N120 Martin CARDIO

Preload

• Volume of blood received by the ventricles at the end of diastole, right before heart contracts

• Increase in preload results from…

  • Hypovolemia: increased blood fluid → increased blood volume

  • Valvular regurgitation: heart valve leaks or blood flows backwards into the heart chamber.
    Adds extra blood on top of what’s coming in

  • Heart failure: heart can’t pump out effectively so blood starts to back up

Afterload

• Pressure or resistance the heart has to overcome to eject/ pump out blood of the ventricles

• Think: push the heart must make to get blood into arteries

• Increase in afterload results from…

  • Hypertension
    High BP puts more pressure in the arteries
    Heart must push harder to eject blood

  • Vasoconstriction
    Blood vessels narrow makes it harder for blood to flow out
    Think: squeezing a hose making it harder for water to come out

  • Aortic valve disease
    Tight/narrow valve increases resistance to blood leaving the left ventricle
    I.e. aortic stenosis

  • Increased systemic vascular resistance
    Caused by things like shock, stress, cold, or certain meds
    More resistance = more afterload

Effects of Increased Afterload

• Increased afterload → increased cardiac workload

• The heart has to work harder, uses more oxygen and overtime can wear out and lead to heart failure

• More pressure → more work → more strain

• Key point: increase resistance = increased afterload

Ejection Fraction (EF)

• How effective cardiac muscle pumps

• Measures how much blood (percentage) the left ventricle pumps out with each beat.

• Think: How strong is the squeeze?

• 50% to 70%
  Heart pumps out half or more of the blood it fills with

• Decline in ejection fraction means worsening cardiac function

• EF below 40% = Heart failure (especially systolic or HFrEF)

• The lower the EF, the weaker the pumping ability
  This means less oxygen-rich blood reaches the body

• Key point:
  Lower EF → weak heart pump → worse cardiac output

Cardiac Output

• The amount of blood pumped into the vascular system in one minute

• Formula: HR x SV = CO

• Tells us about overall blood flow to the body

• Normal: 4 to 8 L/min

Mean Arterial Pressure

• The constant pressure within the arterial system

• Average blood pressure that keeps organs alive and working during one full cardiac cycle

• Formula: SBP + 2(DBP) / 3

• Usually presented as a whole number

• Normal range: 70 to 100

• Bare minimum is 60 to show they’re adequate perfusion to kidneys

• Why does it matter?
  ≥60 mmHg = adequately perfuse vital organs
  Too low = organs not enough blood and risks organ failure
  Too high = increased workload on the heart and vessels (high afterload)

Total Cholesterol

• Measures the total amount of cholesterol in the body

• If low in levels → lower risk for cardiovascular disease

• If high levels → increased risk for heart disease and stroke

Triglycerides

• Most common type of fat in the body

• They come from excess calories (especially from sugar, alcohol, and fat)

• Your body stores them in fat cells and uses them later for energy

• The body converts excess food into triglycerides and stores them as fat for energy.

• Extra food (especially sugar/fat) →
  Stored as triglycerides →
  Excess energy in fat form

• If low in levels → lower risk for cardiovascular disease

• If high levels → increased risk for heart disease and stroke

LDL — Bad Cholesterol

• High LDL increases risk of cardiac disease and stroke

• Deposits cholesterol in the walls of the arteries

• This forms plaque, which narrows and hardens arteries (atherosclerosis) making blood harder to flow

HDL — Good Cholesterol

• High HDL

• Help remove bad cholesterol in the blood by carrying it to the liver to be broken down

• Protects the arteries from plaque build up

• LDL = plaque build up

• Plaque buildup = reduces blood flow

• Leads to MI, Stroke or PAD

D-Dimer

• Fragments of fibrin that are in the blood when clots dissolve

• Fibrin is only present in the body when there is a clot

• D-dimer will not tell where the clot is but will indicate that there is a clot present

• Further testing needed to determine location and deductive reasoning
  • CT scan if stroke is suspected
  • Ultrasound if DVT is suspected

B-type Natriuretic Peptide (BNP)

• Hormone released by the heart's ventricles when they are stretched from too much fluid (volume overload).

• It’s the body’s way of trying to get rid of extra fluid.

• Helps diagnose heart failure

• Done when a patient shows signs of heart failure

• The higher the levels, the worse the heart failure

Troponin (Troponin I or T)

• Protein released when the heart muscle becomes damaged

• Best indicator for diagnosing an MI (gold standard)

• Ordered immediately on arrival when MI is suspected

• Rises 2 to 6 hours after an MI (onset of symptoms of MI)

• Stays elevated for 10 to 14 hours

Myoglobin

• Found in cardiac and skeletal muscles

• Not specific to cardiac

• Used alongside other tests like troponin

• Since myoglobin rises (released) earlier than troponin, they use this test to screen

• Still need troponin to actually rule it out

• Rises very early: within 1 to 2 hours

• Helpful in ruling out acute MIs

• If there's no myoglobin rise early on, the heart is probably not damaged.

• It can’t confirm MI

• It just helps exclude MI early if it’s negative

• Helpful to rule out MI early but not good for confirming it

• Positive myoglobin = maybe MI — get troponin to confirm

Creatinine Kinase

• CK is released when heart, brain or skeletal muscle becomes damaged

• CK-MB specific to cardiac muscle

• Won't see an increase until 6 to 8 hours after an MI

• Not for acute settings

• Used after troponin testing

• Rises: 3 to 6 hours after MI

• May be helpful to detect re-infarction (2nd MI)

• Troponin stays high for days while CK-MB drops fast so a new rise suggests new damage

• Used in some settings or if troponin is not available

• Key point:
  CK-MB is no longer the primary test.
  Troponin is preferred. CK-MB may be used in specific cases like re-infarction.

Echocardiogram

• Non-invasive test that uses ultrasound (sound waves) to create images of the heart in motion

• Basically an ultrasound of the heart to check structure, blood flow, valves, ejection fraction and heart motion

• Records:
  • Direction of flow
  • Measures valve abnormalities
  • Congenital
  • Heart defects
  • Wall motion
  • Ejection Fraction
  • Heart function

Purpose

• To diagnose heart failure

• Assess valve disease

• Check post-MI complications

• Monitor chronic cardiac conditions

Per Lewis

• Chamber size and wall thickness

• Wall motion
  To see if any part of the heart isn't contracting properly (common in MI)

• Valve structure and function
  Stenosis, regurgitation, prolapse

• Ejection Fraction (EF)
  To assess pumping strength

• Blood flow direction
  Using Doppler echo

• Doppler echo shows the speed and direction of blood flow through the heart and vessels

• Congenital heart defects
  Holes, abnormal vessels

Stress Echocardiogram

• Combination of exercise test and echocardiogram; while connected to telemetry while being monitored

• Patient is on treadmill or exercise bicycle

• Increase intensity (30 to 40 minutes) unless chest pain or significant change in vital signs

• Transthoracic echo will be performed after

• A heart ultrasound done before and after the heart is "stressed" — either by exercise or medication — to see how well the heart works when it's working harder

Transesophageal Echocardiogram (TEE)

• Immediately done after surgery

• Clear images of…
  • Heart size
  • Wall motion
  • Valve abnormalities
  • Endocarditis vegetation
  • Possible source of thrombi without interference from lungs or chest ribs

• Patient needs to be NPO

Per Lewis

• Detect blood clots, especially in the left atrial appendage (like in atrial fibrillation)

• Evaluate valve problems (like endocarditis or prosthetic valve issues)

• Look for tumors, aortic dissection, or congenital heart defects

• Mild sedation is given

• Simplified:
  Clearer view
  Great for spotting clots, valve issues or infections

Coronary Angiogram / Angioplasty

• Angiogram → Diagnostic

• Angioplasty → Procedure

• Radial or femoral approach

• Diagnose and treat CAD and MI

Nursing Considerations:

• Lay flat for four hours (to 6 hours)
  To prevent bleeding from the artery used during the procedure (especially if femoral)
  For this procedure they have to puncture either femoral or radial arteries. That puncture site needs pressure after the procedure. If patient does not lay flat for at least 4 hours, artery can reopen

• Assess distal blood flow - to make sure blood is still flowing past insertion site
  No blockage, clot or compromised circulation

• Use 6Ps

Complication:

• Bleeding

• Clot formation at site

• DVT

Per Lewis

• Diagnostic test that uses contrast dye and xrays to see if there are blockages or narrowing in the coronary arteries

Coronary Angioplasty

• Treatment done during or after coronary angiogram to open narrowed or blocked arteries

Simplified:

• Angiography → diagnostic; find blockage in heart arteries

• Angioplasty → treatment; open blockages that were found using a balloon or stent

Coronary Artery Bypass or CABG

• Open Heart Surgery

• Bypasses blocked coronary arteries using a healthy blood vessel (graft) from another part of the body

• Restores blood flow to the heart muscle

• Think: re-routing

• Treat CAD and MI

Nursing Considerations

• ICU 24 to 48 hours

• Monitor…
  • BP (hypo/hypertension)
  • Heart rate and rhythm due to risk for arrhythmias
  • Fluid and electrolytes

• Early ambulation is key
  • To prevent DVT, lung expansion, and circulation
  • Speeds up recovery
  • Big issue with early ambulation is usually pain due to altering of rib cage during operation

• Increases risk for PNA so use incentive spirometer

Complications

• Bleeding from incision, chest tube or catheter site

• Anemia from blood loss

• DVT due to immobility

Electrocardiogram (ECG/EKG)

• 2 lead:
  12 perspectives using 10 electrodes

• Diagnoses:
  • Conduction problems
  • MI
  • Cardiac hypertrophy

• At one point in time

• Essential for both acute and routine cardiac evaluations

Before the test:

• Prep skin clean and dry

• If hairy, shave beforehand to avoid artifacts on EKG

• Alcohol wipes to dry skin if electrodes still won’t stick

• Patient is supine or HOB 30 degrees

• Instruct patient to lay still and hold their breath
  • Tiny movements can affect reading

• Only takes 10 seconds to take

Who can perform it?

• CNAs, CMAs, Nurses – as long as they are trained

• Doctors read the results but be aware so proper interventions can be implemented (i.e. calling provider)

• Nurses CANNOT interpret or diagnose based on EKGs

Depolarization or Contraction

• Intracellular: Na+ and Ca2+
• Extracellular: Potassium
• The chamber is DEcompression

Repolarization

• Returning to resting state of ions
• Intracellular: potassium
• Extracellular: Na+ and Ca2+
• The chamber is RE-filling

Conduction of the Heart — Source and Rate

SA

60 to 100 bpm

Pacemaker

AV

40 to 60 bpm

- Back-up generator - Responsible for pausing electrical activity to allow ventricles to fill with blood

Purkinje Fibers

30 to 60 bpm

- Can stimulate some contraction if nodes fail - Last ditch effort

SA Node

• Source: SA

• Rate: 60 to 100 bpm

• Note: Pacemaker

AV Node

• Source: AV

• Rate: 40 to 60 bpm

• Note:

  • Back-up generator

  • Responsible for pausing electrical activity to allow ventricles to fill with blood

Purkinje Fibers

• Source: Purkinje Fibers

• Rate: 30 to 60 bpm

• Note:

  • Can stimulate some contraction if nodes fail

  • Last ditch effort

P wave

• Part: P wave

• Represents: Atrial depolarization/ contraction

QRS complex

• Part: QRS complex

• Represents:
  Ventricular depolarization
  Always evaluated as whole (atrial repolarization)

T wave

• Part: T wave

• Represents:
  Ventricular repolarization
  Should be bigger than p wave
  Asymmetrical

U wave

• Part: U wave

• Represents: Purkinje repolarizing (re-filling)

RR Interval

• Part: RR Interval

• Represents: Length of time between each heart beat per minute

PR Segment

• Part: PR Segment

• Represents:
  Only the flat line between the end of the P wave and start of the QRS
  The delay at the AV node — the time the impulse is briefly paused before being sent to the ventricles
  Electrical delay at the AV node (signal is paused before going to ventricles)

PR Interval

• Part: PR Interval

• Represents:
  Time for impulse to travel from atria to AV node then ventricles
  SA → AV → Ventricles

ST segment

• Part: ST segment

• Represents:
  Time between ventricular depolarization and repolarization
  Time the ventricles are fully contracted and just starting to recover but not contracting again yet
  Time between VD to start of VR
  Think: a pause before they let go
  (Should be flat)

ST Interval

• Part: ST Interval

• Represents: Period between end of ventricular depolarization to complete end of ventricular repolarization

QT Interval

• Part: QT Interval

• Represents:
  Total time for ventricles to depolarize and repolarize
  total time the ventricles are working — from the start of the squeeze to the end of the relax

Normal Sinus Rhythm

• EKG Rate: 60 to 100 bpm

• Rhythm: Regular

• P wave:

  • Uniform in appearance

  • Upright

  • Normal shape

  • One preceding each QRS complex

• QRS complex: Normal

Normal Sinus Bradycardia

• Rate: Less than 60 bpm

• Rhythm: Regular

• P wave:

  • Uniform in appearance

  • Upright

  • Normal shape

  • One preceding each QRS complex

• PR Interval: Normal

• QRS complex: Normal

• Causes:

  • Vagal stimulation

  • Medication toxicity or use:

    • Opioids

    • Benzodiazepine

    • Beta Blockers (digoxin) (Antidote is glucagon)

    • Ca2+ channel blockers

  • Decreased metabolic demand

  Signs and Symptoms:

  • Syncope

  • Fatigue

  • Dizzy

  • Lightheaded

  • Confusion

  • Think: low and slow

  Treatment:

  • Address underlying issue

  • Medication: atropine (speeds up the heart) (Given under physician supervision)

  • Percutaneous pacing:

    • Performed if unresponsive to atropine to buy time

    • Keeps the heart going until something more permanent can be done

    • Pads or wires placed on the skin (like defibrillator pads) to send electrical signals

    • Different from defibrillator; PP is for slow heartbeat, defibrillator is for chaotic or absent heartbeat

  Complications:

  • Low cardiac output

  • Decreased perfusion

  Note:

  • Can be asymptomatic

  • Intervene only if symptomatic

  • Give atropine if severe

Sinus Tachycardia

• Rate: 100 to 160 bpm

• Rhythm: Regular

• P wave:

  • Uniform in appearance

  • Upright

  • Normal shape

  • One preceding each QRS complex

• PR Interval: Normal

• QRS complex: Normal

Causes:

• Physiological stress

• Psychological stress

• Medications:

  • Beta 2 (albuterol)

  • EPI

  • Addy

  • Thyroid medications

  • Molly, coke, meth

Signs and Symptoms:

• SOB

• Palpitations

• Syncope

• Headache

Treatment:

• Address underlying issue

• Medication: Adenosine (if SVT or Supraventricular tachycardia; beats of 150 to 250 bpm)

• Patient awake with EKG, 3 lead monitor, and defibrillator ready

• Adenosine briefly stops heart’s electrical activity for a few seconds

• Warn patient beforehand

• Have defibrillator nearby in case heart does not restart

• IVP fast followed by rapid saline flush

• Short half-life, works 5 seconds or less

• Goal: slow heart rate

• Can be given up to 3 times

• If no improvement → cardioversion

• If no pulse → CPR

Cardioversion:

• Used for organized rhythms

• Sedation needed

• Synchronized electrical shock timed at R wave (avoid T wave)

• Used when meds like adenosine don’t work or patient unstable

Atrial Fibrillation

EKG

• Rate:

  • Atrial → 300 to 600 bpm

  • Ventricular → 120 to 200 bpm

• Rhythm: Irregular

• P wave: Not visible

• PR Interval: Not measurable

• QRS complex: Normal

Causes:

• MI, CAD, HF, heart surgery, valvular disease, COPD

Signs and Symptoms:

• Asymptomatic

• Fatigue

• SOB

• Anxiety

• Dizziness

• Hypotension

Treatment:

• Stable:

  • O2

  • Ca channel and beta blockers to slow ventricular response (bring HR down)

  • Anticoagulants to prevent clots

  • Antiarrhythmics: amiodarone to help restore normal sinus rhythm

• Unstable:

  • O2

  • Synchronized cardioversion - go straight to this without waiting for medication

Notes:

• If a-fib lasted more than 48 hours, there's a higher risk for stroke from clots in the LA

• V fib is more dangerous than afib

Shocking:

• Stable → Cardioversion

  • Synchronized shock

  • Shock delivered during R wave of QRS, low energy used

  • Avoid T wave → vfib

  • Patient needs a QRS complex

  • Need sedation

  • Patient is stable (AFib)

• Unstable → Defibrillation

  • Asynchronized shock

  • Higher energy used

  • Patient is unstable

  • Pulseless ventricular tachycardia or ventricular fibrillation

  • Cardiac arrest

  • Assessment: palpate pulse to determine QRS effectiveness

  • If no pulse → defibrillate

Coronary Artery Disease (CAD)

Pathophysiology:

• Damage of the coronary arteries due to atherosclerosis

• Partial obstruction → ischemia or low O2 causes anginal pain

• Complete obstruction → MI and heart tissue starts to die

Signs and Symptoms:

• Asymptomatic

• Angina

• SOB

• Claudication

• Leg pain (usually in calves) that happens when you walk or exercise and goes away when you rest

• Due to poor blood flow to the leg muscles

• Think: leg version of angina

Diagnostics:

• EKG

• Lipid levels

• Cardiac cath

Medications:

• Acetylsalicylic Acid or ASA - blood thinner and anti-inflammatory drug (aspirin)

  • Used for pain and clot prevention

• Antihyperlipidemic to lower LDL

• Statins

• Other: beta-blockers, nitroglycerin

Treatment:

• Percutaneous coronary intervention (PCI)

  • Non surgical procedure used to treat narrow coronary arteries of the heart found in CAD

  • Also called angioplasty with or without stent

Education:

• Diet modification

  • Low fat, low sodium

• No smoking

• Exercise when tolerated

• Medication adherence

• Recognize signs of angina

Nursing Interventions:

• Monitor

  • Cholesterol

  • HTN

  • DM

• Assess for complications such as MI, Thrombus

Hypertension — Types

• Primary/Essential/Idiopathic

  • No definitive cause

  • Not curable

  • Usually caused by an altered RAAS

• Secondary

  • Caused by another medical condition

Diagnosis

• BP more than 140/90

• Must be elevated on 2 separate visits, at least 2 weeks apart

S/S

• Silent killer

• Fatigue

• Dizziness

• Palpation

• Angina

• Occipital Headache (HA)

• Chest pressure (CP)

• Visual changes

• Epistaxis (nose bleeds)

Management (Nonpharmacological):

• Avoid risk factors

• Heart healthy diet

Medications

Drug	Suffix	Purpose / Notes
ACE inhibitor	-pril	Lowers BP by relaxing blood vessels and reducing fluid; No salt substitutes
Angiotensin receptor blockers (ARBs)	-sartan	Blocks angiotensin II receptors → vasodilation → ↓ BP
Beta blocker	-lol	Slows heart rate & lowers BP to reduce heart workload; Not for congestive heart disease or asthma (bad breathers)
Ca2+ channel blocker	-dipine	Relaxes blood vessels and lowers heart workload; Blocks absorption and excretion of calcium for repolarization and depolarization
Diuretics	-ide	Reduces fluid volume to lower BP
Digoxin	none	Slows heart rate and strengthens contractions (used more in HF/A-fib)

Complications

• Stroke

• Vision loss

• HF or Heart attack

• Kidney disease/failure

• Sexual dysfunction

• Orthostatic hypotension

Catagories

Category	Systolic	Diastolic
Normal	<120	<80
Elevated	120 to 129	<80
Stage 1	130 to 139	80 to 89
Stage 2	140 <	90 <

Hypertensive Emergency

• Onset course to a few days (develops over hours to days)

• BP greater than 220/140

• Target organ damage:

  • Intracranial hemorrhage

  • MI

  • Renal failure

  • Heart failure

Treatment:

• Lower BP with IV antihypertensives: Sodium nitroprusside

• Maintain airway

• Monitor BP every 5 minutes

• Strict one-to-one monitoring because medication can lead to hemorrhagic stroke

• Elevate HOB

• Strict I&O

• High BP can damage kidneys → ↓ urine output → acute renal failure

• Helps catch kidney failure early, guide BP treatment, and balance fluids during a hypertensive emergency

• Lookout for intense HA pain

Hypertensive Urgency

• Onset days to a few weeks

• BP greater than 180/120

• No target organ damage

• Could be due to not taking meds when needed

Treatment:

• Oral antihypertensive medications (captopril)

• Recheck BP after one hour of administration

• If patient does not respond: IV sodium nitroprusside

Simplified:

• High BP w/o organ damage

Angina Pectoris

Definition:

• Chest pain associated with ischemia

• Ischemia: inadequate blood supply to an organ or part of the body especially the heart muscles

Pathophysiology:

• Coronary arteries are narrowed

• Cardiac muscle deprived of O2 especially when there is an increase in O2 demand (exercise or stress)

• Increased workload of the heart

• Temporary ischemia → angina

Causes:

• Times of high O2 demand

• Exercise

• Stress

Signs & Symptoms:

• Chest pain

• Fatigue

• Anxiety

• Pallor

• Diaphoresis

Treatment

• Rest to decrease heart’s oxygen demand

Medication:

• Nitrates

  • Dilate coronary arteries to reduce chest pain

• Calcium channel blockers

  • ↓ HR & BP → reduce heart workload

• Beta Blockers

  • Vasodilation + ↓ contractility

• Anti-platelet

  • Prevent clot formation in narrowed vessels

• Anticoagulant

  • Further clot prevention if unstable angina

Angina Pectoris — Types

• Stable Angina

  • Predictable

  • Pain brought by exertion

  • Narrowed coronary artery

  • Pain is relieved by rest or nitroglycerin

  • Normal ECG

• Unstable Angina

  • Dangerous

  • Medical emergency

  • Pain without exertion

  • Precursor to an MI

  • ECG: inverted T wave or ST depression

Nitroglycerine

Use:

• Treat and prevent angina

• Prevent attacks

• Relieves chest pain from ischemia (low oxygen to heart)

• Given PO, sublingual, transdermal (patch or ointment), or IV

• Nasal spray is alternative for acute use

Action:

• Vasodilator → opens up blood vessels

• Decreases…

  • Vascular resistance

  • Cardiac workload

  • Oxygen consumption

• Decrease results in more blood + oxygen to the heart = less pain

Side Effects:

• Most common side effect is headache (HA)

• Hypotension

• Flushing

Contraindications:

• Phosphodiesterase inhibitors can cause dangerous drop in BP (i.e. viagra)

• Head trauma or increased ICP

• Severe anemia

Dosing for Acute Attack:

• Sublingual or nasal spray

• 1 pill every 5 mins (max 3 doses)

• If chest pain does not go away after the first dose/5 minutes → call 911

Prevention

• Patch/ointment → wear gloves

• Use patch or ointment for ongoing angina control

• Extended release (ER)

  • Prevents angina attacks — not for acute chest pain

Extra Notes:

• If acute:

  • Sublingual tablet or spray

  • IV nitroglycerin if emergency in hospital setting

• For prevention:

  • Transdermal patch, topical ointment or ER PO

Myocardial Infarction

Overview:

• Complete blockage in one or more coronary arteries

NSTEMI:

• Patient is stable

• Partial blockage

• EKG: ST depression

• Troponin elevated

• Treatment: antithrombotics, percutaneous artery surgery

• Weigh patient daily

• Put patient in fluid deficit to reduce heart stress

• Similar to unstable angina but with elevated troponin

• UA is a warning sign — no muscle death yet

STEMI:

• Unstable

• Total blockage

• EKG: ST elevation (infarct)

• Troponin elevated

• Treatment: rapid cardiac catheterization

• Patients may feel the need to poop — do NOT let them (risk for ventricular tachycardia)

• Differentiated from NSTEMI only by EKG

Signs & Symptoms of MI:

• Tightness

• Pain radiating to back, neck, jaw/tooth, shoulder, and arm

• Crushing chest pain

• Left arm pain

• Shortness of breath (SOB)

• Diaphoresis

• Pale skin

Women’s Symptoms:

• May be asymptomatic

• Fatigue

• Shoulder discomfort

• Heartburn

MONA

Initial Treatments for Chest Pain or Suspected MI
(Not given in order)

• Morphine

  • Relieves pain and anxiety

  • Reduces sympathetic drive

  • Decreases O2 demand

  • Caution: Only if chest pain is unrelieved by nitrates

• Oxygen

  • If SPO2 < 90% or signs of hypoxia

  • Improves O2 delivery to heart

• Nitroglycerin

  • Vasodilates and opens coronary arteries

  • Reduces angina, preload, and O2 demand

• Aspirin

  • Antiplatelet to prevent worsening clots

  • Given immediately

Prevention of MI

• Stop smoking

• Diet changes

• Exercise

• Antihypertensive medications

• Cholesterol “statin” drugs

Risk Factors for MI

• Coronary Artery Disease (CAD)

• High cholesterol

• High blood pressure (BP)

• Family history

• High stress levels

• Smoking

Diagnosis & Treatment of MI

Diagnostics:

• Increased troponin + ST elevation = acute MI (STEMI)

• ECG changes:

  • NSTEMI → ST depression or T wave inversion

  • STEMI → ST elevation only

Treatment:

• IV medications

• Thrombolytics or “clot busters” (suffixes: -teplase, -ase)

• Dietary changes: decrease sodium, cholesterol, and caffeine

Peripheral Venous Disease (PVD) vs Peripheral Arterial Disease (PAD)

Feature	Peripheral Venous Disease (PVD)	Peripheral Arterial Disease (PAD)
Problem	Blood can’t get back up from the legs	Blood can’t get down to the legs (insufficient tissue perfusion due to narrowing/occlusion)
Pain	Yes: dull, constant, achy, painful	Yes: sharp, worse at night, intermittent, claudication
Pulse	Yes, but may not be palpable due to edema	Yes, very poor or absent
Edema	Yes: blood pooling in the leg	No: no blood in extremities
Temperature	Yes: warm	No: cool, no blood → cool leg
Color	Brown or yellow; stasis dermatitis	Pale, dry, scaly, thin skin due to decreased O2
Wound	Venous stasis ulcers: irregularly shaped, shallow	Regular-shaped red sores; round, “punched out” appearance
Gangrene	No: too much blood	Yes: tissue death due to lack of blood supply
Positioning	Elevate legs/veins; DO NOT dangle, stand, or sit for long periods	Dangle legs/arteries (dependent position)
Treatment	Keep veins open: elevate legs, aspirin, cholesterol meds, surgery (angioplasty, CABG, endarterectomy)	Get blood moving: dangle legs, daily skin care; DO NOT apply heat (skin fragile)

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Mnemonic to Remember:

• PVD = Volume in Veins go eleVate

• PAD = Arteries dAngle