Cardiovascular

Understanding:

• Made up of blood, heart, and blood vessels.

• Activity of system begins when fetus is barely one month

• Last system to cease at end of life

• Despite advances in disease detection and treatment, cardiovascular disease remains leading cause of death in US

• MI is primary cause of cardiovascular related death

• MI can occur with no warning

Basic Risk Factors for Cardiovascular Disease

• Modifiable: Elevated lipid levels, hypertension, smoking, diabetes mellitus, sedentary lifestyle, stress, obesity.

• Nonmodifiable: Age, gender (male gender and women after menopause), genetics, race

Hypertension

• Primary cause is unknown

• Secondary cause is any underlying health problems

• Over 140/Over 90 mmHg

• Complications: Atherosclerosis, aneurysms, heart failure, stroke, hypertensive crisis (medical emergency), renal damage, vision loss, metabolic syndrome, problems with memory or understanding.

• Symptoms:

  • Can be asymptomatic

  • Severe headache, shortness of air, nosebleeds, severe anxiety

• Signs: Elevated BP consecutively

• Emergency: Over180/over120 in the presence of end-organ damage

  • Malignant: End-organ damage where the eyes, kidneys, or brain are infected. Malignant hypertension requires immediate medical intervention to prevent irreversible damage and may necessitate hospitalization for close monitoring and treatment.

  • Hypertensive encephalopathy: Cerebral edema leading to neruo symptoms

  • Symptoms: Nause, vomiting due to cerebral edema, chest pain, shortness of air, blurry vision, confusion, loss of consciousness.

  • Can cause:

    • Retinal hemorrhages, exudates, or papilledema.

    • Renal involvement with AKI, proteinuria, hematuria.

    • Cerebral edema can cause seizures and coma.

    • Pulmonary edema

    • MI

    • Hemorrhagic stroke

Primary Hypertension

• Risk Factors: Age. race, family history, overweight, physical inactivity, Tobacco use, high sodium diet, low potassium diet, high vitamin D intake, excessive alcohol consumption, stress.

• Prolonged elevation in Bp that needs treatment

• JNC Guidelines

  • Over age of 60 (less than 160/less than 90)

  • Less than 60 (less than 140/less than 90)

  • All ages with diabetes and/or CKD

Secondary Hypertension:

• Caused by systemic disease or meds

  • Renal disease, adrenal gland tumors (pheochromocytoma), Congenital heart failure, meds like Birth control, antihistamines, and decongestants, and illegal drugs.

Atherosclerosis

• Plaque, composed of cholesterol, fat, and other substances, build up inside of arteries, narrowing them and leading to serious health problems like an MI or stroke.

• Starts with damage to inner linings of arteries (endothelium). Inflammatory cells and cholesterol accumulate at damaged areas and form plaque.

• Plaque builds up, hardens, and causes arteries to narrow reducing blood flow.

• Can affect any artery in the body, particularly common in arteries supplying the heart (coronary arteries) and brain (carotid arteries).

• Causes and Risk Factors:

  • High cholesterol

  • High BP: damages artery walls

  • Smoking: Damages arteries

  • Diabetes: Damage blood vessels

  • Obesity: Increases risk of high cholesterol

  • Lack of Physical Activity: Can contribute to high cholesterol

  • Genetics: Family history of heart disease or stroke

  • Age: Increases with age

  • Inflammation

Varicose Veins (Venus Insufficiency)

• Vein in which blood has pooled

• Damaged valve

• Related to trauma and prolonged standing on feet.

• Chronic Venous Insufficiency Symptoms: Hyperpigmentation, purple discoloration, elevation of extremities lower dependent edema, edema may obliterate pulses, venous stasis ulcers appear, paresthesia.

• Stages

  • C1: Spider veins

  • C2: Varicose veins

  • C3: Edem

  • C4: Skin changes

  • C5 and 6: Venous ulcer

Thrombus/Embolus

• Thrombus attaches, remains attached. May occlude

• Embolus: clot that has dislodges goes elsewhere and causes problems.

• Types: Fatty plaques, Blood Clot Formation, dehydration, prolonged sitting, Air (from IV or other outside cause like stabbing), Fat, bacteria, Amniotic fluid

• Deep Vein Thrombosis (DVT): Pulse present, skin color is rubor and temp is cool, edema is present.

  • Complications:

    • Pulmonary embolism (most serious): Blood clot travel to lungs and blocks and artery. Causes chest pain, shortness of breath, death

    • Chronic Venous Insufficiency: Long term where damaged valves in veins prevent blood flow back to heart normally. Leads to swelling, pain, and skin ulcers.

    • Post Thrombotic Syndrome (PTS): Group of symptoms that develop after DVT (pain, swelling, discoloration). Can be chronic and debilitating condition.

Peripheral Artery Disease (PAD) (Arterial Insufficiency)

• Inadequate blood flow through arteries.

• Occurs because of: Atherosclerosis, blood clots, and trauma

• Symptoms: Intermittent claudication (pain in legs during exercise), numbness of feet or toes, coldness in extremities, ulcers on feet or toes that do not heal, weak or absent pulsed in legs, gangrene (in severe cases).

• 5 P’s: Pain, Pallor, Pulselessness, Paresthesia, Paralysis

Arterial Thrombus:

• Pain that is sharp, throbbing, or cramping

• Pulses that are weak or absent

• Skin color that is pale or cyanotic

• Skin temp is cool

• Edema is minimal or absent

Intermittent Claudication: Caused by PAD

• Reduces blood flow to muscles leading to pain when they exert themselves

• Symptoms: Pain in legs, pain that worsens with exercise but improves with rest, cramping or burning sensation, numbness or tingling in legs, shiny or cold skin on affected leg.

Raynaud’s

• Blood vessels in extremities temporarily narrow in response to cold or stress causing a triphasic color change

  • White, then blue, then red as blood flow returns.

• Attacks vasospasms of small arteries and arterioles in extremities. Primarily affects fingers.

• Linked to an autoimmune disorder

• More common in women, symptoms start before age 30, runs in families

• People often have more than 1 autoimmune with Raynaud’s

• Clinical manifestations more severe and prolonged.

• Accompanied with pain and numbness. Pulse is present

• Necrosis/tissue damage suggest secondary cause.

Thromboangitis Obliterans (Buerger Disease)

• Rare, blood vessels of hands and feet get inflamed, swollen and blocked.

• Unknown cause

• More common in young men who are Middel Eastern or Asian. Heavy tobacco users.

• Accompanies by thrombi, inflammation, and vasospasms

• Leads to gangrene and amputation

• S/S

  • Red, enlarged, tender cordlike veins

  • Pain and tenderness

  • Numbness and tingling in limbs

  • Discoloration

  • Usually, two or more limbs affected

  • Pain may increase with activity like walking and decrease with rest.

  • May worsen with exposure to cold or emotional stress

  • Pulse may decrease or be absent

  • Leads t Critical Limb Ischemia (CLI), skin ulcers, and gangrene of the digits

Aneurysms - Malformation of Artery

• Localized abnormal weakness of a blood vessels (usually artery), due to congenital defect or weakness inwall of vessel. Can occur in any blood vessel. Some people are born with weakness in blood vessels of brain which can lead to cerebral aneurysms which can rupture when stressed.

• S/S (depend on location): Chest and back pain, shortness of breath, difficulty swallowing, abdominal discomfort, sense of fullness, wide aortic pulsation palpable in abdomen, tachycardia, BP discrepancies (different in each arm), rupture of aorta (most serious).

• Symptoms of Brain Aneurysms: Often unnoticeable until large or ruptures. Headache, weakness, vision change, eye pain, numbness on head or face.

• Three Types

  • Saccular

  • Fusiform

  • Dissecting

• Aortic Aneurysm: Particularly susceptible to aneurism formation. Can occur anywhere alone aorta or down in abdomen.

  • Risk Factors: 4x more common in men, ages 65 and above, long standing hypertension, hyperlipidemia, COPD, family history, trauma, smoking.

  • Aortic Dissection: Life threatening medical emergency. Symptoms vary depending on location and severity of tear.

    • Sidden chest or upper back pain (tearing or ripping sensation that spreads to neck or down back), sudden severe stomach pain, shortness of breath, similar symptoms to MI and strokes, nausea and vomiting, weakness or numbness on one side of body, difficulty speaking, vision loss, leg pain, difference in BP between arms.

Heart Disease

• Preload: Volume of blood in ventricles at end of diastole. Increase in hypervolemia, regurgitation of cardiac valves, and heart failure.

• Afterload: Resistance left ventricle must overcome to circulate blood. Increased in hypertension and vasoconstriction. Higher afterload = high cardiac workload.

• EKG or ECG: Read by electrocardiogram

  • P Wave: Atria depolarization

  • QRS Complex: Ventricular depolarization

  • T Wave: Ventricular repolarization

  • Normal: P wave corresponds to depolarization of SA node and atria. QRS complex responds to ventricular depolarization. T wave corresponds to ventricular repolarization. Atrial repolarization is masked by larger QRS complex.

  • Heart Excitation Related to ECG: SA node generates impulse, atrial excitation begins. Impulse delayed at AV node. Impulse passes to heart apex, ventricular excitation beings. Ventricular excitation completes.

• SA Node

• AV Node

• Bundle of HIS

• Cardiac Conduction: Electrical impulse generated at SA node stimulates atria to contract. Impulse travels to AV node where there is brief delay. Sweeps to bundle of HIS and divides into left and right bundle branches. Conduction to purkinje fibers causes contraction of ventricles.

• Normal Sinus Rhythm (NSR): electrical activity when impulse originates in SA node

• Dysrhythmias: Abnormal. Can result from illnesses such as MI or electrolyte imbalances.

• Coronary Arteries

  • Coronary Artery Disease: Similar to peripheral artery disease. Something builds up and blocks blood vessels that provide O2 and nutrients to cardiac muscle resulting in damage to heart.

Hypertension Comparison Chart