Sys Med 1: Cardiovascular Disorders

Heart is pumping against

- gravity

- pressure of arteries leading away from it

pumping requires

1. energy/oxygen (supplied by blood vessels to heart)

2. organized filling and contraction

The pressure the heart is pumping against is

blood pressure

Describe the relationship between heart and blood pressure

as blood pressure increases, the heart needs to get larger, needs more blood supply

decreasing lumen size, increases resistance

who gets high blood pressure?

- 1 out of 3 adults

- Men > women

who do we screen for HTN

al adults

If we have a higher risk patient, but they have overall good long term prognosis, the the systole goal is

systole should be less than 130

If we have a lower risk patient and they have overall good long term prognosis, the the systole goal is

systole less than 140 or 130

If we have a patient with poor long term prognosis, the the systole goal is

systole less than 150

in 95% of patients, the cause of HTN is

essential --> there no anatomical or physiological case --> its just bound to happen

4 causes of HTN

1. obstructive sleep apnea

2. anxiety

3. alcohol

4. stenosis

HTN is secondary to two other issues

1. Renal Artery Stenosis

2. Hyperaldosteronism

6 things that make HTN worse

1. obesity

2. sodium intake

3. alcohol use

4. smoking

5. sleep apnea

6. lack of exercise

what are 3 non-pharmalogical ways to make HTN better

1. DIET: decrease sodium intake

2. EXERCISE: 30 min daily, 5x a week

3. STOP SMOKING

4. REDUCE ALCOHOL -->

- 2 drinks a day for men under 65

- 1 drink a day for men over 65

- 1 drink a day for women any age

1 drink = 12 oz of beer, 5 oz of wine, 1.5 oz of distilled spirits

3 main medicine categories for treating HTN

1. DIURETICS --> HCTZ or chlorthalidone

2. ACE/ARBS --> ACE: end in "pril"; ARBS end in "-sartan"

3. CALCIUM CHANNEL BLOCKERS: amlodipine

3 main cardiovascular complications that occur due to HTN

1. Atherosclerosis

2. Aortic aneurysms & dissection

3. Peripheral artery disease

what cerebrovascular complication can HTN cause

stroke and TIA

what renal complication can HTN cause

Nephropathy

what ocular complication can HTN cause

Hypertensive retinopathy

what is Dyslipidemia

unhealthy balance of fats in blood

- high LDL (bad cholesterol )

- low HDL (good cholesterol )

- high triglycerides

where do LDL do

accumulate in vessel walls and promotes an inflammatory response

what do HDL do

"pull" lipids out of the blood stream

what is atherosclerosis

cholesterol build up in vessels and make them hard and narrowed

With Dyslipidemia, how do we determine who needs to be treated?

we treat those with LDL greater than 160, use 10 year ASCVD risk calculation

how do we treat Dyslipidemia

- diet and exercise

- STATINS

what causes Coronary Artery Disease (CAD)

atherosclerosis --> which is caused by untreated hypertension and dyslipidemia

who does CAD affect?

#1 killer since 1900

7 risk factors of CAD

1. Hypertension

2. Dyslipidemia

3. Diabetes

4. Tobacco use

5. Chronic Kidney Disease

6. Increasing Age

7. Male gender

symptoms associated with CAD

- narrow arteries --> decreased perfusion

- low grade ischemia --> chest pain and shortness of breath with exertion

how do symptoms present in woman and diabetics

asymptomatic

3 diagnostic tests for CAD

1. Stress Test --> put pt on treadmill and have them walk fast, check to see any symptoms and look at ECG to see if heart isnt getting enough oxygen

2. CAT scan

3. Cardiac Catheterization & angiography

what is the best test to find narrowed arteries

Cardiac Catheterization & angiography

how is CAD treated

- treat HTN and hyperlipidemia as previously mentioned (STATINS)

- Stop smoking

- exercise, diet, weight loss

- Aspirin? --> not really helpful

- Questionable role for stenting

If CAD is not treated, it can progress to

Acute MI

Symptoms of Acute Mi

- unstable angina

- chest pain at rest

- acute heart failure

3 ways to diagnose Acute MI

1. ECG --> looking for ST segment elevation

2. Troponin --> this is a marker, indicating damage to heart

3. Cardiac Catheterization --> we are looking for blocked/narrowed vessels

how to treat Acute Mi

1. Stents --> opening up artery

2. Plavix --> blood thinner, prevents blood clots

what are complications of chronic MI

- Heart Failure

- Most arrythmias

what is the most common diagnosis in hospitalized elderly?

Heart Failure

what causes Heart Failure

1. HTN

2. MI

how does Heart Failure happen

Heart is a pump, pump fails

bc muscle is damaged, the heart cant pump --> there is decreased contractility, increased preload, increased afterload --> leads to circulatory congestion

what is congestive heart failure (CHF)

circulatory congestion secondary to heart failure

- there is volume overload

1 type is Left Sided Heart Failure

what occurs in Left Heart Failure

- Blood to the left side of the heart is returning from the lungs

- if left heart stops working --> blood moves backward and goes into lungs first, then right heart next

Symptoms of Left Sided HF

- Fatigue: lungs cant get enough oxygen to lungs

- Dyspnea: shortness of breath with activity

- Orthopnea: shortness of breath laying down (they are drowning in their own blood)

- Paroxysmal Nocturnal Dyspnea

5 ways to diagnose Left Sided Heart Failure

1. Chest X-ray

2. Echocardiogram

3. BNP levels

4.. Nuclear Medicine studies

5. CT and MRI

What occurs in Right heart failure?

- the right ventricle loses its ability to pump blood efficiently to the lungs

- this causes blood to back up into the systemic veins

Signs and Symptoms of Right HF

- Pedal/ankle edema

- Jugular Venous Distention

- Hepatomegaly

- Pitting Edema

Non-Pharm treatment of HF

1. Diet and Lifestyle

- Fluid restriction

- Salt restriction

- Daily weights

- Alcohol and smoking cessation

2. Treat underlying disorders (HTN, CAD, obstructive sleep apnea, Pulm HTN)

5 Pharm treatment of HF

1. Aldosterone antagonist

2. SGLT2 inhibitors --> Gliflozins

3. Diuretics --> Furosemide

4. Beta blockers --> Carvedilol

5. ACE/ARBs and ARNIs --> Losartan and Entresto

Clinical manifestations of Cardiac Dysrhythmias

1. Palpitations

2. Dizziness

3. Syncope

4. Sudden death

Main cause behind Cardiac Dysrhythmias

Ischemia: CAD, AMI

how are Cardiac Dysrhythmias diagnosed

1. ECG: 12 lead with 2 minute rhythm

2. Holter Monitor &/or Event Recorder

what is most common Cardiac Dysrhythmias

Atrial Fibrillation (A-Fib)

what is Atrial Fibrillation (A-Fib)

- fast and irregular from atria

- caused by HF or Pulm Disease

- risk is for stroke

what is the most dangerous Cardiac Dysrhythmias

Ventricular tachycardia

Describe Ventricular tachycardia

- very very fast

- discoordinated activity

- can be fatal

2 types of valvular heart disease (VHD)

1. Stenosis

2. Insufficiency

Describe Aortic Stenosis

- most common

- caused by aging

- aortic valve connects left ventricle to aorta

- valve gets less compliant and becomes harder and narrows, reducing blood flow, making heart work harder

- signs and symptoms: angina and syncope

Describe Mitral Regurgitation

- mitral valve sits between left atrium and left ventricle

- mitral valve doesnt close tightly, causing blood to leak backward into the upper chamber (left atrium)

- less symptomatic than aortic stenosis

how do we diagnose VHD

listen for murmur (abnormal blood flow)

treatment for VHD

- valve replacement surgery

what is Abdominal Aortic Aneurysm/ AAA

aorta wall weakens and expands forming a "balloon"

risk factors of Abdominal Aortic Aneurysm/ AAA

HTN, hyperlipidemia, smoking, Marfans

how is Abdominal Aortic Aneurysm/ AAA screened?

with ultrasound

what is main complication associated with Abdominal Aortic Aneurysm/ AAA

rupture

what is Aortic Dissection

tear in the wall of the vessel creates false lumen

- caused by HTN

- presents with terrible chest pain

- treat with surgery

what is Giant Cell Arteritis

immune system is attacking linking of temporal artery

what autoimmune disease is associated with GCA

polymyalgia rheumatica

signs and symptoms of GCA

Headache, visual disturbance, jaw claudication

how do we diagnose GCA

temporal artery biopsy

what is Peripheral Artery Disease/ PAD

hardening of arteries that go to calf --> results in reduced blood flow to limbs (specifically legs)

how is Peripheral Artery Disease/ PAD diagnosed

ultrasound

complication associated with Peripheral Artery Disease/ PAD

Poor wound healing, ulcers, and gangrene

what are varicose veins

enlarged, bulging, twisting blood vessels on legs

- occur when weak or damaged valves in the veins allow blood to pool

what is venous insufficiency

long term condition where legs veins fail to return blood back to heart, blood pools in the legs --> legs swell

what is deep vein thrombosis

A blood clot in a deep vein, usually in the legs

- presents with unilateral leg swelling

complication associated with DVT

clot can break and go to lungs --> Pulmonary embolus