Med Surg session 6: Cardiovascular

 

 

Session 6

 

Cardiovascular

 

Cardiac index is the CO when the size of the person is taken into account.

  • normal is 2-4
  • This accounts for: 100lb person with 8L CO and a 300 lb person with a 8L CO


the higher the SVR the tighter the blood vessels are.

  • Systemic vascular resistance
  • this is low in neurogenic shock, and septic shock.

 

Men often present with Heart disease around 50 yo and have generic symptoms

  • Chest, jaw, left shoulder pain, SOB

Women present in a less typical way and onset around 60 yo

  • nausea, vomiting, anxiety, back or arm pain, fatigue

 

HTN

 

  • JNC8 are the new guidelines
  • keep DM and CKD pts under 140/90
  • HT crisis
  • emergency
  • severe HA, seizures, coma
  • HCT (hydrochlorothiazide) is the first line drug for HTN

 

CAD

  • to prevent the increase of this disease, Exercise, blood glucose management
  • Drugs that this person would be on: ASA, plavix, Beta blocker, (not a diuretic necessarily because we are trying to directly decrease HR and the ability to form a thromboembolism)

 

Angina

  • Chronic stable angina – pain upon exertion that is relieved with nitro and rest. Predictable.
    • the cause is usually atherosclerosis
    • medications for this: nitro, beta blockers, ASA, CCB
      • take 8-12hr time off of nitro (usually at night) because when used too chronically it loses effectiveness.
  • Vasospastic angina (prinzmetal)
    • doesn’t happen upon exertion, happens randomly
    • treat with CCBs relax vessels and make them less spastic
  • When to worry
    • persisting longer than 5 mins call 911, then take two more tablets total in five minute intervals

 

Myocardial Infarction

  • irreversible necrotic tissue
  • troponins labs will be high
  • usually in the left ventricle
  • Diagnostics for MIs
    • ECG changes
      • STEMI – st elevation MI
  • Clot busters () (fibrinolytic therapy) are given if there is no cath lab in the hospital to use a balloon to move the clot against the artery wall.  
    • TPA, alteplase, streptokinase
  • Cardiac catheterization (PCI)
    • inserted through the femoral artery (sometimes the radial)
    • goes into the heart arteries to balloon open up the artery section.
    • Check KIDNEY FXN! the dye used to visualize the clot and PCI are hard on the kidneys
  • MONA – morphine (pain, vasodilation, and cheap), O2, Nitro, ASA

 

Heart failure

  • left sided
    • EF > 40% (normal is 50%-70%
    • systolic HF (HFrEF)- reserved (decreased) ejection fraction
    • diastolic HY(HFpEF) – preserved ejection fraction
  • Drugs to increase CO
    • diuretics, ACE, ARBs, Beta and CCBs (if the EF is not too small)
  • VAD – Ventricular assist Device – used so the heart does not have to work. it is inside the person’s body.

 

Cardiomyopathy

  • 3 types: dilated, hypertrophic, and restrictive
  • Dilated: most common, decrease in CO,
    • the volume in the heart chambers increases, and there are thin walls
  • Hypertrophy: Increased O2 consumption in the Heart muscle, and decreased volume of blood that can flow into the ventricles during diastole.
    • volume in the chambers decreases, the heart walls are thick.

 

PVD (peripheral Vascular Disease)

  • decreased peripheral perfusion from a decrease in the size of peripheral blood vessels
  • pathology similar to atherosclerosis, but in the periphery
  • s/s: slows healing, pain, decreased pulses, ulcers, and edema
  • can affect the arteries, or venous system (tends to affect the venous system more often)

 

Peripheral venous disease –

  • Risk factors: venous stasis, Immobile, hypercoagulability, increased viscosity (often from dehydration),
  • s/s: increase in: heat, malaise, erythema
  • Encourage mobility

 

DVT – deep vein thrombosis

  • prevent with: tight stockings, auto compression devices (compress the legs at regular intervals to increase venous return and decrease stasis), AMBULATE.
  • If a clot develops then put the patient on bed rest so they do not throw the clot
    • Drugs once there is a clot: (thrombolytics) TPA, alteplase, and streptokinase
  • If the clot detaches it will end up in the lungs (if there is a patent foramen ovale (hole in the septum in the heart) the clot can pass through that hole then end up in the brain).

 

Aneurysms

  • aortic aneurysm – out pouch of the aorta
    • can repair with surgery by adding in a graft to strengthen the wall and bypass the aneurysm site.
    • Diagnosis from a CT scan with Dye to visualise the pouch
    • TAA- thoracic Aortic aneurysm
      • send embolisms to the brain and extremities
    • AAA – Abdominal aortic aneurysm
      • sends embolisms to the kidneys and lower extremities (cannot get to the upper extremities or brain because of the low position of the aneurysm)

 

patients with DM and now has angina may present differently when their heart is ischemic

  • Hyperglycemia, nausea, malaise
  • Also Pioglitazone (actos) may increase the chance of exacerbating the patient’s HF

 

Lasix (furosemide) things to look for to measure effectiveness

  • decreased weight, urine output, BP decreasing, decreased edema
  • Monitor these labs: K, BUN and Creatinine, (electrolytes and kidney function)

 

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