Cardiovascular System PDF

# Cardiovascular System By Dr. Angela Banks, RN, PhD ## Hypertension - 90% of cases-etiology is unknown - 10% renal disease - Pre-eclampsia of pregnancy - Pheochromocytoma Leads to Secondary Hypertension Benign or malignant tumor of the adrenal gland Adrenalectomy - surgical removal of adrenal g...

# Cardiovascular System By Dr. Angela Banks, RN, PhD ## Hypertension - 90% of cases-etiology is unknown - 10% renal disease - Pre-eclampsia of pregnancy - Pheochromocytoma Leads to Secondary Hypertension Benign or malignant tumor of the adrenal gland Adrenalectomy - surgical removal of adrenal gland ## Classification of BP for Adults | Category | SBP (mmHg) | DBP (mmHg) | | --------------------- | ----------- | ----------- | | Normal | <120 | <80 | | Pre hypertension | 120-139 | 80-89 | | Stage 1 | 140-159 | 90-99 | | Stage 2 | ≥160 | ≥100 | ## Hypertension The image shows a blood pressure gauge with a red needle pointing to "Very High!". Below the needle are the labels "High" and "Normal", both with red lines indicating the normal range. ## Silent Killer! The image shows a side view of a woman's body, with the circulatory system highlighted. The heart is labeled, as well as the kidneys, brain, and blood vessels. Arrows are indicating the direction of blood flow to these organs. On the right side of the image, a list of conditions that chronic high blood pressure can lead to are listed: - Stroke - Blood vessel damage (arteriosclerosis) - Heart attack or heart failure - Kidney failure ## Physiological control of BP in Hypotension - Adrenergic nervous system (Sympathetic) - Baroreceptors in right atrium, aortic arch, and carotid bodies - Renin-angiotensin-aldosterone system (RAAS) ## Antihypertensive therapy - Beta blockers - Propranolol (Inderal) - Nonselective (Block Beta 1 & Beta 2) - Nadolol (Corgard) – Nonselective (Block Beta 1 & Beta 2) - Metoprolol (Lopressor) - Cardio-selective (Block Beta 1 only) - Atenolol- (Tenormin) – Cardio-selective (Block Beta 1 only) - Angiotensin converting enzyme inhibitors (ACE inhibitors) - Benazepril (Lotensin) - Captopril (Capoten) ## Ca Channel Blockers Cardizem (Diltiazem), Procardia, (Nifedipine) | | | | | | ------------------------------- | -------------------------------------------- | ----------------------------------- | ---------------------------------------------------------------- | | Slow the Movement of Calcium in the cell membrane | Increases Arterial Diameter | Slows electrical conduction | Blood vessel dilation | | Decreases Muscle contraction | Vasodilation and a Reduction in Blood Pressure | Decreases Heart Rate | Reduction in the amount of oxygen required by the heart | ## Centrally Acting Adrenergic Inhibitors - Clonidine (Catapres) - Adult dosage is 1 mg BID - Methyldopa (Aldomet) - Adult dosage is 250 mg 2-3 times daily for 2 days The image contains handwritten notes in purple ink, which read "Cross blood bawin buur", and may be a medication instruction that was added after the original presentation. ## Vasodilators - Minoxidil (Loniten) - Vasodilator - Used for Refractory Hypertension (HTN is not controlled by 5 or more drugs, including diuretic) - Nitroprusside (Nipride) Intravenous Medication - Potent and direct vasodilator ## Arteriosclerosis/Atherosclerosis - Arteriosclerosis is a generic term - “Hardening of arteries" - Atherosclerosis is the most common type - Leads to myocardial ischemia (lack of oxygenation to cardiac muscle) The image shows a cross-section of an artery, labeled with different components: - Tear in artery wall - Macrophage cell - Cholesterol deposits - Red blood cell - Macrophage foam cell - Fat deposits ## Unmodifiable Risk Factors Age & Gender The image shows a visual representation of the intima media thickness of a normal versus damaged carotid artery. Plaque buildup within the artery is shown to be a contributing factor to the thickening. Arrows indicate the direction of blood flow in each vessel. ## Genetics The image is a photograph of a man with a pained expression, holding his chest. ## Modifiable Risk Factors - High blood pressure - Smoking - Stress - Hyperlipidemia - Sedentary lifestyle - Obesity The image shows a group of overweight women walking down a sidewalk. On the right side, a woman is shown smoking a cigarette. ## Diabetes Mellitus The image shows a circle with several spokes, each segment labeled with a contributing factor to Type 2 Diabetes. The spokes are: - High fat & cholesterol levels - High blood pressure - Smoking - Overweight - Sedentary lifestyle - Type 2 Diabetes ## Angina Pectoris - Stable angina - Relieved by rest - Unstable angina - Not relieved by rest - More serious - New signs and symptoms ## Treatment for Angina Pectoris - Morphine - Opiate analgesic - Oxygen - Improves oxygen supply - Nitroglycerin - vasodilates veins & arteries - **Side effect of nitroglycerin is a headache** - Aspirin - decreases platelet aggregation ## Myocardial Infarction The image shows a diagram of the heart, with the artery labeled and a blood clot blocking the flow. It shows how the lack of blood flow causes the heart muscle to die. - Occurs predominately in left side of heart - Most common is the left anterior descending (LAD) - Major Pump ## Diagnosis and Screening 12-Lead Electrocardiogram - ST elevation - injury - ST depression - ischemia - Deep and wide Q waves are pathologic - Infarction - Myocardial Infarctions lead to necrosis and death of cardiac tissue - Irreversible The image shows a diagram of the chest, with the electrode placement for a 12-lead ECG. It also shows a section of a heart rhythm strip viewed on an ECG machine. ## Laboratory Tests Cardiac Biomarkers - CPK-MB >3% - Troponin I - <.04ng/mL - Troponin T - <.01ng/mL Elevations in troponin levels usually indicate a myocardial injury: - Myocardial Infarction (Heart Attack) - Elevations may also indicate: - Congestive heart failure - Inflammation of the heart muscle - Emotional Strain caused by (grief & loss) The image shows a patient having blood drawn from a vein in their arm with a syringe and needle. ## Stress Test - Treadmill - Heart's response - Physical activity The image shows a patient walking on a treadmill, with a medical professional monitoring. The patient is wearing an ECG monitoring vest, and there is a computer monitoring the test. ## Drugs - ASA - ↓ platelet aggregation - **Lipid reducing agent** Lovastatin (Mevacor) ↓ Total cholesterol and LDL levels - **Vasodilators** Nitroglycerin (Sublingually) (No more than 3 tablets) **Each tablet 5 minutes apart** The image shows a patient laying in bed with medical professionals assessing them. ## Drugs - Ca Channel Blockers - Used to Dilate coronary arteries - Reduces myocardial oxygen demand by decreasing the blood pressure - Beta blockers - Decrease the HR and contractility Propranolol (Inderal), Carvedilol (Coreg) Labetalol (Normodyne - **Contraindicated** for clients with asthma, emphysema, chronic bronchitis - Anticoagulants **Heparin** will prevent coronary artery thrombosis ## Physical Assessment of the Heart The image shows the location of the heart on a man's chest, with the following areas labeled: - Mid Clavicular Line - Pulmonic Area - Aortic Area - Anterior Axillary Line - Sternum - Tricuspid Area - Mitral Area ## Focused Cardiac Assessment - Location of Pain - Radiation - Quality - Aggravating factors - Alleviating factors ## Percutaneous Coronary Intervention Non-Surgical Procedure Performed in the Catheterization Laboratory The images show a visual representation of before and after a Percutaneous Coronary Intervention (PCI). They represent the narrowing of an artery and the opening of the artery after the procedure. ## Percutaneous Coronary Intervention with Stent Placement The images show a visual representation of before and after a Percutaneous Coronary Intervention (PCI) with a stent. The artery is shown initially narrowed, the stent being placed, and finally with the stent inserted. ## Coronary Artery Bypass Graft (CABG) The images show a visual representation of a heart before and after a CABG procedure. The first image shows a blocked artery, and the second image shows the artery unclogged with a bypass graft. - Restores blood flow to heart muscle - Relieves angina - Prolongs life ## Heart Failure Major Causes of Heart failure - A. Excessive workload (Tachycardia) - B. Hypertension - C. Myocardial Infarction - D. Alcohol Abuse - E. Cocaine Abuse ## Treatment for Heart Failure - Diuretics - Agents that Inhibit the Renin Angiotensin Aldosterone System (RAAS) - *Ace Inhibitors - Cardiac Glycosides - *Digoxin (Lanoxin) - Positive inotropic effects - Negative Chronotropic effects ## Ace inhibitors - Enalapril (Vasotec) - Lisinopril (Prinivil) - Fosinopril (Monopril) - Quinapril (Accupril) - Ramipril (Altace) ## Angiotensin Receptor Blockers (ARBs) - Candesartan (Atacand) - Valsartan (Diovan) - Mechanism of action ARBs block the action of Angiotensin 2 - Results in vasodilation, reduced blood volume - Decreases mortality of heart failure patients