Cardiovascular Alterations - PDF

Cardiovascular Alterations Dr. Shazam Bacchus Spring 2025 Hypertensive crisis Angina MI Cardiomyopathy Interventional studies Arterial Venous Normal Structure (1 of 2)  Heart  Mediastinal space  Covered by pericardium  Composed of three layer...

Cardiovascular Alterations Dr. Shazam Bacchus Spring 2025 Hypertensive crisis Angina MI Cardiomyopathy Interventional studies Arterial Venous Normal Structure (1 of 2)  Heart  Mediastinal space  Covered by pericardium  Composed of three layers  Epicardium  Myocardium  Endocardium Normal Structure (2 of 2)  Right side is low pressure  Left side is high pressure  Flow of blood  Cardiac valves Autonomic Control  Sympathetic nervous system  Norepinephrine  Parasympathetic nervous system  Acetylcholine  Chemoreceptors  Baroreceptors Cardiac Function  Coronary circulation  Conduction system  Hemodynamics  Heart sounds  S1, S2, S3, and S4  Heart murmur  Turbulent blood flow through valves Heart Murmur  Caused by a turbulence of blood flow through the valves  Rumbling, blowing, harsh, or musical in sound  Identify location, sound, loudness, and intensity and whether other heart sounds are heard Coronary Artery Disease (CAD)  Progressive narrowing of coronary arteries by atherosclerosis  Coronary heart disease  Atherosclerotic heart disease Pathophysiology of CAD (1 of 3)  Injury to epithelial cells in intima  Platelet aggregation  Migration of monocytes  Lipoproteins enter intima  Fatty streak  Monocytes develop into macrophages  Lipid-rich "foam cells” develop  Atheroma Pathophysiology of CAD (2 of 3)  Damage to intima  Liberates platelet-derived growth factor  Proliferation of smooth muscle cells  Fibrous cap forms  From connective tissue and low-density lipoprotein (LDL)  Fibrous cap often ruptures  Thrombus  Clotting cascade initiated Pathophysiology of CAD (3 of 3)  Adhesion: platelets bind to receptors  Activation: platelets change shape and activate receptors  Release: thromboxane A2 and serotonin  Activate glycoprotein IIb/IIIa receptors  Aggregation: platelets clump together  Drugs administered to stop the process  Aspirin  Glycoprotein IIb/IIIa inhibitors Risk Factors Nonmodifiable factors Modifiable  Age  Smoking  Men > 45 years  Inactivity  Women > 55 years  Overweight  Family history  Cholesterol  High LDL  Low levels of HDL  Diabetes  Hypertension History  Risk factors  Prior hospitalizations  Shortness of breath, chest pain  Medications  Erectile dysfunction meds if considering nitroglycerin  Psychosocial history  Include stressors Diagnostic Studies (1 of 3)  12-lead electrocardiogram (ECG)  Holter monitor  Exercise tolerance test (stress test)  Exercise to increase demand on heart  Stressed via drugs (e.g., adenosine) if patient cannot tolerate exercise  Monitoring vital signs, ECG  Pharmacological stress testing  Nuclear stress testing  Chest x-ray Diagnostic Studies (2 of 3)  Echocardiography  Ultrasound to visualize cardiac structures  Transesophageal echocardiography  Multigated blood pool study (MUGA scan) Diagnostic Studies (3 of 3)  Positron emission tomography (PET scan)  Cardiac magnetic resonance imaging Cardiac Catheterization and Arteriography  Electrophysiology study  Catheter (right or left)  Heart pressures (similar to PA catheter)  Cardiac output  Arteriography  Visualize blood vessels Post-catheterization Care  Bed rest; head of bed no higher than 30 degrees  Monitor bleeding; newer collagen agents for hemostasis may be used  Monitor pulses  Antiplatelet drugs after the procedure (usually after interventions such as PCI)  May be discharged in 6 to 8 hours; depends on diagnosis and procedures done in catheterization laboratory Laboratory Tests  CBC  Hemoglobin  Hematocrit  Sodium  Potassium  Calcium  Magnesium Cardiac Enzymes  Troponin I and T  As early as 1 hour after injury  Normal values less than 0.5 mcg/L for Troponin I  Normal values less than 0.1 mcg/L for Troponin T Cholesterol in CAD  Categories  HDL is considered good  LDL is considered bad LDL Target Levels (NIH)  No CHD and fewer than two risk factors o 160 mg/dL  No CHD and two or more risk factors o 130 mg/dL  CAD o