Cardiovascular Disease: Risk Factors and Assessment

Cardiovascular Disease: Risk Factors and Assessment

Introduction

• The main concern with the cardiovascular system is cardiovascular disease (CVD).
  • Understanding risk factors and disease processes is crucial for patient education.

Risk Factors for Cardiovascular Disease

• Modifiable Risk Factors:
  • Smoking
    • Causes vasoconstriction, increasing blood pressure and oxygen demand.
    • Makes the cardiovascular system work harder.
  • High cholesterol levels (LDL - bad cholesterol)
    • Increased LDL levels increase the risk of developing cardiovascular disease.
  • Hypertension
    • Forces the heart to work harder, leading to potential heart failure.
• Comorbidities: Diabetes, obesity
  * Should be managed with, diet, exercise, and healthy lifestyles.
• Non-Modifiable Risk Factors:
  • Family history of cardiovascular disease
    • Increases risk due to genetic predisposition.
  • Age: Likelihood for hypertension increases, lack of elasticity.

High-Risk Populations

• African Americans:
  • Have a higher risk of developing hypertension, a major risk factor for CVD.

Emergency Situations: Myocardial Infarction (MI)

• Myocardial Infarction (MI) is a heart attack.

Impact of Hypertension on the Heart

• The heart works harder, leading to fatigue and potential heart failure.
• Analogous to muscle fatigue from excessive exercise.

Aging and the Cardiovascular System

• Arteriosclerosis:
  • Thickening and stiffening of artery walls.
  • Causes increased blood pressure, especially systolic.
• Atherosclerosis:
  • Plaque buildup in arteries.
  • Increases risk of heart attack and stroke.
• Cardiac Output:
  • Remains relatively stable at rest in older adults.
  • Decreases with activity due to reduced compensatory ability.
  • Leads to activity intolerance and fatigue.
• Left Ventricular Hypertrophy:
  • Enlargement of the left side of the heart due to increased resistance.
• Dysrhythmias:
  • Common and expected in older adults.
  • Ectopic beats (extra beats) are normal.
• Murmurs:
  • Expected in older adults.
  • Important to determine if new or previously diagnosed.
• Apical Impulse:
  • May be more difficult to palpate due to increased AP diameter.
  • Palpate at the fourth or fifth intercostal space with one finger pad.
• S3 Heart Sound:
  • Can be a normal finding in aging adults.

ADLs and Cardiac Function

• Reduced cardiac output during activity can affect Activities of Daily Living (ADLs).
• Examples: Difficulty climbing stairs, reduced walking ability.

Subjective Data Collection

• Aim: To rule out heart attack, heart failure, or other cardiac emergencies.
• Chest Pain:
  • Causes other than heart attack: anxiety, stress, pulmonary issues, heartburn/GERD, musculoskeletal problems.
  • Differentiating questions:
    • Tight squeeze or pressure (heart attack).
    • Worsening pain with breathing (lung issues).
  • Heart attack pain does not resolve.
• Dyspnea:
  • Subjective feeling of difficulty breathing.
  • Feeling unable to take a deep breath.
• Orthopnea:
  • Inability to breathe lying flat; requires sitting upright.
  • Graded by the number of pillows needed to sleep.
  • Causes: Fluid overload in the lungs, heart failure.
• Paroxysmal Nocturnal Dyspnea:
  • Awakening after a couple hours of sleep with a need to sit up and take deep breaths.
• Cough:
  • Indicates possible fluid in the lungs.
  • Associated with heart failure causing backup into the lungs.
• Fatigue:
  • Signals reduced oxygenated blood supply due to heart dysfunction.
• Cyanosis and Pallor:
  • Assess for color changes in the skin after activity.
• Edema:
  • Usually bilateral and pitting in the feet and legs.
  • Worse in the evening and improves in the morning after lying down.
• Nocturia:
  • Frequent urination at night.
  • Recumbent position promotes kidney efficiency; excess fluid is excreted.

Cardiac History

• Previous MIs, hypertension, transient ischemic attacks (TIAs).
• Family history of cardiovascular disease, diabetes, and hypertension.

Patient-Centered Care

• Educate patients on mitigating modifiable risk factors.
• Promote healthy lifestyle: green leafy vegetables, balanced diet, regular exercise.
• Recommendations:
  • 150 minutes of exercise per week.
• Manage blood pressure and diabetes appropriately.

Physical Assessment

• Carotid Artery Palpation:
  • Palpate one at a time gently.
  • Grade amplitude on a scale; aim for 2+ bilaterally.
  • Bounding pulses may indicate fluid overload.
• Carotid Artery Auscultation:
  • Perform on older adults and those with risk factors for CVD.
  • Use the bell of the stethoscope with gentle pressure to avoid false bruit sounds.
  • Listen for bruits (swishing sound).
• Jugular Venous Distension:
  • Position patient supine at 30-45 degrees without a pillow, head turned.
  • Look for pulsations; distension indicates fluid overload.
  • Veins should flatten above 45 degrees.
• Precordium Assessment:
  • Inspect and palpate across the precordium.
  • Palpate with palmar surface for thrills (vibrations).
  • Auscultate using landmarks.
  • Listen to rate and rhythm. Normal rhythm should be 60-100.
  • Apical and radial pulses should be checked for any pulse deficit.
  • S1 loudest at apex, S2 loudest at base
  • Diaphragm first for regular heart sounds, then bell for murmurs.
  • Position change: Left lateral position to accentuate S3 and S4 sounds.

Abnormal Findings

• Bruit:
  • Swishing sound auscultated over carotid arteries.
• Murmur:
  • Swishing, blowing sound auscultated with the bell of the stethoscope.
  • May be accompanied by a thrill (vibration).
• Heave/Lift:
  • Visible or palpable forceful rising of the chest wall.

Healthy Lifestyle Promotion

• Blood pressure and cholesterol monitoring.
• Diabetes management.
• Physical activity: 150 minutes per week.
• Aspirin therapy
  • May be prescribed as an antiplatelet for high-risk individuals to prevent stroke or heart attack.