Cardiovascular 1

• Blood in the right atrium comes from either the superior vena cava, inferior vena cava or coronary sinus
• Serum lipids test for triglycerides and cholesterol
• Lipoproteins are proteins in the blood that carry cholesterol and triglycerides
• Chest X-rays are used to examine the lungs and size of the heart
• Electrocardiogram (ECG) are electrodes used to record cardiac electrical activity
• Cardiac stress test is used to assess cardiac function by stressing the heart
• Echocardiogram is an ultrasound to assess the structure and function of the heart
• Coronary angiography is a contrast medium injected into the coronary arteries during a cardiac catheterization
• Diagnostic studies:

  • serum lipids
  • lipoproteins
  • chest x-ray
  • electrocardiogram
  • cardiac stress test
  • echocardiogram
  • coronary angiography
• Hypertension is a perfusion problem since it affects how the blood reaches the tissues
• AOBP: automated office blood pressure

  • uses an automated device without the provider present (patient left unattended)
  • 3-5 oscillometric consecutive readings are taken
• OBPM: office blood pressure measurement

  • performed using an upper arm device with the provider in the room
  • electronic devices are preferred
  • if not, use auscultatory devices
• ABPM: ambulatory blood pressure monitoring

  • requires use of a validated oscillometric device
  • worn by the patient for 24 hours
  • measurements taken every 20 to 30 minutes
• HBPM: home blood pressure monitoring

  • self monitoring method at home
  • patient measures their BP twice in the morning and evening for 7 days
• Cardiac output is the amount of blood ejected by the heart in one minute
• Stroke volume is the amount of blood ejected by a ventricle is one contraction
• Systemic vascular resistance is the force of blood opposing the movement of blood within the blood vessels
• Blood pressure is the force of blood exerted on artery walls
• Cardiac output: stroke volume x heart rate
• Arterial BP is affected by cardiac output x systemic vascular resistance. If there is more resistance due to constriction of blood vessels, the BP will go up
• Renal fluid volume control influences BP. If the kidneys retain salt and water, the BP will go up
• Hypertension can be primary (essential or secondary). Primary hypertension affects 90 to 95% of patients and is believed to be caused by an interaction between genes and the environment. Secondary hypertension has a specific cause and can often be corrected
• Children are mostly affected by secondary hypertension (around 80% of hypertension in children)
• Restricting sodium intake is an important part of dietary management of hypertension
• Risk factors for HTN:

  • advanced age
  • excessive alcohol intake and cigarette smoking
  • diabetes
  • elevated serum lipid
  • excess dietary sodium
  • gender and ethnicity
  • obesity and sedentary lifestyle
  • family history of CVD
  • stress
• Hypertension is often referred to as the silent killer because patients are frequently asymptomatic. Symptoms are often secondary to target organ disease such as heart, cerebro-vascular and kidney disease
• Hypertension can lead to artherosclerosis, hardening and damage of the arteries
• Creatinine is a chemical waste molecule that is generated from muscle metabolism. It is often transported through the bloodstream to the kidneys, which dispose most of it in the urine
• Collaborative care of HTN:

  • regular monitoring including cardiovascular risks
  • health behavior changes (nutrition, weight reduction, limit alcohol consumption, physical activity, smoking cessation, stress management)
  • drug therapy
• Examples of moderate intensity exercise are running, biking, walking and swimming