Cardiovascular Diseases: PAD and Afib

• The following are study notes based on your questions regarding cardiovascular diseases and related topics.

Peripheral Artery Disease (PAD)

• PAD is a circulatory problem where narrowed arteries reduce blood flow to the limbs, typically the legs.

Risk Factors for PAD

• Risk factors include smoking, diabetes, obesity, high blood pressure, high cholesterol, increasing age, and a family history of PAD or other cardiovascular diseases.

Atrial Fibrillation (Afib)

• Afib is an irregular and often rapid heart rhythm arising from chaotic electrical activity in the atria.
• Risk factors include age, high blood pressure, underlying heart disease, chronic conditions such as thyroid problems, diabetes, sleep apnea, and heavy alcohol use.

Complications of PAD Requiring Immediate Attention

• Acute limb ischemia is a sudden decrease in blood flow to a limb that threatens tissue viability
  • Manifestations include pain, pallor, pulselessness, paresthesia, and paralysis ("the 5 P's").

Metabolic Syndrome

• Metabolic syndrome is a cluster of conditions that occur together, increasing the risk of heart disease, stroke, and type 2 diabetes.
• Risk factors include obesity (especially abdominal), high triglycerides, low HDL cholesterol, high blood pressure, and high fasting blood sugar.
• Management includes lifestyle changes (diet, exercise, weight loss) and medications to control individual risk factors. Treatment interventions are tailored to address each component of the syndrome.

Hemoglobin A1c (HbA1c)

• HbA1c measures average blood sugar levels over the past 2-3 months.
• The normal range is generally below 5.7%.

Adverse Effects of Amiodarone

• Adverse effects can be significant and include thyroid problems, liver problems, pulmonary toxicity, vision problems, and skin discoloration.

Hyperthyroidism Symptoms

• Symptoms include weight loss, rapid or irregular heartbeat, sweating, irritability, and muscle weakness.

Hypothyroidism Manifestations

• Manifestations include fatigue, weight gain, constipation, dry skin, and sensitivity to cold.

DASH Diet

• The DASH (Dietary Approaches to Stop Hypertension) diet emphasizes fruits, vegetables, low-fat dairy, and whole grains while limiting saturated fat, cholesterol, and sodium.

Orthostatic Hypotension Assessment

• To check for orthostatic hypotension, measure blood pressure and heart rate after the patient has been lying down for at least 5 minutes, then immediately upon standing, and again after 1-3 minutes.
• Take the initial blood pressure while the patient is supine.

Nursing Assessments Before BP Medications

• Assess blood pressure and heart rate before administering BP medications. Also, assess for any symptoms of hypotension (dizziness, lightheadedness).

Priority Teaching for DM Foot Care

• Priority teaching includes daily foot inspection, washing feet daily with lukewarm water and mild soap, drying feet thoroughly, moisturizing (but not between toes), wearing appropriate shoes and socks, and avoiding walking barefoot.

Hypokalemia Manifestations

• Manifestations may include muscle weakness, fatigue, constipation, and cardiac arrhythmias.

Hypoglycemia Manifestations

• Manifestations include shakiness, sweating, hunger, dizziness, confusion, and blurred vision.

Fluid Overload Manifestations

• Manifestations include edema, weight gain, shortness of breath, and increased blood pressure.

Action of Aspirin

• Aspirin is an antiplatelet medication that inhibits platelet aggregation, reducing the risk of blood clots.

Modifiable Stroke Risk Factors

• Modifiable risk factors include high blood pressure, high cholesterol, smoking, diabetes, obesity, and physical inactivity.

Non-Modifiable Stroke Risk Factors

• Non-modifiable risk factors include age, race, gender, and family history.

T-wave on ECG Strip

• The T-wave represents ventricular repolarization.

Normal Sinus Rhythm on ECG Strip

• Normal sinus rhythm is characterized by a heart rate between 60-100 bpm, regular R-R intervals, a P wave preceding each QRS complex, and a consistent PR interval.

Hyperkalemia and the T-wave

• Hyperkalemia can cause peaked T-waves on an ECG.

Decreasing Cardiovascular Disease Risk

• You can decrease the risk through lifestyle modifications such as a healthy diet, regular exercise, maintaining a healthy weight, not smoking, and managing stress.

Modifiable Risk Factors for Atherosclerosis

• Modifiable risk factors include high LDL cholesterol, low HDL cholesterol, high blood pressure, smoking, diabetes, obesity, physical inactivity, and an unhealthy diet.

Pacemaker Contraindications

• A relative contraindication may include frequent MRI scans, depending on the type of pacemaker.

Diagnostic Tests for DVT

• Diagnostic tests include D-dimer blood test and ultrasound (duplex ultrasonography).

Digoxin Toxicity Manifestations

• Manifestations include nausea, vomiting, loss of appetite, visual disturbances (blurred vision, yellow halos around objects), and cardiac arrhythmias.

Nursing Interventions for Hyperkalemia

• Nursing interventions include monitoring ECG, administering medications to shift potassium into cells (e.g., insulin with glucose), administering medications to bind potassium in the GI tract (e.g., sodium polystyrene sulfonate), and possibly dialysis.

Diagnostic Lab Tests for Angina and MI

• Troponin, CK-MB, and ECG.

Left-Sided Heart Failure Manifestations

• Manifestations include shortness of breath, pulmonary edema, cough, and fatigue.

AFib Rhythm

• AFib is an irregular rhythm.

Priority Nursing Interventions for MI

• Administer oxygen, administer pain medication (e.g., morphine), administer aspirin, administer nitroglycerin, and prepare for possible PCI (percutaneous coronary intervention).

Triggers for Angina

• Triggers include physical exertion, emotional stress, cold weather, and heavy meals.

Stable Angina

• Stable angina is chest pain that occurs with predictable exertion or stress and is relieved by rest or nitroglycerin.

Unstable Angina

• Unstable angina is chest pain that occurs at rest or with minimal exertion and is not relieved by rest or nitroglycerin. It is a medical emergency.

Raynaud's Disease Risk Factors

• Risk factors include female gender, family history, age (typically between 15 and 30), and certain connective tissue diseases.

Priority Nursing Interventions for V-Fib

• Initiate CPR immediately and defibrillate.

Priority Nursing Interventions for V-Tach

• Assess the patient's stability. If there is a pulse, administer antiarrhythmic medications. If pulseless, treat as V-Fib (CPR and defibrillation).

Arrhythmias for Defibrillation vs. Cardioversion

• Defibrillation is used for pulseless V-Tach and V-Fib.
• Cardioversion is used for unstable supraventricular tachycardia (SVT), atrial fibrillation, and atrial flutter.

When to Call 911 After Nitroglycerin

• Call immediately if chest pain is not relieved or worsens 5 minutes after taking the first nitroglycerin tablet.

Overview of Peripheral Artery Disease (PAD) and Atrial Fibrillation (Afib), including risk factors and complications. PAD is a circulatory problem with narrowed arteries reducing blood flow, while Afib is an irregular heart rhythm due to chaotic electrical activity in the atria. Immediate attention is required for acute limb ischemia.