Cardiac Notes

Increasing Blood Pressure 1. ADH (antidiuretic hormone) (Vasopressin) a. Decreases urination- Increases blood volume b. VasoCONSTRICTS i. INCREASES BLOOD PRESSURE c. Created in the hypothalamus, released from the posterior pituitary 2. Aldosterone a. Decreases urination-increases blood volume b. vasoconstricts c. Renin is released from the kidneys i. Moves to the liver which produces angiotensin I ii. Moves to the lungs which produce angiotensin II iii. Moves to the adrenal glands which produce aldosterone Decreasing Blood Pressure 1. Atrial Natriuretic Peptide a. Comes from atria in the heart where stretch receptors can notice when pressure is too high b. Increases urine output- decreases blood pressure c. Vasodilates Perfusion- getting enough oxygen to the tissue 2. Objectively measured by blood pressure 3. CO- left ventricle pumps 4 to 8 L of blood to the body q minute a. Take the stroke volume x heart rate= CO Females have about 6 L of blood Males have about 8 L of blood 4. Stroke Volume- the amount of blood the left ventricle ejects to the body in 1 beat. a. Preload: volume of blood at the end of diastole (EDV) (end-diastolic volume) i. Associated with Diastolic Blood pressure b. Afterload: the amount of resistance that the ventricle must overcome to pump blood to the rest of the body i. Systemic vascular resistance: afterload in the left ventricle ii. Associated with Systolic Blood Pressure c. Contractility: the myocardium’s ability to stretch and contract in response to the heart filling with blood i. Ejection fraction: body normally ejects about 55-70% of blood in left ventricle 1. The amount of blood left in the left ventricle at the end of diastole (EDV) is 100 ml and EF is 45% then 45 ml are ejected and 55 ml remain 2. The EDV is 100 ml and EF is 70% then 70 ml are ejected and 30 ml remain 3. EF can be effected by: a. Preload b. Afterload c. Electrolytes d. Acid-base e. Autonomic nervous system 5. Heart rate-beats per minute (60-100) • • • Brain can survive without oxygen for about 6 minutes Body can survive without oxygen for several hours Heart can survive without oxygen for about 20 minutes 6. Starling Forces a. Hydrostatic pressure: pushing pressure i. Originates in heart and pushes blood to the rest of the body ii. Higher on the arterial end iii. No net movement on the capillary end iv. Lower on the vascular end b. Oncotic pressure: pulling pressure i. What’s happening in our veins to return blood to the heart ii. Remains the same Hypertension 7. Ranges a. Normal: 120/80 b. Pre-high: 121-139/81-89 c. High: >140/>90 8. Symptoms a. Headache (temple) b. Nosebleed c. Facial flushing- red cheecks d. Nausea-vomiting e. End organ damage- result of HBP 9. Primary hypertension is caused by a factor that cannot be altered a. genetics 10. Secondary hypertension is caused by a factor that can be altered a. Diet Hypotension 1. 2. 3. 4. 5. 6. Headaches in nape of neck Cold extremities- not enough perfusion Dizziness/weakness Pallor Poor tissue perfusion- result Orthostatic hypotension- hypotension caused by a change in posture a. Sitting for a long period then standing up (seeing stars) b. Blood has pooled into leg tissue and when you stand up there is a lack of perfusion to the brain c. Body increases HR to compensate Coronary Artery Disease 1. This is what happens to your heart when it doesn’t get the oxygen it needs to pump blood to the rest of your body 2. Coronary circulation a. Right- right coronary i. Supplies right atrium and right ventricle with blood ii. Obstruction of the artery most often causes an area of ischemia between the right and left ventricles b. Left- left coronary i. Left anterior descending (LAD) 1. Widow maker 2. Supplies blood to the left ventricle 3. Obstruction of this artery causes an area of ischemia at the bottom of the left ventricle… BIG PROBLEM. ii. Left circumflex 1. Supplies blood to the back of the heart 2. Obstruction of this artery causes an area of ischemia at the top of the left ventricle 3. Dyslipidemia- an imbalance of the lipid components of the blood a. LDL- “lousy” cholesterol b. HDL- “healthy” cholesterol 4. Atherosclerosis- narrowing and hardening of the arteries due to plaque buildup a. Plaque can rupture and cause a blood clot i. Thrombus- a blood clot that obstructs or partially obstructs an artery 1. Can break off and become an embolus 5. Angina-chest pain often caused by ischemia a. Stable angina- chest pain that is relieved by rest i. Stable fixed plaque b. unstable angina- chest pain that is NOT relieved by rest i. unstable plaque ii. can put aspirin under tongue to thin the blood (or use nitroglycerine) 6. NSTEMI- unstable angina that has an elevated heart markers such as troponin and creatine kinase a. Non- ST elevated Myocardial infarction b. Plaue has ruptured and created a thrombus causing complete blockage 7. STEMI- unstable angina with elevated heart markers such as troponin or creatine kinase a. ST elevated Myocardial infarction i. Not getting enough ventricular repolarization ii. Heart is unable to relax b. Plaque has ruptured and created a thrombus causing complete blockage Heart failure- weakened ventricular muscle that is unable to sufficiently pump blood into the arterial circulation (or the pulmonary) to meet the needs of the tissues. 8. Right sided heart failure (cor pulmonale)- congestion of peripheral tissue a. Dependent Edema- swelling of the legs b. Ascites- swelling/fluid buildup of the abdomen c. Liver congestion- liver failure d. GI tract congestion- anorexia, GI distress, look thinner but same weight e. Distended jugular veins f. High peripheral venous pressure 9. Left sided heart failure- blood is caught in lungs a. Decreased cardiac output due to decreased stroke volume b. Pulmonary congestion i. Cough ii. Crackles iii. Wheezing iv. Cyanosis v. Hypoxia vi. Tachypnea vii. BLOOD TINGED SPUTUM viii. Paroxysmal nocturnal dyspnea (needs to sleep in recliner because they feel like they are drowning) 1. Restlessness/fatigue ix. Activity intolerance x. Tachycardia xi. Confusion 10. Systolic heart failure- inability of the heart to squeeze properly a. HEFrEF i. Heart failure with reduced ejection fraction 1. Ejection fraction is below 55% ii. Usually caused by myocardial damage following a MI 11. Diastolic heart failure- inability of the heart to relax a. HEFpEF i. Heart failure with preserved ejection fraction Peripheral Artery and Venous Diseases 1. Peripheral arterial disease (PAD)- not enough hydrostatic pressure (ARTIC) a. Not getting enough blood flow to the extremities b. Most common in the legs c. No pedal pulse or weak pedal pulse due to less perfusion d. Prolonged capillary refill due to less blood flow e. Intermittent claudication (very sharp pain) i. Often occurs when moving due to an increased need for bloodflow f. Pale/cool extremities/pallor g. Dry ulcerations or sores i. Black eschar- often on the bottom of foot or tips of toes ii. Round smooth sores h. No edema 2. Peripheral venous disease (PVD)- not enough oncotic pressure a. Not returning enough blood to the right atrium b. Pulse present c. Dull acing pain d. Red and warm to the touch e. Swelling/lower leg edema f. Wet ulcerations and sores i. Found typically at the ankles and the calves ii. Irregular borders on sores iii. Yellow slough 3. Thrombophlebitis- blood clot causing a backup but not complete blockage a. Typically happens in smaller veins/ superficial arteries b. Red/swollen extremity i. Often associated with PVD but not always c. Elevated d-dimer d. Positive homan’s sign 4. Acute arterial occlusion- complete blockage usually in a larger artery a. Polar b. Pallor c. Paresthesia- cant feel it/tingling feeling d. Paralysis e. Painful f. Pulseless