Common Health Conditions of the Cardiovascular System PDF Fall 2024

COMMON HEALTH CONDITIONS OF THE CARDIOVASCULAR SYSTEM TIMOTHY OLADOSU HYPERTENSION Blood pressure is the pressure exerted on the walls of blood vessels because of cardiac output and volume of circulating blood Hypertension (HTN), also known as high blood pressure, is defined as persistent e...

COMMON HEALTH CONDITIONS OF THE CARDIOVASCULAR SYSTEM TIMOTHY OLADOSU HYPERTENSION Blood pressure is the pressure exerted on the walls of blood vessels because of cardiac output and volume of circulating blood Hypertension (HTN), also known as high blood pressure, is defined as persistent elevated arterial blood pressure A systolic blood pressure at or above 140mmHg or a diastolic blood pressure at or above 90mmHg indicates hypertension High blood pressure can be viewed in three ways; as a sign, a risk factor for atherosclerotic cardiovascular disease, or a disease  The two main types of hypertension are essential (primary) hypertension and secondary hypertension Essential (primary) hypertension makes up the majority of all diagnosed cases. There is no agreement on the cause, but there are risk factors (modifiable & nonmodifiable) Nonmodifiable risk factors are; Age (> 30years); Gender (Men); Race (African Americans); Family history Modifiable risk factors are Smoking (nicotine constricts blood vessels); Obesity (associated with increased blood volume); High-sodium diet (increases water retention, which increases blood volume); Elevated serum cholesterol (leads to atherosclerosis and narrowing of blood vessels); Oral contraceptives or estrogen therapy; Alcohol (increases plasma catecholamines (biologically active amines, epinephrine, norepinephrine), which leads to blood vessel constriction); Emotional stress (stimulates the sympathetic nervous system, which leads to blood vessel constriction); Sedentary lifestyle (regular exercise helps lower blood pressure over time)  Secondary hypertension is attributed to an identifiable medical diagnosis (such as, Renal vascular disease; Diseases of the adrenal cortex; Coarctation of the aorta; cranial tumor; Pregnancy-induced hypertension Secondary hypertension subsides when the primary disease process is treated or corrected The results of untreated secondary hypertension can lead to atherosclerosis; aneurysms; heart failure; weakened or narrowed vessels in the kidneys; thickened, narrowed, or torn vessels in the eyes; metabolic syndrome; trouble with memory or understanding Malignant hypertension is a severe, rapidly progressive elevation in blood pressure (diastolic pressure greater than 120 mm Hg) that causes damage to the small arterioles in major organs (heart, kidneys, brain, eyes) Unless medical treatment is successful, the course is rapidly fatal. The most common causes of death are MI, HF, stroke, renal failure  Hypertension is essentially a disease without symptoms until vascular changes occur in the heart, brain, eyes, or kidneys Management is directed at controlling hypertension and preventing complications Drugs used in the management of HTN are; Diuretics (thiazides, loop diuretics, potassium-sparing drugs); Beta-adrenergic blockers (such as metoprolol, nadolol, propranolol, acebutolol, atenolol, bisoprolol, timolol); ACE inhibitors (such as captopril, enalapril, lisinopril); Angiotensin II receptor blockers (such as valsartan, losartan, irbesartan, candesartan, telmisartan); Calcium channel blockers such as diltiazem, amlodipine, nifedipine, felodipine, verapamil); Alpha-agonists (such as clonidine) The main goal for a client with HTN is keeping the blood pressure within normal limits. The regimen is referred to as a stepped-care approach  The first step is to encourage the client to try some diet and lifestyle changes, including; losing weight if >15% over optimum weight; limiting sodium, saturated fat, cholesterol, and alcohol intake; exercising on a regular basis; stopping the use of nicotine; maintaining an adequate intake of calcium, magnesium, and potassium If the BP still remains high, the second step is the addition of a diuretic or a beta blocker to the client’s care regimen. The client is again evaluated for a period of time, usually 2 months If the BP still is not < 140/90mmHg, the third step of increasing the drug dosage, trying another drug, or adding a second antihypertensive drug from another class of drugs is implemented. If the BP is maintained at < 140/90mmHg, the regimen is continued If the BP is still high, the last step is implemented by adding a second or third antihypertensive drug Nonpharmacologic therapy includes; lose excess weight; exercise regularly; reduce saturated fat; limit alcohol intake; consume enough potassium, calcium and magnesium; reduce sodium intake; stop smoking; use relaxation technique and stress management ANGINA PECTORIS Angina pectoris refers to the paroxysmal (severe, usually episodic) thoracic pain and choking feeling caused by decreased oxygen flow to or lack of oxygen (anoxia) of the myocardium. Angina means a spasmodic, cramp-like, choking feeling. Pectoris refers to the breast or chest area Angina pectoris occurs when the cardiac muscle is deprived of oxygen. Atherosclerosis of the coronary arteries is the most common cause Stable AP occurs when the patient develops symptoms of chest pain during activity but goes away upon rest or taking medication (nitroglycerin). Unstable AP occurs when the patient has an increase in the severity and frequency of chest pain that is not alleviated with rest or nitroglycerin. If unstable angina cannot be relieved, it may precipitate a MI Manifestations include pain (pressure, burning, squeezing, fullness), mild indigestion, shortness of breath, nausea and vomiting, pallor, diaphoresis, dizziness or lightheadedness Nitroglycerin is standard treatment for angina pectoris, and it is a medication patients are encouraged to carry with them at all times to alleviate episodes of angina pectoris Use of IV nitroglycerin is contraindicated in patients with a systolic pressure of less than 90 mmHg QUIZ Which of the following statements is true? The pain of an MI usually is sudden, sharp, and severe, but lasts for a brief period of time The pain of angina can be relieved with sublingual nitroglycerin Thrombolytic medications are used to prevent angina symptoms Rest and nitroglycerin usually do not relieve the pain of angina  MYOCARDIAL INFARCTION Myocardial infarction (MI), or heart attack, is the necrosis (death) of heart muscle. It is caused by a severe reduction or cessation of blood flow through coronary arteries to the heart muscle. Lack of blood flow results in ischemia which results in cellular death The extent to which a myocardial infarct impairs the heart’s ability to pump blood volume depends on the location and severity of the ischemic episode The obstruction is caused either by an atherosclerotic plaque, rupture of atherosclerotic plaque, embolus. Other potential causes of MI include drug use, coronary artery anomalies, aortic dissection Manifestations include pain, shortness of breath, dizziness, weakness, anxiety, fear, unusual fatigue Management is designed to restore cardiac tissue perfusion and reduce the workload of the heart. Promoting tissue oxygenation, relieving pain, preventing complications, improving tissue perfusion, preventing further tissue damage The mnemonic MONA (Morphine, Oxygen, Nitroglycerin, and Aspirin) is used for this drug therapy regimen HEART FAILURE Heart failure (pump failure) is the inability of the heart to work effectively as a pump Major types of heart failure are; left-sided heart failure (congestive heart failure); right-sided heart failure; high-output heart failure Causes of LHF include hypertension, coronary artery disease, valvular disease, pulmonary congestion LHF can be divided into 2 subtypes; systolic heart failure and diastolic heart failure SHF (forward failure) results when the heart cannot contract forcefully enough during systole to eject adequate amounts of blood into the circulation. Cardiac output is decreased and there’s fluid back up in the pulmonary system DHF occurs when the left ventricle cannot relax adequately during diastole, thus preventing the ventricle from filling with sufficient blood to ensure adequate cardiac output HHF occur when cardiac output remain normal or above normal. Is caused by increased metabolic needs or hyperkinetic conditions, such as septicemia, high fever, anemia, hyperthyroidism  RHF occurs when the R ventricle cannot empty completely, as a result of left ventricular failure, right ventricular MI, pulmonary hypertension. It leads to increased volume and pressure in the venous system plus peripheral edema Common causes and risk factors for HF are hypertension, coronary artery disease, cardiomyopathy, substance abuse (alcohol, illicit drugs), valvular disease, congenital defects, cardiac infections & inflammations, dysrhythmias, DM, smoking/tobacco use, family history, obesity, severe lung disease, sleep apnea, hyperkinetic conditions (hyperthyroidism) Manifestations of LHF include; fatigue, weakness, oliguria at day (nocturia at night), angina, confusion, restlessness, dizziness, tachycardia, palpitations, pallor, weak peripheral pulses, cool extremities, cough (worse at night), dyspnea, crackles or wheezes in lungs, frothy sputum, tachypnea Manifestations of RHF include; jugular (neck pain) distention, enlarged liver and spleen, anorexia, nausea, edema on the legs and sacrum, distended abdomen, swollen hands and fingers, polyuria at night, weight gain, raised BP (from excess volume) or low BP (from failure)  Commonly used drugs for pts with systolic HF are; Angiotensin-converting enzyme (ACE) inhibitors e.g., enalapril, fosinopril. They are first-line drug of choice Diuretics (loop; potassium sparing) e.g., furosemide. They are most effective for fluid volume overload Human B-type natriuretic peptides e.g., nesiritide. They are used to treat acute HF Nitrates Inotropics (beta-adrenergic agonists; phosphodiesterase inhibitors; calcium sensitizers; digoxin) Beta-adrenergic blockers Other nonsurgical options are continuous positive airway pressure; cardiac resynchronization therapy, investigative gene therapy Heart transplantation is the ultimate surgical choice for end-stage HF CARDIOMYOPATHY Cardiomyopathy is a term used to describe a group of heart muscle diseases that primarily affect the structural or functional ability of the myocardium. This primary dysfunction is not associated with CAD, hypertension, vascular disease, or pulmonary disease Cardiomyopathies are classified into two: primary (dilated, hypertrophic, or restrictive) & secondary Dilated cardiomyopathy: is the most common type, characterized by ventricular dilation Hypertrophic cardiomyopathy: this results in increased size and mass of the heart because of increased muscle thickness (especially of the septal wall) and decreased ventricular size Restrictive cardiomyopathy: here, the ventricular walls are rigid, thus limiting the ventricles’ ability to expand and resulting in impaired diastolic filling  Secondary cardiomyopathy include (1) infective (viral, bacterial, fungal, or protozoal myocarditis); (2) metabolic; (3) severe nutritional deprivation such as in anorexia nervosa; (4) alcohol (large quantities consumed over many years leading to dilated cardiomyopathy); (5) peripartum (unexplained cause; may develop in the last month of pregnancy or within the first few months after delivery); (6) drugs (doxorubicin or other medications) ; (7) radiation therapy; (8) systemic lupus erythematosus; (9) rheumatoid arthritis; and (10) “crack” heart, caused by cocaine abuse Manifestations are angina, syncope, fatigue, and dyspnea on exertion, severe exercise intolerance, peripheral edema, ascites, hepatic dysfunction Management consists of treatment of the underlying cause and HF management to slow the progression of the disease and symptoms. Medications may include diuretics, ACE inhibitors, antidysrhythmics, and beta-adrenergic blockers. An automatic internal defibrillator occasionally is implanted In patients with advanced disease that is not responding to medical treatment, cardiac transplantation CARDIOGENIC SHOCK Cardiogenic shock occurs when the actual heart muscle is unhealthy and pumping is directly impaired It occurs when the heart’s ability to contract and to pump blood is impaired and the supply of oxygen is inadequate for the heart and tissues Myocardial infarction is the most common cause of direct pump failure. Other causes or risk factors are; Cardiac arrest; Ventricular dysrhythmias (fibrillation or tachycardia); Cardiac amyloidosis; Cardiomyopathies (viral or toxic); Myocardial degeneration In cardiogenic shock, cardiac output is compromised. Impaired tissue perfusion weakens the heart and impairs its ability to pump blood forward, the ventricle does not fully eject its volume of blood at systole As a result, fluid accumulates in the lungs. Patients with this condition may experience angina pain and develop dysrhythmias and hemodynamic instability  The goals of medical management are to limit further myocardial damage and preserve the healthy myocardium and improve the cardiac function by increasing cardiac contractility, decreasing ventricular after load and also increase oxygen supply to the heart muscle Monitoring arterial blood gas values and pulse oximetry values helps to indicate whether the patient requires a more aggressive method of oxygen delivery Appropriate fluid is necessary in treating cardiogenic shock. Incremental intravenous fluid boluses are cautiously administered to determine optimal filling pressures for improving cardiac output NB: A fluid bolus should never be given quickly because rapid fluid administration in patients with cardiac failure may result in acute pulmonary edema CARDIAC ARREST & CARDIOPULMONARY RESUSCITATION Cardiac arrest is the sudden cessation of cardiac output and circulatory process Conditions leading to cardiac arrest are severe ventricular tarchycardia, ventricular fibrillation, ventricular asystole Manifestations include abrupt loss of consciousness with no response to stimuli, gasping respirations followed by apnea, absence of pulse (radial, carotid, femoral, and apical), absence of blood pressure, pupil dilation, pallor, cyanosis CPR is initiated immediately. The aim is to reestablish circulation and ventilation; prevention of severe damage to the brain, heart, liver, and kidneys as a result of anoxia (lack of oxygen) Cardiopulmonary resuscitation (CPR) is a technique of basic life support for the purpose of oxygenating the brain and heart until appropriate, definitive medical treatment can restore normal heart and ventilatory action https://allsaintsuniversity.instructure.com/courses/1433/files/122429/download?download_fr d=1 INFECTIVE ENDOCARDITIS Infective endocarditis is an infection or inflammation of the endocardium (the inner lining of the chambers and valves of the heart) Cases of infective endocarditis is due to bacterial infection (80%-90%) with streptococci, staphylococci, and enterococci; Fungal endocarditis (