pain, and moist skin, tachycardia, palpitations, tachypnea, and shortness of breath (SOB)
- Atypical symptoms (in diabetics, elderly, women) are fatigue, nausea/vomiting, SOB, weakness, and dizziness
- The major goal of treatment is to relieve symptoms. MONA (morphine, oxygen, nitroglycerin, aspirin) is used. Thrombolytic therapy dissolves blood clots. Percutaneous coronary intervention (PCI) such as angioplasty and stenting is also used. Coronary artery bypass graft (CABG) and a pacemaker might be used as well.
- Thrombolytic therapy is administered to patients with chest pain for >20 minutes, unrelieved by nitroglycerin, and ST segment elevation in at least 2 similar leads, but not given to patients with active bleeding or known bleeding disorders.
Atherosclerosis
- Endothelial injury leads to an inflammatory response, which activates macrophages and white blood cells (WBCs). The WBCs engulf lipids such as LDL, accumulating and creating plaques. These plaques grow and can rupture, exposing their contents to the bloodstream, which can form a thrombus (blood clot) and block blood flow to the coronary arteries, causing ischemia in the heart.
- Angina (chest pain) has two types: stable (can be triggered by exertion) and unstable (more unpredictable and occurs at rest).
Coronary Artery Disease (CAD)
- Narrowing or blockage of the coronary arteries
- Assessment includes skin color, capillary refill, jugular vein distension (JVD), xanthelasma (yellow plaques around the eyes), and increased blood pressure and pulse pressure
- Signs and symptoms of coronary artery disease include angina, left-sided pain (shoulder, upper back, arm, jaw, neck), SOB, nausea/vomiting and, in women, neck, shoulder blade, jaw pain, and indigestion.
- Diagnostic tests include ECG, stress tests, blood work (troponin I or T levels), cardiac catheterization, and Holter monitor
- General management includes decreasing oxygen demand and increasing oxygen supply, decreasing modifiable risk factors (weight loss, diet, smoking cessation), and medications (nitrates, beta-blockers, calcium channel blockers, antiplatelets, anticoagulants)
- Signs and symptoms of myocardial infarction (MI) cannot be distinguished from unstable angina.
Heart Failure
- The heart is unable to pump blood adequately enough to meet the oxygen needs of the tissues.
- Risk factors include coronary artery disease (CAD) and myocardial infarction (MI), hypertension (HTN), diabetes, smoking, high sodium intake, valvular disease, cardiomyopathy, pericarditis/endocarditis, chemotherapy, alcohol, and drugs.
- Clinical manifestations are left-sided (dyspnea, crackles/pulmonary edema, paroxysmal nocturnal dyspnea (PND) and dyspnea on exertion (DOE), anxiety, S3 ventricular gallop, orthopnea, cough) and right-sided (JVD, dependent edema and pitting, weight gain due to fluid retention, ascites, weakness, anorexia, nausea, hepatomegaly)
- Diagnostics include ECG, ejection fraction (EF), brain natriuretic peptide (BNP), chest x-ray (CXR), cardiac stress test, and cardiac catheterization.
- Management includes diuretics, decreased sodium intake and fluid restriction, daily weights, ACE inhibitors, beta-blockers, inotropes, anticoagulants, and oxygen.
- Overall goals are to relieve symptoms, improve quality of life, and extend survival
- Objectives include eliminating or reducing causative factors (hypertension or atrial fibrillation), reducing the workload of the heart by decreasing preload and afterload, maximizing cardiac health and lifestyle, and providing patient education.
Arteries and Veins:
- Arteries carry oxygenated blood from the heart, veins carry deoxygenated blood to the heart
- Arteries can change diameter, veins cannot
- Arteries have high pressure, veins have low pressure
- Arteries have thicker walls, veins have thinner walls
- Arteries have no valves, veins have valves
- Arteries can become occluded (blocked) by plaque and thrombus, veins can become occluded by thrombus
- Arteries have pulsation, veins do not
Peripheral Artery Disease (PAD)
- Assessment includes skin changes such as pallor, dependent rubor, cyanosis, dry, cool, scaly skin, paranesthesia, ulcerations, brittle nails, hair loss, and muscle atrophy.
- The "6 P’s" sign of PAD are pallor, rubor, paresthesia, pulse reduced/absent, poikilothermal (cool), pitting edema, and pain.
- Symptoms of PAD include intermittent claudication (muscle cramp pain in extremities that increases with activity and is relieved by rest) and critical limb ischemia (persistent pain in the forefoot at rest, indicating severe ischemia and often worse at night).
- Acute limb ischemia is a sudden ischemia in an extremity that threatens tissue viability, presenting with a cold, pulseless, and mottled extremity.
- Assessment includes checking pulse scales bilaterally
- Diagnostic evaluations include ankle-brachial index (ABI), invasive procedures, and hyperbaric oxygen treatment
- Treatment options include exercise, percutaneous transluminal angioplasty (PTA), stents after angioplasty, atherectomy, bypass, and hyperbaric oxygen therapy
Aortic Aneurysms
- Localized sac or dilation formed at a weak point in the arterial wall
- Classifications include saccular (projects from one sided of the vessel) and fusiform (entire segment dilated).
- Most are asymptomatic and silent.
- Risk factors include smoking, hypertension, hyperlipidemia, family history, advanced age, and male gender.
- Etiology include atherosclerosis (damage to media and intima of the arterial wall), genetics/congenital weakness, disease, and trauma.
- Management includes antihypertensives, endovascular grafting, and surgical repair.
Venous Disease
- Deep Vein Thrombosis (DVT) is a blood clot that forms in a vein, usually due to Virchow’s triad ([stasis], vessel wall injury, and hypercoagulability).
- Venous Thromboembolism (VTE) is a blood clot that travels from the veins to the lungs, causing a pulmonary embolism
- Post-thrombotic syndrome is a condition that develops after DVT. It causes swelling, pain, and discoloration in the affected leg.
- Chronic venous insufficiency (CVI) is a condition that occurs when the venous wall and valves in the leg veins are not working properly, leading to impaired venous return.
Deep Vein Thrombosis (DVT)
- Predisposing conditions (risk factors) for DVT include oral contraceptives and smoking, advanced age, obesity, pregnancy, cancer, constrictive clothing.
- Clinical manifestations include pain, tenderness, erythema (warm to the touch), unilateral edema, and prominent superficial veins.
- Complications include pulmonary emboli, chronic venous insufficiency, varicosities, venous ulcers, edema, and venous gangrene.
- Anticoagulation (heparin, enoxaparin, apixaban/dabigatran, warfarin), thrombolytic therapy, surgery, and endovascular management are used to treat DVT.
- Nursing management includes monitoring blood (PTT, PT/INR, H/H), monitoring bleeding and thrombocytopenia, providing comfort, and preventing DVT through identifying high-risk patients, using pneumatic compression devices, proper body positioning, exercise, and anticoagulant therapy.
Chronic Venous Insufficiency (CVI)
- Defective valves allow for backflow of blood, leading to impaired venous return
- Risk factors include blood clots (DVT), varicose veins, cancer, right heart failure, obesity, and leg trauma.
- Signs include leg swelling, skin color and texture changes, and venous ulcers.
Post-thrombotic Syndrome
- Develops after DVT and is symptomatic CVI
- Obstruction of venous valves leads to reflux of blood and venous congestion.
- Incompetent valves and venous hypertension can lead to this condition, affecting 20-50% of patients with DVT.
- Signs include edema, stasis, dermatitis, redness, dependent cyanosis, varicose veins, hyperpigmentation, and healed ulcers
- Symptoms include heaviness, cramps, pain, paresthesia, swelling, bursting pain, and itching.
Arterial and Venous Ulcer Comparison
- Arterial ulcers are often punched out and located on the toes and feet, while venous ulcers are irregular in shape and typically located on the ankles.
- Arterial ulcers have no edema or a weak pulse, but venous ulcers have lower leg edema and a present pulse.
- Arterial ulcer drainage is usually absent, while venous ulcers typically have drainage.
- Black eschar is common in arterial ulcers, while yellow slough or ruddy skin is common in venous ulcers.
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Description
This quiz explores the impacts of aging on the cardiovascular system, particularly focusing on changes in blood vessels, heart structure, and cardiac function. It also covers the types and causes of hypertension, including its risk factors and effects on vital organs. Test your knowledge on these critical health issues.
