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Cardiac Valves: stiffen, calcify, degenerate = expect murmurs ("swish")
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Conduction System: coronary arteries get poor blood = necrosis, arrhythmias; lose pacemaker cells, lose conduction, fat in SA node, coming from ectopic muscle
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Left Ventricle: atrophies, stiffens, enlarges, becomes less distensible, dec. SV & CO, dec. EF, most noticeable w/ physical activity
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Aorta & Large Arteries: thicken, stiffen, less distensible = pumps harder ( inc. HR) & inc. systemic vascular resistance
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Baroreceptors: located in carotid arteries; help regulate BP; less sensitive w/ age; most noticeable w/ position changes
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Ask about...
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Occupation?
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Insurance?
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Support system?
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Pets at home?
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Hobbies that may help?
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MODIFIABLE RISK FACTORS
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Age: symptoms start by 40yo, unlikely to survive MI if <30yo b/c collateral circulation
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Ethnicity: more prevalent in non-Hispanics, death rate higher in African Amer. (HTN)
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Heredity: HTN, inc. lipids, DM, obesity
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Gender: men > women until menopause, childbearing women have 25% chance, women >40yo & after menopause > men (r/t heart size & collateral circulation)
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NON-MODIFIABLE RISK FACTORS
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BP: biggest problem = insidious - take meds if needed
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HLD: goals - total cholesterol < 200; HDL > 50, LDL < 70 - take meds if needed
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Smoking: temp of vape = hyperplasia, asthma-like symptoms; causes 21% of CVD deaths; carcinogenic; inc. epic & norepi = heart works harder, vasoconstriction & dec. circulation, C monoxide = inc. vessel perm.
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DM: r/t early atherosclerosis, inc. thickening of blood
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Physical Inactivity: "new smoking", exercise inc. collateral circulation
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Obesity: extra burden on heart
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Personal Factors: stress, psych. response
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SUBJECTIVE DATA (History of Symptoms)
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Chest Pain: (activity w/) onset? location? severity? type? precipitating factors? other Sx? may c/o nausea, indigestion
- Causes: cardiac (myocardial), pulm., m/s |
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Dyspnea or SOB: often assoc. w/ left side heart pain, dec. perfusion, orthopnic
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Palpitations: usually PAC, c/o rapid HR = dec. EF & CO (caffeine)
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Fatigue: mild to severe, may attribute to getting older (compare to daily activity)
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Extremity Pain: arm (may be R), jaw
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Syncope: if issue w/ CO
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Weight Gain: fluid, daily wt, anasarca
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OBJECTIVE DATA
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General Appearance: AAOx3?, posture
- Restlessness assoc. w/ change in O 2 |
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Vital Signs: BP? HTN < 130/80, check BP bilat., may see a paradoxical change in BP
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Heart Sounds: S
1, S2; may hear S3 & S4, murmurs, clicks |
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Cyanosis & JVD: pallor; JVD = R-sided HF (cor pulmonale), seen w/ OSA; = give Lasix
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20 & electrolytes |
SERUM CARDIAC ENZYMES (SERUM MARKERS) OR CARDIAC BIOMARKERS
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Troponin: GOLD STANDARD OF CP; appears 2-4 hr after damage to myocardial muscle, inc. further depending on damage
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CK-MB: r/t cardiac muscle; detected 2-4 hr after damage, elevated 72 hr max
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CK-MM: r/t skeletal muscle
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CK-BB: r/t brain tissue
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Myoglobin: byproduct of muscle breakdown, appears in 2-4 hr, then dec.; affects kidneys; rhabdomyolysis
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BNP: r/t stretch of heart; correlates + w/ HF; secreted by ventricles r/t stress
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CRP: non-specific inflammatory marker; correlates + w/ atherosclerosis; good for determining severity of disease process
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Myeloperoxidase: leukocyte enzyme r/t plaque instability and enzyme production
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Ischemia Modified Albumin: circulating albumin touches ischemic tissues
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Homocysteine: get from eating meat (in amino acids), linked to disease development
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Serum Lipids: correlates + w/ intravascular plaques
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COAGULATION STUDIES
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Unfractionated Heparin: if elevated, give protamine sulfate
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APTT
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PT/INR: if elevated, give vitamin K
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OTHER
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EKG
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shows issues r/t heart rhythm; 12-lead EKG w/ age 40yo+
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Telemetry
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continuously monitoring EKG, ambulatory
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Holter Monitor
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ambulatory type, pt takes it home & writes down what they do to compare it to the rhythm
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X-Ray
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shows enlargement, fluid; pulmonary edema r/t CHF?
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STRESS, NUCLEAR, & ULTRASOUND TESTS
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Exercise Stress Test
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look at BP and HR w/ inc. exercise and inc. myocardial O
2 demand |
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Nuclear Perfusion Imaging
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stress test & blood flow through the heart
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Echocardiogram
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shows wall movement, overall ventilatory performance; can tell how badly heart was damaged
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TTE
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2-D
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TEE
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3-D (better)
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K
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biggest electrolyte r/t heart
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Hypokalemia: inc. electrical instability, a fib, digoxin toxicity
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Hyperkalemia: P-wave issues, bradycardia, asystole, ventricle issues; give Kayexalate, insulin (IVP 10 units) + D
50; give Lasix |
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Na
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r/t CHF
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Hyponatremia
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Hypernatremia
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Ca
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Hypocalcemia
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Hypercalcemia
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Mg
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Hypomagnesemia
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Hypermagnesemia
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P
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Hypophosphatemia
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Hyperphosphatemia
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Cheatography n. The art of mapping complex subjects into clear, instantly navigable reference guides.