Cardiovascular Disease

what is hypertension?

the consistent elevation of systemic arterial blood pressure,

how much force needs to be lifted for your heart to perfuse your body

what is primary hypertension?

can be genetic and environmental, your blood vessels are at fault for high blood pressure

what is secondary hypertension?

cause by systemic disease that raises peripheral vascular resistance and or cardiac output

ex: cushings disease, glomerulonephritis

what can cause primary hypertension?

high sodium diets, genetics, obesity, insulin resistance, endothelial cell dysfunction, dysfunction of natriuretic (sodium- releasing) hormones, increased sns activity, increased activity of the RAAS system, low dietary potassium, inflammation, magnesium, and calcium

what are some non-modifiable characteristics of primary hypertension?

family history, aging, sex (males more susceptible, pre menopausal females have hormones to protect against hypertension), race

how can hyperglycemia affect the body? (high blood sugar)

within diabetic patients, hyperglycemia causes endothelial damage to blood vessels,

having diabetes is a risk factor of hypertension

what are the symptoms that come with hypertension?

asymptomatic! which is why hypertension is called the “silent killer”

testing for hypertension?

cbc, kidney panel (BUN, creatine), urinalysis, lipid profiles, EKG, ECHO

how can you reduce the risk of getting hypertension?

low-sodium diets, DASH diet (dietary approaches to stop hypertension), exercise, weight loss, decreasing stress, alcohol moderation, education on risk reduction

what is used to medicate hypetension?

ALWAYS suggest lifestyle changes before any medication

diuretics (helps patient release fluid more often to lower their blood pressure), ACE inhibitors (angiotensin-converting enzyme inhibitors), angiotensin-II receptor blockers (ARBs), calcium channel blockers, beta blockers, aldosterone agonists,

what is hypertensive crisis?

at or above 180/120, MEDICAL EMERGENCY

what can hypertensive crisis lead to?

aneurysms, stroke, retinopathy, atherosclerosis, kidney failure, angina, MI, congestive heart failure

what is atherosclerosis?

a specialized form of arteriosclerosis (artery hardening), macrophages filled with lipids cause a plaque (atheroma) to be deposited to endothelial blood vessel damage

what is atheroma?

an accumulation of cellular debris (lipids/calcium) that lie between the endothelium and smooth muscle

what is atherosclerosis the leading cause to?

coronary heart disease and cerebrovascular disease (strokes)

how does someone get atherosclerosis?

hypertension, smoking, hyperlipidemia, toxins, viruses, inflammation

restriction of which electrolytes is recommended in the management of high blood pressure?

sodium

what is the most reliable indicator that a person is experiencing an acute myocardial infarction (MI)?

ST - segment elevation

a patient with left heart failure starts to have a cough and dyspnea. pulmonary symptoms common to left heart failure are a result of:

pulmonary vascular congestion

a patient presents to the emergency department with a diastolic blood pressure of 132 mm Hg, retinopathy, and symptoms of an ischemic stroke. this symptomology is likely the result of….

hypertensive crisis

a patient with left-sided heart failure is likely to exhibit….

dyspnea

diagnostic tests used to diagnose or confirm MI include…

EKG, electrocardiogram

it can be explained to a patient that high blood pressure increases the risk of….

ischemic heart disease, cerebral vascular accident (stroke), renal disease/real failure

a 65 - year old male with a history of untreated hypertension is now experiencing left heart failure. a nurse recalls his untreated hypertension led to…

myocardial hypertrophy and ventricular remodeling

what does hyperglycemia do to your body?

causes endothelial damage to blood vessels

how to medicate hypertensive patients…

• diuretics

• ace inhibitors

• angiotensin -II receptor blockers (ARBs)

• calcium channel blockers

• beta blockers

• aldosterone agonists

what is atherosclerosis?

a specialized form of ateriosclerosis (artery hardening), macrophages filled with lipids cause a plaque (atheroma) to be deposited due to endothelial blood vessel damage

what is an atheroma?

an accumulation of cellular debris (lipids/calcium) that lie between the endothelium and smooth muscle, tissue wear and tear

what is the leading cause of coronary artery disease and cerebrovascular disease (stroke)?

atherosclerosis

what part of your body does coronary artery disease affect?

the vessels that specifically nourish the heart

what is peripheral artery disease?

disease of the vessels that do not nourish the heart

what are the types of angina?

• stable angina

• unstable angina

• prinzmetal angina

when does stable angina occur?

during physical activity / exertion

what sensation comes from stable angina?

chest tightness / choking sensation

is stable angina short or long? and how much time?

short, 1-5 mins

how do you treat stable angina?

rest and nitroglycerin

what are the two pathways of acute coronary syndrome?

• unstable angina (reversible myocardial ischemia)

  or

• myocardia infarction (irreversible myocardial cell death)

when does unstable angina occur?

during rest

how to treat unstable angina?

does not work: nitroglycerin and rest

when does myocardial infarction happen?

when coronary artery is obstructed (via a thrombus or embolus); can be either fully or partially obstructed

how long does unstable angina last for?

5-10 mins

what is unstable angina a telltale sign for?

MI

what are the types of myocardial infarction?

STEMI (ST-elevation MI), non-STEMI (non-ST elevation MI)

STEMIs are more serious and indicate full blockage of major arteries

what does a MI feel like?

like theres an elephant on your chest, epigastric pain is reported, nausea, vomiting, diaphoresis

when does an MI most common happen?

during the mornings when you first wake up (bec of epinephrine and vasoconstriction), the body demands more in the morning,

as a nurse, how do you treat a patient with a MI?

• 12-lead EKG within 10 minutes of arrival

• IV access

• relieve pain

• treat complications

• restore o2 supply preventing ischemia

• use troponin biomarker

how to manage treatment with MI?

MONA

• morphine

• o2

• nitrates

• aspirin

how to treat a MI surgically?

• coronary artery bypass graft (CABG)

• percutaneous coronary intervention (balloon angioplasty)

• external counter pulsation

what are complications of a MI?

• sudden death

• cardiogenic shock

• congestive heart failure

• thromboembolism’s that can cause strokes

treatment for pain metal angina?

• acutely: nitroglycerins

• for maintenance: calcium channel blockers

what is heart failure?