Sect 7.4 - Cardiac Diseases

Arteriosclerosis

hardening and narrowing of blood vessels to repeated injury and healing leading to scar tissue

smoking, DM, and high BP, age

Atherosclerosis

process of fatty plaque accumulation

associated with high LDL and low HDL

peripheral vascular disease (PVD)/DVT

plaque in the arms or legs

associated with reduced peripheral circulation and reduced oxygenation of tissue

coronary artery disease (CAD)

plaque in vessels that supply blood to the heart

associated with angina and myocardial infarction

cerebrovascular disease (CVD)

plaque in vessels that supply the brain or that are located in the brain

associated with stroke

genetic or acquired causes

plaque developed in organs such as liver and kidneys

can lead to impaired function, then organ failure

women with elevated levels of homocysteine and Lp(a) are at significant risk for heart disease/MI

Explain the significance of elevated levels of homocysteine and Lp(a) in women

estrogen

In women, what hormone helps maintain HDL and low LDL

increase in LDL, decrease in HDL

A decrease in estrogen during and after menopause causes an increase in what?

Women do not usually display the hallmark S/S of heart attacks

Women are often said to experience "silent heart attacks", why?

S/S of heart attack in women

sluggish (extreme fatigue)

nausea, vomiting, indigestion, abdominal pain

lower back pain

headache

jaw pain

Conditions that affect women at young age

Pregnancy

Gestational diabetes

Preeclampsia and eclampsia

Polycystic Ovarian Syndrome (PCOS)

Low birth weight children

Sig natural hormonal fluctuations during lifetime with menstrual cycles

Use of oral contraceptives/hormone replacement therapy

S/S of AMI

classical symptoms:

Chest pain/pressure

Sweating

Shortness of breath

Pressure/Pain in back or shoulders (radiating up left arm & neck)

Sudden weakness

Fast or irregular heartbeat

Men's plaque distributes in clumps

Women's plaque distributes more evenly throughout artery walls

Difference between men and women's plaque distribution

men: 66 years

women: 70 years

Average age of first heart attack in men vs women

Congestive Heart Failure (CHF)

clinical syndrome that results from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill or eject blood

lungs

When the left side of heart is unable to pump, excess fluid accumulates where?

result: produces pulmonary edema and reduced output of blood to systemic circulation

kidney response by retaining excess fluid, making HF worse

systemic circulation

When the right side of heart is unable to pump, excess fluid accumulates where?

result: generalized edema occurs (swelling in legs, ankle, feet)

coronary artery disease (CAD) and cardiomyopathies

2 common causes of Congestive Heart Failure (CHF)

coronary artery disease (CAD)

disease of the arteries surrounding the heart, eventually leading to AMI

cariomyopathy

disorders of the walls of the heart from damage caused by factors other than artery or blood flow problems

S/S of CHF

Congested lungs, leading to shortness of breath with exercise, or difficulty breathing at rest/lying flat in bed

Dry, hacking cough or wheezing

Mild to server fluid/water retention due to less blood to kidneys (nocturia, loss of appetite/nausea due to bloating in stomach)

Dizziness, fatigue, weakness

Rapid or irregular heartbeats

Stage A of CHF

high risk with no S/S -- no structural abnormalities

Stage B of CHF

structural heart disease noted; no S/S

Stage C of CHF

structural heart disease present; current or prior S/S

Stage D of CHF

advanced structural heart disease; marked S/S at rest despite medical therapy

natural decrease in GFR associated with aging

Elderly patients may have electrolyte distribution that differs from younger adults, caused by

diuretics and blood pressure medications

The difference in distribution of water and electrolytes in geriatric patients may affect the distribution and excretion of drugs such as

diuretic medication

affects the kidneys and causes excretion of water and imbalances of Na and K

loss of H2O, Na+, K+

blood pressure medication

may also lead to electrolyte imbalances if there is a water imbalance due to diuretics

Potassium (K+)

Replacement of __________ is needed in many elderly patients in order to maintain electrolyte balance and heart pacemaker rhythm

changes in GFR

changes in body tissue composition

Dosage of medication have to be considered for elderly patients. Overdoses can occur from

Diagoxin

maintains normal heart rhythm and heart rate when the heart has been damaged

used for older pts

Statin drugs

inhibit the enzyme HMG-CoA reductase → responsible for endogenous cholesterol production in the liver

used in pts with high LDL

Clofibrate type drugs

increases LPL enzyme activity → enhances the removal of triglyceride-rich lipoproteins from the blood vessels

Niacin

decrease the production of VLDL by sequestering bile acids, resulting in increased HDL levels

CK and CK-MB

Delay in seeking a dx renders what 2 markers useless due to quick resolution to normal values within 48hrs after AMI

Lactate Dehydrogenase (LD)

isoenzymes that remain in blood longer (4-7 days), but are nonspecific with regard to heart disease

LD1 greater than LD2

"flipped pattern" with LD that is associated with cardiac muscle damage

still non-specific

Troponin

Which biomarker assay offers increased opportunities for detection of "silent heart attacks" in patients, especially women

Troponin I and T

the preferred marker of detection of AMI

replacing LD isoenzyme studies, CK total and CK-MB detection

Myglobin

earliest indicator of MI, but not specific to heart

30 min

Myoglobin is released within __________ following AMI, with peak levels being reached within 2-3 hours

Type II

type of diabetes that is at an increased the risk of developing cardiac complications

especially if they have had diabetes for a long period of time & also demonstrate lipid abnormalities

triglycerides

Type II diabetics cannot utilize glucose for energy, so excess glucose is converted to

Arteriosclerosis

high glucose in vessels lead to

Atherosclerosis

high triglycerides (VLDL → LDL) in vessels lead to

Causes of Cardiovascular Problems in Type II Diabetes

Insulin resistance (glucose intolerant)

Obesity

Sedentary lifestyle

Low HDL cholesterol levels

High triglyceride levels

High blood pressure (caused by arteriosclerosis)