Aneurysm
Weakening of an artery, Wall of artery weakens and stretches, risk of clot formation
Where can an artery occur?
abdominal aorta, thoracic aorta, cerebral femoral, and popliteal arteries
Aneurysms can...
rupture - exsanguination (bleeding), hemorrhage
Risk factors of Aneurysms
congenital defects, atherosclerosis, hypertension, dyslipidemia, diabetes mellitus, tobacco, advanced age, trauma
True aneurysms
affect all 3 vessel layers
Saccular aneurysm
bulge on the side
fusiform aneursym
occurs the entire circumference
false aneurysms
does not affect all 3 layers of the vessel
dissecting aneurysms
occurs in inner layer
aortic aneurysm
involve any part of the aorta, look for pulsating mass, most dreaded complication is rupture, risk increases with size of aneurysm, dissecting aneurysm is acute, life threatening
signs and symptoms of aneurysms
depend on location and size, may be asymptomatic, may include: pulsating mass, pain, respiratory difficulty, and neurologic decline
diagnosis of aneurysms
exam, x-ray, echocardiogram, CT, MRI, arteriograph
Tx of aneurysms
eliminating or managing cause and surgery
Risk factors of hypertension
advancing age, ethnicity, family history, being overweight or obese, physical inactive, tobacco use, high-sodium diet, low-potassium diet, high vitamin D intake, excessive alc. intake, stress and other chronic conditions
hypertension
prolonged elevation in bp, excessive cardiac workload due to increased afterload and vasoconstriction
sign & symptoms of hypertension
fatigue, HA, malaise, and dizziness; early detection and management is essential to prevent complications
complications of hypertension
atherosclerosis, aneurysms, heart failure, stroke, hypertensive crisis, renal damage, vision loss, metabolic, syndrome, memory problems
lifestyle modification has been shown to reduce BP
wt reduction, regular exercise, reduce salt, smoking cessation, reduce alc
Primary HTN
most common form, develops gradually over t
secondary HTN
tends to be more sudden & severe causes: renal disease, adrenal gland tumors, certain congenital heart defects, certain meds, illegal drugs
Hypertensive Crisis/Malignant HTN
acclerated or severe form may not respond as well to tx situations in which markedly elevated BP is accompanied by progressive or impending target-organ damage associated w/ secondary HTN diastolic BP>120 severe HTN= SBP>180/DBP>110 hypertensive urgency= DBP>110 and HA or dyspnea hypertensive emergency = DBP>120 and rapidly progressing damage and symptoms
Pregnancy-induced hypertension
S/Sx: high blood pressure, proteinuria, edema Risk factors: history of pregnancy-induced hypertension, renal disease, diabetes mellitus, multiple fetuses, and maternal age less than 20 years or greater than 40 years May cause seizures, miscarriages, poor fetal development, and placental abruption TX: bed rest and magnesium sulfate
Pheochromocytoma
Tumor of chromaffin tissue that contain sympathetic nerve cells that stain with chromium salts. Most commonly in adrenal medulla Can cause serious hypertension Tumor cells secrete epinephrine and norepinephrine. Hypertension is from massive release of catecholamines. Periodic episodes of HEADACHE, excessive sweating, palpitations, nervousness, tremor, pallor, weakness, fatigue May have sustained or intermittent HTN.
Coarctation of Aorta
Narrowing of the aorta. • Results in increase in systolic BP and blood flow to upper body; Blood pressure in lower extremities may be normal or low. • Need to take BP in both arms and one leg! • Maintenance of blood pressure to lower body probably a result of renin-angiotensin-aldosterone system activated by decreased renal blood flow. TX: surgical repair or balloon angioplasty
Oral Contraceptives
• Most common cause of secondary hypertension in young women. • Take blood pressure regularly. • May increase risk of long-term development of hypertension. • Complications usually in >35 and smokers.
Target organ damage
Typically asymptomatic • Problems usually associated with kidneys, heart, eyes, blood vessels. • Risk of atherosclerosis • Increased workload on the heart • Chronic HTN leads to kidney problems • Dementia and other cognitive problems more common.
orthostatic hypotension
• Abnormal drop upon standing • Baroreceptors in thorax and carotid sinus initiate reflex constriction of veins and arteries • AKA postural hypotension. • Causes: Reduced blood volume, medications, aging, bedrest and immobility, and autonomic nervous system disorders
varicose veins
• Engorged veins resulting from valve incompetency • Most common in the legs • May also occur as esophageal varices and hemorrhoids • Can cause stasis pigmentation, subcutaneous induration, dermatitis, and thrombophlebitis • Risk factors: genetic predisposition, pregnancy, obesity, prolonged sitting or standing, alcohol abuse and liver disorders (esophageal varices), and constipation (hemorrhoids)
S/Sx of Veins
–Pedal edema –Fatigue –Aching in the legs –Shiny, pigmented, hairless skin on the legs and feet –Skin ulcer formation -Irregular, purplish, bulging veins
Dx & Tx of Varicose Veins
exam, Doppler ultrasound, and venogram
elevate affected leg, compression stockings, avoid prolonged standing or sitting, exercise, sclerotherapy(treat bv malformations), and surgical removal
venous thrombosis
Stationary blood clot • Virchow’s Triad – endothelial injury, sluggish blood flow, and increased viscosity • Emboli – traveling body –Maybe a thrombus, air, fat, tissue, bacteria, amniotic fluid, tumor cells, and foreign substances –Can become lodged in places like the lungs, brain, and heart
S/sx, DX of venous thrombosis
Depends on location
Arteriography, ultrasound, echocardigram, MRI
Prevention of Venous Thrombosis
increasing mobility, hydration, antiembolism hose, sequential compression devices, antiplatelet agents, and anticoagulants
Tx of Venous Thrombosis
thromblytic agents and embolectomy
D/o that affect whole heart
Coronary Artery Disease, Pericardial Disorders, Myocardial Diseases
Coronary Artery disease
Atherosclerotic changes of the coronary arteries, impairs myocardial tissue perfusion, angina (stable & unstable), infarction, causes are arthrosclerosis, vasospasms, thrombus blood clots and cardiomyopathy
Angina
Intermittent chest pain resulting from myocardium ischemia
Stable angina
Goes away with the demand reduction while doing some thing
Unstable angina
increased intensity or frequency, does not go away with the demand reduction, or occurs at rest
Infarction
Necrotic damage to myocardium
Complications of coronary artery disease
Myocardial infarction, heart failure, dysrhythmias, and sudden death
Signs and symptoms of coronary artery disease
Angina, indigestion like sensation, nausea, vomiting, clammy extremities, diaphoresis, and fatigue
Diagnosis of coronary artery
History, exam, contributing factors, stress test, echocardiogram, ECG
Treatment of coronary artery disease
Similar to dyslipidemia/atherosclerosis but add meds to help reduce workload on the heart and manage blood pressure and dysrhythmias and O2
Acute coronary syndrome
ECG changes and serum cardiac markers
Acute coronary syndrome ECG changes
T-wave inversion, ST segment depression or elevation, abnormal Q wave, T wave and ST segment also known as ventricular repolarization are usually the first involved in myocardial ischemia and injury
Acute coronary syndrome serum cardiac markers
Proteins released from the necrotic heart cells like myoglobin, creatine kinase, troponin
Acute myocardial infarction
Death of the heart muscle, coronary artery blood flow is blocked due to atherosclerosis, thrombus, or vasospasms, risk factors are the same as those for atherosclerosis
Signs and symptoms of acute MI
Some asymptomatic - “silent” MI, includes angina, fatigue, N/V, SOB, sweating, indigestion, elevation in cardiac markers, EKG changes, neck/ear pain and women may present with different symptoms in men
How is chest pain in acute myocardial infarction
Severe, crushing, constrictive or like heartburn
How is the sympathetic nervous system response in acute myocardial infarction
GI distress, nausea, vomiting, tachycardia, vasoconstriction, anxiety, restlessness, feeling of impending doom
Hypotension and shock in acute myocardial infarction
Weakness in arms and legs
Diagnosis of acute MI
Exam, ECG, cardiac markers, stress testing, nuclear imaging and angiography
Treatment of acute MI
Treatment varies depending on timing of treatment, need to reestablish blood flow within 20 to 40 minutes, I want to limit the formation of fibrous scar tissue
Immediately MONA in acute myocardial infarction
Pain management (MORPHINE) Increase O2 (OXYGEN) Open up vessels (NITRATE) Keep platelets from blocking (ASPIRIN)
What else can you administer in acute MI
Thrombolytics which are clot busters
Post MI
Similar to those for atherosclerosis
Complications of acute MI
Heart failure, dysrhythmias, cardiogenic shock, pericarditis, thromboemboli/thrombosis, rupture of the heart, death, ventricular aneurysms
Chronic ischemic heart disease
Imbalance in blood supply and the heart demands for oxygen When there is less blood… Atherosclerosis, vasospasm, thrombosis When there is higher oxygen demand… Stress, exercise, cold
Chronic ischemic heart disease – chronic stable angina
Pain when hearts oxygen demand increases
Chronic ischemic heart disease – variant (vasospastic) angina
Pain when coronary arteries spasm
Chronic ischemic heart disease - Silent myocardial ischemia
Myocardial ischemia without pain
Ischemic heart disease is characterized by…
Stable angina, which is associated with plaques that are fixed obstructions
Unstable angina is characterized by…
Plaques with platelets that to them (these are likely to form a thrombus) they cause a range of coronary artery syndromes
Endocardial structures
Lining the heart can cause heart failure
If the AV valves leading into the into the ventricles do not work (mitral or tricuspid) can cause
Heart failure
If the semilunar valves leading out of the ventricles do not work (aortic or pulmonary) problems it can cause
Heart failures
Infective endocarditis
Formally called bacterial endocarditis, commonly caused by staphylococcus, but also streptococcus and enterococci are common, vegetation forms on internal structures and creates small thrombi, micro emboli occur as they are dislodged resulting in micro hemorrhages
Risk Factors of infective endocarditis
IV drug use, valvular disorders, prosthetic heart valves, rheumatic heart disease, coarctation of the aorta, congenital heart defects and Marfan syndrome
Signs and symptoms of infective endocarditis
Flu like symptoms, embolization, heart murmur, petechiae, splinter hemorrhages under the nails like glass, hematuria and Osler‘s nodes
Diagnosis of infective endocarditis
Exam, blood cultures, CBC, urinalysis, serum rheumatoid factor, erythrocytes sedmentation rate, ECG, echocardiogram
Treatment of infective endocarditis
Identify cause, anti-infective meds, bed rest, oxygen therapy, antipyretics, surgical valve repair, and prosthetic valve replacement
Rheumatic heart disease (endocardial d/o)
Immune mediated, multi system inflammatory disease, occurs at a few weeks after group a beta hemolytic streptococcal pharyngitis, inflammation of myocardium, pericardium and heart valves, chronic valvular dysfunction biggest consequence, may have persistent deformity of heart valves from scar tissue (vegetations)
Valvular heart disease
Disrupt blood flow through the heart in any of the four valves, stenosis or regurgitation can occur
stenosis in valvular heart disease
Narrowing, less blood flow can flow through the valve, causes decreased cardiac output, increase cardiac workload, and hypertrophy
Regurgitation in valvular heart disease
Insufficient closure, blood flows in both directions to the valve, cause decreased cardiac output, increase cardiac workload, hypertrophy and dilation
Causes of valvular disorders
Congenital defects, infective endocarditis, rheumatic fever, MI, cardiomyopathy, and heart failure
Signs and symptoms of Valvular disorders
Depends on the valve involved, reflect alteration in blood flow through the heart, may cause signs and symptoms of left-sided or right sided heart failure
Diagnosis of valvular disorders
Exam, heart catheterization, chest x-ray, echocardiogram, MRI, ECG
Treatment of valvular disorders
Diuretics, anti-dysrhythmics, vasodilators, angiotensin converting enzyme inhibitors and beta adrenergic blockers (BP meds), anticoagulants, oxygen therapy, low sodium diet, surgical valve repair and prosthetic valve replacement
Mitral valve disorders
Mitral valve stenosis, mitral valve regurgitation, mitral valve prolapse
Aortic valve disorders
Aortic valve stenosis, aortic valve regurgitation
Mitral valve regurgitation
Mitral valve does not close as it should, portion of the stroke volume (amt of blood ejected by the ventricle) leaks back into the left atrium, decreases the amount of blood that is ejected during that beat (SV), often from rheumatic heart disease
MItral valve prolapse
Seen more in women, may be familial mucous degeneration of the mitral leaflets, may or may not cause regurgitation most asymptomatic, but most may have prolonged chest pain, dyspnea, fatigue, anxiety, palpitations and lightheadedness characterized by spectrum of findings when you listen with a stethoscope stop stimulants like caffeine, nicotine, alcohol to control symptoms
Identifying Defective Leaflets
The blood going through the valve makes a noise which are called heart murmurs
You can identify heart murmurs by
Where they are which valve are they near?, How they sound high or low pitched?, When they happen systole or diastole?
If a valve is stenotic,
You will hear a murmur of blood shooting through the narrow opening when the valve is open
If a valve is reguritant,
You will hear a murmur of blood leaking back through when the valve should be closed
Acute pericarditis
Inflammation of the pericardium causes: pain, exudate, ECG changes
How is the exudate in acute pericarditis
Serous -> pericardial effusion, cardiac tamponade Fibrous -> friction rub, adhesions
Cardiac tamponade
Rapid accumulation of accident compresses the heart
Signs and symptoms of pericarditis
Pericardial friction rub, sharp, sudden, severe chest pain that increases with deep inspiration and decreases when sitting up and leaning forward, dyspnea, tachycardia, edema, flu like symptoms (think inflammation)
Pericardial friction rub
Grating sound heard when breath is held
Diagnosis of pericarditis
History, exam, complete blood count, ECG, chest x-ray, echocardiogram, CT, MRI
Treatment of pericarditis
Identify and resolve the underlying cause, NSAIDs, meds for inflammation, pain meds, bed rest, oxygen therapy, pericardiocentesis, and pericardiectomy
Pericardial effusion
Accumulation of fluid in the pericardial cavity, usually result of infectious or inflammatory process including pericarditis, may also develop with neoplasm, cardiac surgery, and trauma, it compresses the chambers of the heart, if small amount may not be symptomatic but if rapid or large rises intra cardiac pressures, echocardiogram can detect
Pericardial effusion cardiac tamponade
Cardiac compression from excessive fluid accumulation, life-threatening
Signs and symptoms of cardiac tamponade
Falling arterial pressures, rising venous pressures, narrowing pulse pressure, and muffled heart sounds
Complications of cardiac tamponade
Heart failure, shock, death
Cardiac tamponade and pulses paradoxus
On inhaling, the right ventricle fills with extra blood because the heart cannot fully expand when the right ventricle is overfilled, the left ventricle is compressed and cannot accept much blood on the next heartbeat, The left ventricle does not send out much blood: systolic blood blood pressure drops