UNIT 1: THE CARDIOVASCULAR SYSTEM (pt.4)

Edema and Weight Gain

Classic signs of Right-Sided Heart Failure and fluid retention

Dependent Edema

Swelling in the lower extremities (ankles and feet) that worsens at the end of the day

Sacral Edema

Seen in bedridden patients as fluid pools in dependent areas

Pitting Edema

Graded from +1 to +4 based on the depth and duration of the indentation

Weight Gain

A sudden ____ of 2 to 3 lbs in a day or 5 lbs in a week is a critical indicator of worsening heart failure, rather than true body mass gain

Palpitations

The subjective sensation that the heart is skipping a beat, fluttering, or beating too fast/hard.

• Arrhythmias

• Non-cardiac causes

Palpitations Causes

Anxiety, stress, caffeine intake, hyperthyroidism, or electrolyte imbalances

Non-cardiac causes in palpitations:

Fatigue

An early warning sign of heart failure or cardiovascular decompensation

Fatigue

Caused by a decrease in cardiac output, resulting in inadequate blood flow and oxygen delivery to skeletal muscles and vital organs

Fatigue

Often described as an overwhelming feeling of exhaustion

Cardiac fatigue

it interferes with basic activities of daily living (ADLs)

Dizziness, Syncope, and Changes in LOC

Indicators of decreased cerebral perfusion

cerebral perfusion

reduced blood flow to the brain

Syncope

A brief lapse in consciousness (fainting).

Postural (Orthostatic) Hypotension

A significant drop in blood pressure when moving from lying/sitting to standing.

Arrhythmias

Bradycardia or ventricular tachycardia severely dropping cardiac output.

Aortic Stenosis

Restricts blood flow leaving the heart, especially during exertion.

Skin and Extremity Changes

Reflects the adequacy of systemic tissue perfusion.

Central Cyanosis

 Bluish tinge in the tongue and buccal mucosa

serious cardiopulmonary failure

 Bluish tinge in the tongue and buccal mucosa indicates ___

Peripheral Cyanosis

Bluish tinge in the nail beds, lips, or earlobes

reduced localized blood flow or cold exposure

Bluish tinge in the nail beds, lips, or earlobes indicates __

Pallor

Pale skin indicating anemia or decreased arterial perfusion

Clubbing of Nails

Thickening of the nail bed due to chronic oxygen deprivation

chronic oxygen deprivation

Thickening of the nail bed due to __

myocardial infarction or cardiogenic shock

Cool, clammy skin often accompanies a ____

Intermittent Claudication

A key manifestation of Peripheral Arterial Disease (PAD)

Intermittent Claudication

A cramping pain, weakness, or fatigue in the calves, thighs, or buttocks that occurs during ambulation (walking).

Intermittent Claudication

Lactic acid buildup due to inadequate arterial oxygen supply to the exercising muscle

Blood Studies

Detect myocardial cellular damage, fluid overload, and risk factors

Non-Invasive Tests

Evaluate electrical activity, wall motion, valvular function, and perfusion

Invasive Tests

Direct visualization of coronary anatomy, intracardiac pressures, and electrical pathways

Troponins (TnI & TnT)

They begin to rise within 3 to 4 hours after injury, peak at 12 to 24 hours, and remain elevated for 1 to 3 weeks

3 to 4 hours ; 12 to 24 hours; 1 to 3 weeks

Troponins (TnI & TnT) begin to rise within ____ after injury, peak at ___, and remain elevated for ____

7–10 days ; 10–14 days

Troponins (TnI & TnT) begin to rise within 3 to 4 hours after injury, peak at 12 to 24 hours, and remain elevated for 1 to 3 weeks (TnI up to ____; TnT up to ____),

Troponins (TnI & TnT)

making them ideal for both acute and delayed diagnosis

< 0.5 ng/mL

Normal Value of Troponin I & T

Troponin I & T

Gold Standard for myocardial injury

Troponin I & T

highly specific to cardiac muscle

3-4 hours

Initial Rise of Troponin I & T

CK-MB

It begins to rise in 4 to 8 hours, peaks at 12 to 24 hours, and returns to baseline within 36 to 48 hours.

4 to 8 hours ; 12 to 24 hours ; 36 to 48 hours

CK-MB begins to rise in ___, peaks at ____, and returns to baseline within ____.

CK-MB

Useful for detecting re-infarction if chest pain recurs

0% - 3%

Normal Value of CK-MB

CK-MB

Isoenzyme specific to cardiac muscle

CK-MB

useful for detecting re-infarction.

4-8 hours

Initial Rise of CK-MB

Myoglobin

An oxygen-binding heme protein found in cardiac and skeletal muscle

Myoglobin

It rises very early (1 to 3 hours post-injury) and peaks at 12 hours.

5 to 70 ng/mL

Normal Value of Myoglobin

Myoglobin

Negative result excludes acute MI early, but lacks cardiac specificity.

1-3 hours

Initial Rise of Myoglobin

acute myocardial infarction

because myoglobin lacks cardiac specificity, a negative result is primarily useful for ruling out ____ early on

Brain Natriuretic Peptide (BNP)

Released in response to increased ventricular wall stretch and fluid volume overload.

Heart Failure

BNP > 100 pg/mL indicates __

cardiac dyspnea ; pulmonary causes

BNP >100 pg/mL indicates heart failure and can help differentiate ____ from ____

PT/INR & aPTT

Baseline monitoring prior to antiplatelet/anticoagulant therapy.

Potassium & Magnesium

Critical for maintaining cardiac rhythm stability

hypokalemia

___ lowers threshold for dysrhythmias