Exam 3 - Hinkle Ch. 23, 25, and 27

what is the most common type of cardiovascular disease in adults?

coronary artery disease (CAD)

what is the most common reason for cardiovascular diseases?

ATHEROSCLEROSIS!!!

what is the most common symptom of CAD?

angina pectoris

CAD - 4 atypical symptoms that women experience?

1. indigestion

2. nausea

3. palpitations

4. numbness

CAD - which patients are most likely to experience shortness of breath?

patients who are OLDER or have a history of diabetes or heart failure

CAD - besides angina, what are 2 other symptoms that ANY patient may experience?

1. epigastric distress

2. pain that radiates to the jaw or left arm

MI - what is seen on the ECG?

T wave is very elevated!!

angina - what is seen on the ECG?

T wave is INVERTED!!

CAD - MODIFIABLE risk factors

• elevated LDL/low HDL (cholesterol abnormalities

• tobacco use

• HTN

• diabetes

• metabolic syndrome

• PAD/AAA

• HLD

• obesity/physical inactivity

• chronic inflammatory conditions/CKD

statins - 4 examples

1. Zocor

2. Lipitor

3. Crestor

4. Pravachol

statins - most commonly prescribed? most potent? least side effects?

• Lipitor = most commonly prescribed

• Crestor = most potent

• Pravachol = LEAST SIDE EFFECTS/decrease cholesterol the least

CAD - NONMODIFIABLE risk factors

• family history of CAD

• increasing age

• gender

• race

• history of premature menopause

• primary hypercholesterolemia

statins - which lab tests should we monitor?

LIVER FUNCTION TESTS!!!! (Alk Phos, AST, ALT)

CAD - 7 methods of prevention

1. CONTROLLING CHOLESTEROL LEVELS

2. dietary measures

3. physical activity

4. medications (STATINS!!)

5. cessation of tobacco use

6. manage HTN

7. control diabetes

when must patients carry nitroglycerin?

ALL the time, in the chance that angina can happen at any moment, especially moments of exertion

nitroglycerin - how can it be inactivated? how can this be prevented?

by light, heat, air, moisture, and time

• can be prevented by keeping it in its original dark bottle, protecting the light/air from getting in

nitroglycerin - when should it be taken?

take in ANTICIPATION of any activity that may produce pain, such as any sort of exercise OR while pain has started

nitroglycerin - how often should patients renew their supply?

EVERY 6 MONTHS

nitroglycerin - possible side effects (4)

• flushing

• THROBBING HEADACHE

• hypotension

• tachycardia

nitroglycerin - if the pain is severe, what can the patient do?

CRUSH THE PILL, to help accelerate the distribution of the medication

nitroglycerin - how many can they take before needing to call 911? how often should they take them?

• 1 pill every 5 minutes, maximum of 3 pills in a span of 15 minutes (IF NO PAIN RELIEF, CALL 911)

heart failure - what is it? what is it characterized by?

the inability of the heart to pump sufficient blood to meet the needs of the tissues for oxygen and nutrients; characterized by fluid overload and inadequate tissue perfusion

heart failure - indicates a problem with either what 2 things?

1. contraction of the heart (systolic failure)

2. filling of the heart (diastolic failure)

heart failure - right sided (manifestations)

• visceral/peripheral congestion

• JVD

• dependent edema

• hepatomegaly

• ascites

• weight gain

heart failure - left sided (manifestations)

• pulmonary congestion (crackles)

• S3 or ‘ventricular gallop”

• dyspnea on exertion (DOE)

• orthopnea

• dry, nonproductive cough initially

• oliguria

• paroxysmal nocturnal dyspnea

heart failure assessment - CONGESTION (chart 25-1)

• dyspnea

• orthopnea

• PND

• cough (recumbent or exertional)

• pulmonary crackles

• weight gain (rapid)

• dependent edema

• abdominal bloating

• ascites

• JVD

• sleep disturbance

• fatigue

heart failure assessment - POOR PERFUSION/low CO (chart 25-1)

• decreased exercise tolerance

• muscle wasting or weakness

• anorexia or nausea

• unexplained weight loss'

• lightheadedness or dizziness

• unexplained confusion or altered mental status

• resting tachycardia

• daytime oliguria with recumbent nocturia

• cool or vasoconstricted extremities

• pallor or cyanosis

NYHA Staging of HF (classes)

• Class I = no limitation of ordinary level of activity

• Class II = mild limitation of ordinary level of activity

• Class III = marked limitation of activity; patients experience symptoms with exertion

• Class IV = patients experience HF symptoms at rest

what is ejection fraction? what is a normal percentage?

reflects the left ventricle function (amount of blood being ejected out); normal = 60-65%

BNP (brain natriuretic peptide) - what is it?

a cardiac enzyme that is released in response to HF

BNP - what does a level above 150 mean?

a flare-up of heart failure

HF medications - diuretics (which one is primarily used? what lab value should you watch? what would you do if significant?)

• primarily use lasix

• WATCH POTASSIUM!!

• if significant enough, try switching to a potassium-sparing diuretic, such as spironolactone

HF - 3 types of medications used

1. diuretics

2. betablockers

3. ACE inhibitors

HF - ACE inhibitors (what are they meant to do?)

CONTROL BP

HF - betablockers (3 examples)

1. carvedilol

2. bisoprolol

3. metoprolol

HF - ACE inhibitors (2 examples)

1. lisinopril

2. enalapril

which 2 food groups should be encouraged when on a LOW sodium diet?

1. fruits and vegetables

if on a low sodium diet, what should patients do when looking at food labels?

look for keywords such as “salt” and “sodium”

additives in food - sodium alginate? sodium benzoate? disodium phosphate? WHAT PURPOSE DO THEY SERVE IN FOOD?

1. sodium alginate = improves food texture

2. sodium benzoate = preservative

3. disodium phosphate = improves cooking quality in certain foods

does municipal (tap) water contain sodium? how about water softeners?

YES for both

salt substitutes - what is recommended about them?

they should contain a high potassium content

what is important to know about low-sodium diet adherence?

• one should not do severe restrictions or cut out all sodium; one should try to find flavors that he or she likes that contain minimal sodium to suit the patient’s preferences

hypertension - what is it?

blood pressure that is sustained over 140/90 over a span of 2 BP readings on separate occasions

hypertension - risk factors

• advancing adult age

• african american

• CKD

• DM

• excessive alcohol consumption

• family history

• gender (men = increased risk BEFORE 64 yo; women = increased risk AT/AFTER 64 yo)

• hypercholesterolemia

• overweight/obesity

• poor diet habits

• sedentary lifestyle

• tobacco/nicotine product use

• stress

• sleep apnea

blood pressure classifications (normal - HTN crisis)

• normal = less than 120/80

• prehypertension = 120-139/80-89

• stage 1 = 140-159/90-99

• stage 2 = 160 or higher/100 or higher

• HTN crisis =180 or higher/110 or higher

what does DASH diet mean?

• Dietary Approaches to Stop Hypertension

DASH diet - grains/grain products (number of servings daily?)

7-8

DASH diet - vegetables/fruits (number of servings daily?)

4-5

DASH diet - low-fat/fat-free dairy foods (number of servings daily)

• 2-3

DASH diet - lean meat, fish, and poultry (number of servings daily?)

LESS than 2

DASH diet - nuts, seeds, and dry beans (number of servings weekly?)

• 4-5 WEEKLY servings

which race is most known for HTN? 2 others?

AFRICAN AMERICANS!!

1. white Caucasians

2. Hispanic

primary vs. secondary HTN?

• primary = 95% of all HTN; NO IDENTIFIED CAUSE (most likely due to risk factors)

• secondary = 5% of all HTN; FROM AN IDENTIFIED CAUSE, such as CKD, renin excretion, and sleep apnea

hypertensive emergency vs. hypertensive urgency?

• hypertensive emergency (malignancy) = BP is so high that we need treatment right away or there will be DAMAGE TO EYES AND KIDNEYS (fix by using IV dilators)

• hypertensive urgency = BP is high, but there is no evidence of impending target organ damage (fix by treating ORALLY)