Cardiovascular Part 1 PDF

Cardiovascular Part 1: Chest pain, Coronary artery disease, Carotid artery disease, Murmurs Adult 2 Jessica Dong, DNP, FNP-BC U.S Heart Disease Statistics Heart Disease (HD) is the leading cause of death in the U.S. Projection for 2035: 45.1% U.S. population will have some form of HD Estim...

Cardiovascular Part 1: Chest pain, Coronary artery disease, Carotid artery disease, Murmurs Adult 2 Jessica Dong, DNP, FNP-BC U.S Heart Disease Statistics Heart Disease (HD) is the leading cause of death in the U.S. Projection for 2035: 45.1% U.S. population will have some form of HD Estimated direct & indirect cost: Direct costs $318 billion to $749 billion Indirect costs $237 t0 $368 billion Virani et al., 2020 Non-Remediable Risk Major Remediable Other Risk Factors for Factors for CAD Risk Factors for CAD CAD Genetics/Family Hyperlipidemia Obesity History Advanced Age HTN Lack of exercise Smoking Left Ventricular Hypertrophy (LVH) DM Impaired glucose tolerance Physiological Changes in the Heart w/Aging Structural & physiological changes include... Decreased capacity to endure stress Limited functional reserve Maximum HR decreases Fat deposits in the sinoatrial (SA) node Pacemaker cells decrease as we age Physiological Changes Cont’d Baroreceptors are less sensitive (aorta & carotid sinus) leading to a blunted response with BP changes Maximum HR decreases approx. 30% between ages 20 & 80 Cardiac dilation & increased stroke volume compensate somewhat for the diminished HR during exercise Key Symptoms for CV Assessment Dizziness Syncope Palpitations Dyspnea/Dyspnea on Exertion Angina Chest Pain Edema Claudication Baseline ADLs and IADLs Onset, location, duration, characteristics, aggravating & relieving factors, timing (s/s @ rest or w/ activity) Cardiovascular ROS Cont’d Chest pain may present as heartburn or indigestion, jaw pain SOB is a common symptom of an acute coronary event Atypical Presentation of MI includes vague symptoms... Nausea & vomiting Decreased ADL status/fatigue w/o chest pain (women & diabetes) Chest Pain ★ Provoked by physical exertion ★ Provoked by eating a heavy meal Pain may radiate: ★ Jaw ★ Left arm ★ Both arms ★ Left side of neck ★ Back pain Other symptoms: ★ Diaphoresis ★ Elderly, Females, & Diabetics often may have an atypical presentation: SOB, DOE, weakness, N&V, fatigue, syncope Coronary Artery Disease Acute Coronary Syndrome (ACS) Plaque rupture or erosion with thromboses (true medical emergency) 1. ST Elevation Myocardial Infarction (STEMI) ★ Q wave MI ★ Transmural MI (full thickness injury) 2. Non-ST Elevation MI (NSTEMI) ★ non Q wave MI ★ Subendocardial MI (partial thickness injury) 3. Unstable Angina ACS Symptomatology Gradual onset of intense chest pain Steady chest pain Substernal discomfort Squeezing, Crushing, Tightness, Band-like Pain or discomfort at rest Angina relieved by Nitroglycerin or Rest Pain can radiate to the jaw, arm, back May be provoked by physical activity emotional upset, or heavy meal Acute Coronary Syndrome (ACS) Physical Exam: o Diaphoresis o Palpitations o SOB o Watch for atypical presentations such as indigestion, nausea/vomiting, new onset fatigue 21  STEMI EKG Criteria New ST elevation @ J point in 2 contiguous leads of ≥ 1 mm (0.1 mV) In any of the leads other than leads V2-V3 Leads V2-V3 ≥2mm (0.2 mV) in men ≥40 years ≥2.5mm (0.25 mV) in men