Cardiac Risk Factors Study Guide

Cardiac Study Guide

Modifiable Risk Factors

• These are risk factors for cardiac issues that can be changed
• High blood pressure can be managed through diet, exercise, and medications
• Lowering LDL cholesterol and increasing HDL through diet, exercise, and medication helps prevent cardio disease
• Quitting smoking reduces the risk of heart disease
• Diabetes can be controlled through diet, exercise, and medications
• Limit saturated fats(animal products), trans fats (processed), cholesterol (cheese/butter), and sodium in your diet
• Regular exercise helps control weight, lower blood pressure, and improve cholesterol
• Maintain a healthy weight with diet and exercise
• Limiting alcohol helps prevent high blood pressure
• Managing stress through relaxation and exercise improves heart health

Unmodifiable Risk Factors

• These are risk factors for cardiac issues that can not be changed
• Heart disease risk increases with age
• Men are generally at a higher risk at a younger age than women. However, risk for women increases after menopause
• Family history of heart disease increases your risk, especially if closely related
• African Americans, Hispanics, and South Asians have a higher risk of cardiac issues

Diuretics

• Examples include Furosemide (Lasix), Hydrochlorothiazide (HCTZ), and Spironolactone (Aldactone)
• Diuretics remove excess fluid from the body through increased urination
• This helps reduce blood volume and lower blood pressure
• Potential side effects include hypokalemia (low potassium, especially with non-potassium-sparing diuretics), dehydration, dizziness, and orthostatic hypotension
• These should be taken in the morning to prevent nocturia
• If taking non-potassium-sparing diuretics, consume potassium-rich foods like bananas and spinach
• Rise slowly when standing to avoid dizziness

Beta Blockers

• Examples include Metoprolol (Lopressor), Carvedilol (Coreg), and Atenolol (Tenormin)
• Beta-adrenergic receptors are blocked. This results in a slowed heart rate and reduced myocardial oxygen demand and cardiac workload
• Potential side effects include bradycardia, low blood pressure, shortness of breath, fatigue, dizziness, depression, cold extremities, and allergic reactions
• Beta Blockers should not be stopped abruptly, as this may cause rebound hypertension or tachycardia
• Monitor your heart rate, and notify your healthcare provider if it drops below 60 bpm
• Caution should be taken when combining with other medications that lower heart rate
• Alcohol should be avoided

ACE Inhibitors (Angiotensin-Converting Enzyme Inhibitors)

• Examples include Lisinopril (Prinivil), Enalapril (Vasotec), and Captopril (Capoten)
• These prevent the conversion of angiotensin I to angiotensin II, resulting in vasodilation and reduced blood pressure
• Potential side effects include orthostatic hypotension, dry persistent cough (common), hyperkalemia (high potassium), dizziness, and angioedema (rare but serious swelling)
• Monitor for and report a persistent dry cough or any swelling in the face or throat (angioedema)
• Potassium-rich foods or supplements should be avoided
• Blood pressure should be checked regularly, and any significant changes reported

ARBs (Angiotensin II Receptor Blockers)

• Examples include Losartan (Cozaar), Valsartan (Diovan), and Irbesartan (Avapro)
• These block angiotensin II receptors, preventing vasoconstriction and lowering blood pressure
• Potential side effects include hyperkalemia, dizziness, and fatigue
• Potassium supplements and potassium-rich foods should be avoided
• Monitor for dizziness, especially when standing up

Calcium Channel Blockers (CCBs)

• Two types: Dihydropyridines (Amlodipine (Norvasc), Nifedipine (Procardia)) and Non-Dihydropyridines (Verapamil (Calan, Verelan), Diltiazem (Cardizem))
• Blocks calcium from entering cells of the heart and blood vessel walls; this leads to vasodilation and reduced heart rate (non-dihydropyridines), and lower blood pressure
• Dihydropyridines can cause peripheral edema, headache, and flushing
• Non-Dihydropyridines can cause bradycardia and constipation (especially with Verapamil), and dizziness
• Avoid grapefruit juice, which can interfere with drug metabolism
• Report any swelling in the feet/legs (peripheral edema) or changes in heart rate
• Increase dietary fiber and fluids to prevent constipation if taking Verapamil

Statins

• Examples include Atorvastatin (Lipitor), Simvastatin (Zocor), and Rosuvastatin (Crestor)
• Statins inhibit cholesterol synthesis in the liver
• This lowers LDL cholesterol levels and reduces cardiovascular risk
• Potential side effects include muscle pain or weakness, liver dysfunction, and gastrointestinal upset
• Report any signs of muscle pain or weakness to indicate rhabdomyolysis
• Take the medication in the evening for maximum efficacy; avoid grapefruit juice due to increasing the risk of side effects

Nitrates

• Examples include Nitroglycerin (Nitrostat) and Isosorbide Mononitrate (Imdur)
• Nitrates dilate blood vessels
• This reduces preload and myocardial oxygen demand, which relieves angina
• Potential side effects include headache, dizziness, hypotension, and reflex tachycardia
• Nitroglycerin should be stored in a cool, dark place in its original container
• Sit or lie down when taking nitrates to avoid dizziness or fainting due to low blood pressure
• For chest pain, take one dose every 5 minutes (up to 3 doses); seek emergency care if pain persists after the third dose

Anticoagulants

• Examples include Warfarin (Coumadin), Heparin, and Apixaban (Eliquis)
• Anticoagulants prevent clot formation by interfering with the body's clotting process
• Potential side effects include bleeding (e.g., bruising, black stools) and GI upset
• Signs of bleeding should be monitored and reported immediately
• If on Warfarin, maintain a consistent Vitamin K intake (e.g., green leafy vegetables

High Blood Pressure (Hypertension)

• Diagnosed by two or more readings of consistently high blood pressure on separate occasions
• Systolic pressure measures the pressure in arteries when the heart beats
• Diastolic pressure measures the pressure when the heart relaxes
• Stage 1 hypertension: >130-139/>80-89; Stage 2 hypertension: >140/>90
• Hypertension is considered a silent killer because most patients don't know their blood pressure is high
• Significantly high blood pressure can cause headaches, shortness of breath, nosebleeds, chest pain, jaw pain, or shoulder/back pain
• Additional tests may be needed to determine the cause of high blood pressure
• Patients monitor their blood pressure at home for trending purposes
• Accurate blood pressure requires correct cuff size with bladder width at least 40% of the arm and bladder length covering at least 80% of the arm circumference
• Proper positioning while taking blood pressure includes sitting upright with feet flat and arm below heart level
• Relax for a few minutes before measuring and avoid smoking, caffeine, or exercise for at least 30 minutes before measuring

Electrocardiogram (EKG/ECG)

• Measures the electrical activity of the heart
• It helps diagnose arrhythmias, heart attacks (STEMI, MI), and other heart conditions
• Monitors heart health over time, especially if the patient has a known condition
• Evaluates symptoms like chest pain, shortness of breath, dizziness, or palpitations to determine if they are related to heart problems
• Assesses proper function with medications and pacemakers

Echocardiogram ("Echo")

• Ultrasound waves create a detailed image of your heart
• Assesses structure and function including chambers, valves, and blood flows
• It is non-invasive and painless like a normal ultrasound
• Diagnoses heart conditions, heart disease progression, and evaluates treatment effectiveness

Ejection Fraction (EF)

• Measures the % of blood the LEFT ventricle pumps out with each contraction
• A good range is 55% to 70%
• Ejection fraction lower than 50% shows heart is not pumping properly and can lead to heart failure
• Low ejection fraction symptoms: shortness of breath, fatigue, swelling(edema), rapid or irregular heartbeat, mental confusion, loss of appetite/nausea
• Other symptoms: chest pain, exercise intolerance

Lowering Hypertension

• Goal is to lower high blood pressure to a safe level, not cure it
• Untreated high blood pressure can lead to stroke, heart attack, and kidney disease
• Lifestyle modifications can help

Lifestyle modifications to regulate blood pressure

• Exercise, quit smoking, limit alcohol, and reduce sodium intake
• Take medications as prescribed
• Attend regular follow-up appointments and monitor blood pressure at home
• Utilize reminders, understand medications, communicate with PCP, simplify medication routine, and be consistent to adhere to prescribed medications

DASH Diet

• Include fruits, vegetables, whole grains, low-fat dairy, lean protein (fish, poultry, beans), nuts, and seeds
• Reduce sodium intake to 2,300 mg or 1,500 mg per day
• Limit saturated and trans fats, and choose olive oil, avocados, and nut butter

Increase Potassium, Calcium, and Magnesium

• Eat bananas, spinach, yogurt, almonds, and smoothies
• Limit POTASSIUM and SALT SUBS if taking ACE inhibitors (pril), ARBs (sartan), or potassium-sparing diuretics (Spiro, Eplerenone, Triamterene, Amiloride)
• Limit alcohol to 1 drink per day for women and 2 for men
• Avoid sugars and refined carbs, such as soda, sweets, and processed foods
• Low potassium signs: muscle weakness and cramps fatigue constipation abnormal heart rhythms tingling and numbness nausea and vomiting frequent urination and thirst
• Thiazide diuretics (hydrochlorothiazide, chlorthalidone, indapamide, metolazone) used to treat low potassium levels

Effects of Smoking

• Smoking damages blood vessels, increases blood pressure, and increases the risk of heart disease, heart attacks, and strokes
• Tobacco use increases risk for: COPD Emphysema Chronic Bronchitis Lung infection/cancer Weakens bones and increases risk for fractures
• Smoking constricts blood vessels, reducing blood flow to organs and tissues
• Smoking weakens the immune system, increasing the risk of illness
• Risks to reproductive health: infertility complications during pregnancy fetal harm
• Risks to health: gum disease tooth loss oral cancer Increases skin aging (wrinkles/dull skin)

Sympathetic Nervous System response

• Smoking activates the Sympathetic Nervous System: flight or fight
• Increases heart rate and blood pressure with blood vessel constriction
• Releases stress hormones, including epinephrine, that increases heart rate and blood pressure
• Patients considering quitting smoking should identify reasons for quitting and triggers for smoking, and consider nicotine patches or gum
• Counseling and support groups can help

Mean Arterial Pressure (MAP)

• Normal range is 60-100 mmHg. It gives a better understanding of overall blood pressure
• <60 signifies not enough blood which can cause organ damage or stroke

• 100 signifies the heart is working too much and can lead to heart attack or kidney issues

MAP Formula

• MAP = SBP + (DBP x 2) ÷ 3
• SBP = 140 and DBP = 90
• Plug the numbers into the formula: MAP = 140 + (90 x 2) ÷ 3
• Multiply the DBP by 2: МАР = 140 + 180 ÷ 3
• Add the SBP to the product: MAP = 320 ÷ 3
• Divide by 3 to calculate MAP: MAP = 106.7 mmHg

Cardiac Output (CO)

• Equals Stroke Volume (SV) x Heart Rate (HR)
• Normal Resting Conditions Stroke Volume (SV): 70 mL/beat Heart Rate (HR): 72 beats/min
• CO = SV × HR CO = 70 mL/beat × 72 beats/min CO = 5040 mL/min
• CO = 5040 ÷ 1000 = 5.04 L/min. The Cardiac Output is 5.04 L/min, within the normal range

Stroke Volume formula

• End-Diastolic Volume (EDV): 120 mL
• End-Systolic Volume (ESV): 50 mL
• SV = EDV - ESV SV = 120 mL - 50 mL SV = 70 mL

Implications of elevated Heart Rate

• If the heart is 100-110 >BPM and/or tachycardia, this can lead to issues in the long term
• Impact on Ventricles: ventricles do not have enough time to fill with blood before contraction. Reduces the blood pumped out decreasing cardiac output. This can weaken the heart and lead to heart failure
• Impact on Arteries: elevated workload on arteries can lead to high blood pressure because the arterial walls become still and less eleastic (atherosclerosis). This increases the likelihood of heart attack or stroke

Cardiovascular Conditions

• Increased Risk for heart conditions causing heart failure, stroke, and sudden cardiac death
• Reduced heart efficiency: ineffective pumping can lead to dizziness, shortness of breath, and chest pain
• Potential arrhythmias
• Increased Oxygen demand can be dangerous with CAD

Circulatory Measures

• Preload: the stretching that happens with the heart muscle before it contracts, representing the volume of blood returning to heart (filling) the ventricles during diastole
• Afterload: the pressure the heart has to work again to eject blood during systole, influenced by the resistance in the blood vessel (arteries) -Higher afterload means the heart has to work that much harder to pump blood out.
• Stroke Volume: measurement of the blood ejected by the LEFT ventricle of the heart in one contractions

Coronary Artery Disease (CAD)

• Condition where the coronary arteries (that supply the heart muscle) become narrowed or blocked due to plaque (made of cholesterol, fat)
• Plaque buildup (atherosclerosis) can harden or rupture, leading to reduced blood flow to the heart
• Symptoms: chest pain (angina), shortness of breath, and fatigue Sometimes the first sign of CAD is a heart attack
• Risk factors: high blood pressure, high cholesterol, smoking, diabetes, obesity, and a sedentary lifestyle Family history and age also play a role
• Diagnosis: Electrocardiograms (ECG/EKG), stress tests, echocardiograms, and coronary angiograph
• Treatment: Diet, exercise, quit smoking, medications (cholesterol, blood pressure, prevent blood clots), and sometimes surgery
• Prevention: Healthy diet, physical activity, managing stress, and avoid tobacco

Cholesterol-Lowering Medications

• Examples: Atorvastatin (Lipitor), Simvastatin (Zocor), Rosuvastatin (Crestor)
• Mechanism: Inhibits cholesterol synthesis in the liver, lowering LDL cholesterol and reducing plaque buildup in the arteries
• Side Effects: Muscle pain, liver dysfunction, gastrointestinal upset
• Patient Teaching: Take at night for better efficacy Report any muscle pain or weakness Avoid grapefruit juice

Blood Pressure-Lowering Medications: Beta Blockers

• Examples: Propranolol (Inderal), Metoprolol (Lopressor), Atenolol (Tenormin), Carvedilol (Coreg)
• Mechanism: Reduces heart rate and myocardial oxygen demand, lowering blood pressure
• Side Effects: Bradycardia, fatigue, dizziness, cold extremities, not for asthma patients
• Patient Teaching: Do not stop abruptly Monitor heart rate regularly Report a HR under 60 bpm

ACE Inhibitors (Angiotensin-Converting Enzyme Inhibitors)

• Examples: Lisinopril (Prinivil), Enalapril (Vasotec), Ramipril (Altace)
• Mechanism: Blocks angiotensin I from converting to angiotensin II, leading to vasodilation and lower blood pressure
• Side Effects: Orthostatic Hypotension, Dry cough, hyperkalemia, angioedema (rare) Patient Teaching: Report cough or swelling Caution with K-rich foods or supplements.

ARBs (Angiotensin II Receptor Blockers)

• Examples: Losartan (Cozaar), Valsartan (Diovan), Irbesartan (Avapro)
• Mechanism: Blocks angiotensin II receptors, preventing vasoconstriction and lowering blood pressure
• Side Effects: hyperkalemia, dizziness, fatigue
• Patient Teaching: Caution with K-rich foods or supplements Monitor dizziness Report new or worsening symptoms

Calcium Channel Blockers (CCBs)

• Examples: Amlodipine (Norvasc), Nifedipine (Procardia), Verapamil (Calan), Diltiazem (Cardizem).
• Mechanism: Blocks calcium entry into vascular and cardiac cells, leading to vasodilation and reduced blood pressure
• Side Effects: Peripheral edema, flushing, headache, bradycardia (non-dihydropyridines)
• Patient Teaching: Avoid grapefruit juice

Antiplatelet and Anticoagulant Medications (Prevent Blood Clots)

• Antiplatelets examples: Aspirin (low-dose), Clopidogrel (Plavix), Ticagrelor (Brilinta)
• Antiplatelets mechanism: Prevents platelets from clumping together, reducing the risk of clots in coronary arteries
• Antiplatelets side effects: Increased bleeding risk, stomach upset
• Antiplatelets Patient Teaching: Take prescribed, even asymptomatic Monitor for bleeding signs (black stools, bruising) Avoid with NSAIDS prescribed by the provider.
• Anticoagulants Examples: Warfarin (Coumadin), Rivaroxaban (Xarelto), Apixaban (Eliquis)
• Interfere with body's clotting, reducing formation of harmful clots
• Anticoagulants Side Effects: Bleeding, bruising, GI issues
• Patient Teaching: Required monitoring for Warfarin. Maintain Vitamin K intake if on Warfarin. Report signs bleeding immediately

Respiratory Conditions

• Allergic Rhinitis: Sneezing, runny and itchy nose, watery eyes, cough, fatigue Treatment: Avoid allergens. Medications: Antihistamines, decongestants, nasal corticosteroids, and leukotriene. Home Remedies: air filters, keep windows closed, and clean
• Sinusitis (sinus infection): Facial pain/pressure, nasal congestion, thick nasal discharge, headache, fever,, reduced sense of smell Treatment: Nasal Corticosteroids Saline nasal and Antibiotics for Bacterial only
• Pharyngitis: Sore throat, difficulty swallowing, swollen lymph nodes, fever, and red or swollen tonsils Treatment: Viral: rest, hydration, OTC pain relievers Bacterial: ATB
• Tests: Rapid strep or throat culture
• Tonsillitis: Swollen tonsils, white exudate (pus), scratchy/muffle voice, stomachache, vomit, refuse to eat Treatment: Viral: rest and hydrate, OTC meds, gargle salt water Bacterial: ATB Tests: Rapid strep or culture

Laryngitis (voicebox)

• Hoarse and lost voice, sore throat, dry cough, and throat irritation Treatment Viral: from upper resp infections rest voice, stay hydrated, and avoid irritants Bacterial: Treat the secondary infection

Lower respiratory Disorders

• Trachea, Bronchi, Bronchioles, Alveoli, Lungs, and Diaphragm
• Pneumonia: Fever, chills, productive cough shortness of breath, chest pain, fatigue and crackles wheezing Treatments Bacterial: Atb Viral : Antiviral Meds
• COPD: Sputum and chronic cough production, shortness of breath, wheezing, and fatigue Treatments Bronchodialators: albuterol Inhaled Corticosteroids: Fluticasone Pulmonary rehabilitation and breathing exercises, oxygen if levels are under a certain point
• Bronchitis: Cough dry then productive cough, chest discomfort, mild fever, fatigue, and shortness of breath. Treatments Rest, increase fluids humid air Bronchodilators with wheezing for breathing Antibiotics if Bacterial
• Tuberculosis: Latent: Is not Active but can be during immunosuppressing treatments Test Positive but not contagious No symptoms Test: Positive TB skin test/can get IGRA test/ Chest x-ray/ take Isoniazid TB to help not become active Active: Persistent cough 3 weeks more/coughing blood and sputum/ Chest pain coughing, fatigue, weight loss, loss of appetite, fever and chills Treatments for TB Isoniazid avoid alcohol side effects, Liver problems Tingling- peripheral neuropathy Empty Stomach empty/discoloration watch liver issues, Rifampin, Ethambutol(causes vision loss vision changes), Pyrazinamide Side effects: Liver problems/Gout needs increased water TB Airborne Precautions Negative pressure Private Room Nurses use N-95 masks Patients wear surgical patient masks if they leave the room Monitor liver function with toxicity

Other Respiratory Illnesses

• Epistaxis: (Nose Bleeds) This is caused by allergies irritation and being dry Treatment: Pinch Nose forward 20 minutes
• If nose is broken seek professional medical Attention Crookedness Difficulty breathing Persistent bleeding longer than 15 minutes Severe Pain/ Swelling Clear fluid drainage
• SPO2( Oxygen Readings) Normal: 95-100/ Hypoxia under 94% is too low
• Work of breathing Assessment: what are they using from the start and the effort being applied
• Nasal Flaring: Nostrils widening allowing to try and get air flow
• Retractions: Skin Sinking between abdomen and ribs during
• Breath sounds: are there stridor, diminished noises
• In order to test patients assessment palpate and smacking there back can there be movement and are there weird vibration -Vital Test RR, HR and SPO2 always needs to be checked

Incentive Spirometer

• Used to suck in air to prevent fluid within and collapsed Alveoli
• Keeps them open and lungs from collapsing
• Those are mostly needed post surgical and those who have long time lying down and bed-ridden

Normal Lab value Ranges

• Potassium: 3.5-5.0 / Sodium:135-145/ Magnesium:1.7-2.2/ Total Calcium: 8.5-10.5/ Ionized: 4.6-5.3 ABGS: pH: 7.35 - 7.45 PaCO2: 35-45 HCO3: 22-26