Diabetes, blood clots, and cardiovascular conditions

Diabetes

• Diabetes: Initially mentioned as modifiable, but this is nuanced.
  • Type 1: Genetic and not modifiable.
  • Type 2: Partially modifiable through diet and exercise but also has a genetic component.

Cardiovascular Risk Factors

• Dyslipidemia: Modifiable through diet.
• Smoking: Should be avoided.
• Gender: Being male is a risk factor due to genetics, even in trans individuals.
• Diet, Alcohol, and Stress: These are modifiable risk factors, though stress can be challenging to manage, especially in high-stress situations like school or certain jobs.
  • Goal: Minimize the impact of stress (e.g., not taking work home).

Age and Menopause

• Age: Increases blood pressure due to wear and tear on the heart and potential stenosis of coronary vessels, which is generally non-modifiable.
• Menopause: Women have a lower risk of heart attacks before menopause due to the protective effects of estrogen. After menopause, the risk equals that of men due to estrogen level decline.
• Hypertension: Over time, it can lead to strokes, vision loss, heart attacks, bone loss, kidney failure, and blood vessel damage.

Atherosclerosis and Ischemia

• Atherosclerosis: Narrowing of the arteries.
• Ischemia: Reduced blood perfusion to tissues and organs.
• Angina: Chest pain due to reduced blood flow. (Pronunciation: "an-jeye-nuh")

Blood Clotting (Hemostasis)

• Essential components for blood clotting:
  • Platelets.
  • Fibrin.
  • Red blood cells.
• Hemostasis: The process of blood clotting. Platelets and the clotting cascade is required, which involves many chemical reactions. The liver is involved in this process.
  • Fibrin: Hooks platelets together to form a clot.
• Fibrinolysis: The breaking down of fibrin to dissolve the clot when it is no longer needed after tissue repair.

The Process of Clot Formation and Dissolution

• Damage to a blood vessel: Platelets clump together at the site of the injury.
• Clot Formation: They activate the fibrin system, creating a net to stick red blood cells and platelets together.
• Clot Dissolution: Once the tissue is healed, the clot dissolves via fibrinolysis.

Clotting Cascade

• Involves numerous chemicals where one triggers another.
• Calcium is important in the cascade and may affect clot formation if deficient.

Hypercoagulation and Hypocoagulation

• Hypercoagulation: Excessive clotting, which can be dangerous as clots can block blood flow and become emboli.
• Hypocoagulation: Insufficient clotting, leading to excessive bleeding.

Immobility and Blood Clots

• Immobility: Prolonged sitting or stillness can cause blood to clot due to stasis.
• Surgery: Increases the risk of blood clots.

Sequential Compression Devices (SCDs)

• SCDs: Used in hospitals to prevent Deep Vein Thrombosis (DVT). They compress the legs to promote blood flow.
• Importance: DVTs acquired in the hospital are often considered preventable and potentially the nurse's responsibility.

Deep Vein Thrombosis (DVT)

• Symptoms: Calf pain (especially when toes are pushed back), swelling in the leg.
• Diagnosis: Angiogram to visualize blood vessels and detect clots.
• Risk Factors: Immobility, surgery, heart failure.

Heart Failure and DVT

• Heart Failure: Inefficient heart function reduces blood flow to the extremities, increasing DVT risk.
• Muscle Contraction: Leg muscle contractions help push blood back to the heart.

Additional Risk Factors for DVT

• Pregnancy: Physiological changes and weight can impede blood flow to the legs.
• Cancer: Increases DVT risk.
• Smoking: Causes significant damage to the body, increasing DVT risk.
• Trauma and Surgery: Elevate DVT risk.

Pulmonary Embolism (PE)

• PE: A blood clot that has moved into the lungs, blocking blood flow to lung tissue.
• Dyspnea: Shortness of breath, a symptom of PE.

Heart and Lung Interaction

• Heart problems can cause lung problems, and vice versa.
• Understanding the right and left sides of the heart is crucial in understanding heart failure.

Heart Anatomy Review

• Right side: Receives deoxygenated blood.
• Left side: Receives oxygenated blood and pumps it to the body.
• Blood Flow:
  {Superior/Inferior\ Vena\ Cava \rightarrow Right\ Atria \rightarrow Tricuspid\ Valve \rightarrow Right\ Ventricle \rightarrow Pulmonary\ Artery \rightarrow Lungs \rightarrow Pulmonary\ Veins \rightarrow Left\ Atrium \rightarrow Mitral\ Valve \rightarrow Left\ Ventricle \rightarrow Aorta}

Coronary Artery Disease (CAD)

• CAD: Issues with arteries supplying the heart muscle.
• Endothelium: Damage to the inner lining of blood vessels is a key factor.
• Modifiable Risk Factors: Diabetes (to some extent), obesity, high cholesterol (hyperlipidemia), atherosclerosis.

Atherosclerosis in Detail

• Process:
  • Damage to the endothelium.
  • Accumulation and oxidation of LDLs (Low-Density Lipoproteins) in the damaged area.
  • Macrophages consume oxidized LDLs, becoming foam cells.
  • Foam cells accumulate, forming a fatty streak.
  • Smooth muscle cells attach and form a plaque, reducing blood flow.
  • Plaque Rupture: Can lead to thrombus formation.

Consequences of Coronary Artery Disease

• Angina: Temporary lack of blood flow to the heart muscle.
  • Triggers: Exertion or stress.
  • Symptoms: Sweating, chest pain, nausea.
  • Treatment: Rest, vasodilators like nitroglycerin.
• Myocardial Infarction (Heart Attack):
  • Total occlusion of a coronary artery, often due to a thrombus from arteriosclerosis.
  • Symptoms: Dizziness, heavy chest pressure (described as an elephant sitting on the chest), burning, jaw pain, arm pain, anxiety, nausea, indigestion.
  • Physiological Response: Initially, heart rate and blood pressure increase, then decrease as heart function declines.

Diagnostic Procedures

• Echocardiogram: Uses sound waves to create an image of the heart.
• Serum Troponin: A blood test to confirm myocardial infarction.
• Cardiac Catheterization: A procedure to visualize heart vessels, take samples, and potentially intervene in areas with clots or blockages.

Key Points for Exam Preparation

• Review content from weeks three to five.
• Topics include:
  • Older patients.
  • Substance abuse.
  • Effects of drug classes.
  • Different types of pain.
  • The neural system.