Cardio part 1 adult health

Modifiable Risk Factors

• These risk factors can be changed through lifestyle modifications and medical interventions.
• Smoking cessation is crucial for overall health.
• Hyperlipidemia (high cholesterol) is managed through diet, exercise, and medication if necessary.
• Hypertension is controlled through lifestyle changes and medication.
• Optimal blood glucose levels should be maintained through diet, exercise, and medication for those with diabetes.
• Obesity can be addressed by achieving and maintaining a healthy weight through diet and exercise.
• A sedentary lifestyle can be improved by incorporating regular physical activity into one's daily routine.
• Stress and psychological factors should be managed through relaxation techniques, therapy, or other coping mechanisms.
  • Type D personalities, characterized by pessimistic attitudes, chronic negative emotions, and social inhibition, are at higher risk for health issues.

Non-Modifiable Risk Factors

• These are risk factors that cannot be changed.
• Family history indicates a genetic predisposition to cardiac disorders.
• Age increases the risk of certain conditions.
• Gender makes certain cardiac conditions more prevalent in specific groups.
• Culture and ethnic background can predispose certain ethnic groups to specific cardiac disorders.

Head-to-Toe Cardiac Clues

• This is a review of key assessment findings related to cardiac function
• Serves as a reminder of fundamental concepts covered in earlier courses
• Purpose: Provides an overall review of cardiac-specific assessment parameters.
• Reference: Relates back to concepts covered in first-semester fundamentals.

Physical Examination: Inspection

• The initial step in a physical assessment involves visual inspection to identify potential signs of cardiac issues.
• Skin color should be assessed for signs of various conditions.
  • Cyanosis is a bluish discoloration indicating poor oxygenation.
  • Pallor is paleness suggesting reduced blood flow or anemia.
  • Flushing is redness indicating vasodilation or fever.
• Signs of increased respiratory effort should be observed.
  • Labored breathing is difficulty breathing, often accompanied by visible effort.
  • Panting is rapid, shallow breathing.

Overlapping Concepts with Respiratory Disorders

• Symptoms such as cyanosis and clubbing are common to both cardiac and respiratory disorders.
• Key symptoms include cyanosis and clubbing.
• Studying related chapters together enhances comprehension.

Key Cardiac Medications

• Understanding cardiac medications assists in managing various heart conditions
• Jugular Vein Distension (JVD) refers to the prominent visibility of the jugular vein.
• Can indicate underlying cardiovascular issues
• Definition: JVD is a distended jugular vein.
• Assessment Angle: Observe the patient at a 45-degree angle.
• JVD may suggest hypervolemia (excess fluid volume).
• JVD also indicates right-sided heart failure, pericardial tamponade, or constrictive pericarditis.

Edema Assessment

• Edema, particularly dependent edema, happens from fluid accumulation in the interstitial space.
• Assessing edema provides valuable information about a patient's fluid status and potential underlying conditions.
• Dependent edema is located in the lower extremities or other dependent areas of the body.
• Edema severity is graded, often using a scale
• Note whether the edema is pitting (indentation remains after pressure) or non-pitting.

Chest Shape Assessment

• The shape of the chest can provide clues about underlying respiratory or cardiovascular conditions, particularly chronic hypoxic conditions.
• Barrel chest is associated with chronic obstructive pulmonary disease (COPD) and other chronic hypoxic disorders.

Palpation: Point of Maximal Impulse (PMI)

• Palpation involves using touch to assess various aspects of the cardiovascular system.
• The Point of Maximal Impulse (PMI) is a key landmark located during palpation.
• The PMI is normally located on the left midclavicular line, around the fourth to fifth intercostal space.
• The PMI location is the best position to hear heart sounds.
• Have the patient turn to their left side to improve hearing the heart sounds.

Palpation: Peripheral Pulses

• Assessing peripheral pulses is crucial for evaluating arterial blood flow to the extremities.
• Pulse Locations:
  • Radial pulses
  • Pedal pulses
• If radial and pedal pulses are present, it is likely other pulses are also present.
• Check carotid pulses one side at a time.

Peripheral Assessment: Skin Temperature and Color

• Skin temperature and color provide information about peripheral circulation.
• Cool and pale extremities suggest arterial problems.
• Warm and cyanotic extremities suggest venous problems.

Auscultation: Normal Heart Sounds (S1 and S2)

• Auscultation involves listening to heart sounds using a stethoscope. Normal heart sounds, S1 and S2, provide information about the heart's function.
• Normal Heart Sounds: Lub-dub, lub-dub.
• S1 (Lub) represents the closure of the mitral and tricuspid valves.
  • It is louder at the apex of the heart and lower pitched.
• S2 (Dub) represents the closure of the aortic and pulmonic (semilunar) valves.
  • It is louder at the base of the heart and higher pitched than S1.

Auscultation: Abnormal Heart Sounds (S3 and S4)

• Abnormal heart sounds, such as S3 and S4, can indicate underlying cardiac conditions.
• S3 sounds like "Kentucky".
• S3 Heart Sound (Ventricular Gallop) is characterized as a dull, low-pitched sound.
  • It may be normal in children, but in adults, shows congestive heart failure.
  • Represents early diastole filling of the ventricles. Sounds like: "Tennessee".
• S4 Heart Sound (Atrial Gallop) sounds like "Tennessee Tennessee".
  • Heard just before S1, has a higher intensity than S3.
  • Associated with hypertension, aortic stenosis and pulmonic stenosis.
  • Usually not heard in healthy individuals.
• Heart Murmurs are vascular sounds producing vibrations in the heart or great vessels.
  • Can result from stenosis (narrowing of a valve) or regurgitation (backflow of blood through a valve).
  • They may be normal but require focused listening to gain experience in identifying the different types of murmurs.
• Blood Pressure measures the systolic and diastolic pressure.
  • Systolic pressure represents stroke volume.
  • Diastolic pressure represents the resistance of blood vessels.
  • Pulse pressure is usually between 30 and 40 mmHg.

Orthostatic Hypotension

• This details the procedure for assessing orthostatic hypotension, which presents as a drop in blood pressure upon standing.
  • Definition: A drop in blood pressure that occurs when standing up from a lying or sitting position.
  • Assessment Procedure:
    • Supine Measurement: Measure blood pressure while the patient is lying down.
  • Sitting Measurement: Measure blood pressure once the patient is sitting up.
    • Standing Measurement: Then standing up.
  • Diagnostic Criteria:
    • Systolic Drop: A decrease of more than 15 mmHg in systolic blood pressure upon standing.
    • Diastolic Drop: A decrease of more than 5 mmHg in diastolic blood pressure upon standing.
  • Significance: Indicates impaired autonomic control of blood pressure regulation.

Diagnostic Assessments

• The importance of considering additional diagnostic assessments is highlighted
• Complete Blood Count (CBC) helps to provide a comprehensive evaluation of a patient's cardiovascular health
  • Elevated Red Blood Cell Count: May indicate the body's compensation for chronic hypoxia (low oxygen levels in the blood).
• Listen to Lung Sounds, especially in patients with suspected heart failure to see Fluid Accumulation
  • Abnormal lung sounds may indicate fluid accumulation in the lungs due to heart failure.
• Combining cardiac auscultation with other assessments provides a more complete picture of the patient's condition.

Vascular Sounds: Murmurs

• Characteristics: The sound is longer compared to normal heart sounds.
• Focus on the heart sounds, specifically listen for what a murmur sound like
  • A "shuttle shuttle shuttle" sound or a swishing sound to gain experience in identifying different types of murmurs.

Blood Pressure

• Definition: The pressure exerted by the blood on the artery walls during ventricular contraction (systole).
• Systolic Blood Pressure Represents stroke volume, which is the amount of blood ejected by the heart with each beat.
• Diastolic Blood Pressure Definition: The pressure exerted by the blood on the artery walls during ventricular relaxation (diastole). Represents: The resistance of the blood vessels to blood flow.
• Systolic pressure may vary slightly between arms.
• Pulse Pressure Definition: The difference between systolic and diastolic blood pressure.

Key Points Regarding Blood

• Excessive Red Blood Cells: The characteristic is an overproduction of red blood cells.
• Blood Viscosity: The increased number of red blood cells causes the blood to become thicker than normal.
• Clinical Significance: High blood viscosity can impair circulation and increase the risk of blood clots and other cardiovascular complications.

Erythrocyte Sedimentation Rate (ESR)

• ESR measures how quickly red blood cells settle at the bottom of a test tube. An elevated ESR indicates inflammation in the body.
• ESR is a non-specific marker of inflammation.
• Myocardial Infarction (MI) or Heart Attack or Infective Endocarditis can elevate ESR
• Non-Specificity: ESR can be affected by various factors, limiting its diagnostic precision.

Blood Cultures

• Used to detect the presence of bacteria or other microorganisms in the blood, indicating a bloodstream infection.
• Blood samples are drawn from two different sites to minimize contamination. The samples are incubated to allow any bacteria present to grow. If bacteria grow, the specific type is identified to guide treatment.

Cardiac Enzymes and Markers

• Cardiac enzymes and proteins are released into the bloodstream when cardiac cells are damaged or die. Measuring these markers helps in diagnosing and assessing the extent of heart damage.
• Cardiac cell damage leads to the release of specific enzymes and proteins.
• These markers identify myocardial damage.
• Creatine Kinase (CK) and Creatine Phosphokinase (CPK) is an enzyme found in the heart, brain, and skeletal muscles. Elevated levels indicate muscle damage.
  • CK-MB Isoenzyme: CK-MB is specific to heart muscle.
  • Elevation Timeline: Elevated within 2-3 hours of heart damage, peaks within 24 hours, and returns to normal in 24-40 hours.
  • Regular CK levels can be elevated due to skeletal muscle damage from exercise or other causes, reducing its specificity for heart damage.

Troponin

• Troponin is a protein found in heart muscle. Elevated levels indicate heart damage.
  • Troponin T: Can be elevated due to skeletal muscle injury and remains elevated for up to 21 days.
  • Troponin I: Highly specific to cardiac muscle damage and is considered the gold standard for detecting myocardial infarction.
• Rises 3 hours after MI, peaks 14-18 hours later and returns to normal in 5-9 days.

B-Type Natriuretic Peptide (BNP)

• Used to assess heart failure, BNP is a hormone released in response to ventricular stretching.
  • Increasing BNP indicates the heart is under stress
  • Severity: The higher the BNP level, the more severe the heart failure
  • A BNP level greater than 100 pg/mL is considered positive for heart failure.

The D-dimer

• Used to rule out the presence of a blood clot. It measures the amount of cross-linked fibrin degradation products (D-dimers) in the blood.
  • A positive D-dimer indicates the presence of a clot.
  • -Conditions that can cause a positive D-dimer: Deep Vein Thrombosis (DVT)
  • Also look for Pulmonary Embolism (PE), Stroke (CVA) and Disseminated Intravascular Coagulation (DIC).

Electrolytes

• These play a crucial role in maintaining fluid balance and proper cardiac function. Monitoring electrolyte levels is essential in patients with heart conditions.
  • Sodium is important for fluid balance.
  • Potassium is required for relaxation of cardiac muscle. Both high and low levels can significantly affect the heart.
  • Calcium is required for contraction of cardiac muscle.
  • Magnesium maintains electrical excitability in nerves and muscles, including the heart.

Cholesterol

• Monitoring cholesterol levels is vital for assessing the risk of heart disease. Different types of lipoproteins have varying effects on cardiovascular health.
  • Total Serum Cholesterol: Desired level is less than 200.
  • High-Density Lipoproteins (HDLs): "Good" cholesterol; want these to be high.
  • Low-Density Lipoproteins (LDLs) & Very Low-Density Lipoproteins (VLDLs): "Bad" cholesterol; want these to be low.
  • Focus on knowing the total cholesterol levels and understanding which lipoproteins are beneficial versus harmful, rather than memorizing specific numbers for LDLs, HDLs, and VLDLs.

Arterial Blood Gases (ABGs)

• These assess the pH, oxygen, and carbon dioxide levels in the blood, providing insights into respiratory and metabolic balance.
• ABGs measure: pH, Oxygen levels, and CO2 levels. Remember ROME: Respiratory Opposite Metabolic Equal
• Normal triglyceride level: Less than 150. High triglyceride level: Greater than 200 is considered elevated. Elevated triglycerides are associated with heart disease.

PT/INR and PTT

• These tests assess blood clotting times, particularly important for patients on anticoagulants like Coumadin (warfarin) and heparin.
  • PT/INR: Used to monitor Coumadin (warfarin) levels. Therapeutic range for patients on warfarin: 2 to 3. Greater than 3: Blood is too thin. Less than 2: Blood is too thick.
  • PTT: Used to monitor heparin therapy.