Heart Failure
What is the primary way to Dx HF?
Bonus! Name all of the ways (2 more for both, 1 more for Right Sided)
BNP elevated above 100
Bonus:
CXR (to see ventricular remodeling)
Echocardiogram
RHF- lung scan and pulmonary ateriography
S/S DVT
usually not until complications arrive
unilateral swelling of extremity, redness, warmth, pain, cording
risk factors for venous insufficiency
Over 50, obesity/pregnancy, DVT hx, prolonged sitting/standing, varicose veins, smoking
What is CAD? How does it happen?
Bonus!!! what Rx do we use to treat HTN? (name at least 2)
Coronary Artery Disease
progressive disorder in which blood flow serving the myocardium is gradually impeded leading to decreased oxygen and increased risk for MI and angina
Bonus: ACE/ARBS, BB, diuretics, amlodipine (Norvasc)
What meds do we use to treat MI?
MONA
Morphine
Oxygen
Nitroglycerin
ASA
Risk factors for L and R sided HF?
Left - systemic HTN and MI
Right - L sided HF, Cor Pulmonale
What are the components of Virchow's Triad (with at least one example) and what is it's significance?
Virchow's Triad describes causes of DVT, if one or more is out of balance = DVT
describe the patho for venous insufficiency?
chronic condition where venous blood return in decreased primarily in legs. Usually due to incompetent valves (pouching) that cause blood pooling, increased venous pressure = edema and skin changes
how do you tx CAD?
increase HDL, lower LDL, smoking cessation, aerobic and strength training, low sat fat diet high soluble fiber
meds: Atorvastatin (decrease cholesterol)
describe how an MI works
prolonged occlusion of coronary blood flow leading to myocardial necrosis. Severity depends on size of affected area, location of infarct, and collateral circulation
explain the difference between left sided and right sided HF pathologically
BONUSSSS for an extra 100, starting from the lungs, name the path of blood ending at the lungs
Left sided is commonly due to myocardial damage from MI or HTN that results in ventricular remodeling + weakening of myocardium = low CO and pulmonary effects
Right sided however is typically due to left sided HF, infarct, or pulmonary hypertension leading to ventricular remodeling + weakening of myocardium = low CO, and edematous effects
BONUSSSSS
Lungs -> LA -> LV-> vasculature ->RA ->RV -> lungs
What are some complications of DVT to watch for?
S/S of PE
increased risk of another DVT/VI
follow up labs (PTT/PT/INR)
describe the difference in s/s of venous vs. arterial insufficiency
venous: warm, red, normal pulse, edema, pain (worse in PM), hemosiderin, statis dermatitis
arterial: cool, pale, thready pulse, numbness, pain (5 P’s)
risk factors for CAD?
Arteriosclerosis and atherosclerosis, insulin resistance, HTN, smoking, obesity, dyslipidemia (high LDL low HDL), stress
Name the 3 types of angina, what are the difference between them?
Stable Angina - 70-90% occlusion, associated with 4 E’s (exertion, eating, excitement, exposure to cold), consistent pain with each episode, s/s improve with rest, may need Rx
Unstable Angina - >90% occlusion, can happen at rest, pain levels intensify between episodes, s/s do not improve with rest, needs Rx
Variant Angina - coronary artery spasm interrupting blood flow, typically at night or with stimulant use, tx with Ca++ channel blockers
what is the main goal of treatment for HF?
What medications would we use?
lower workload of heart and increase CO
Rx: digoxin, diuretics, ACE, ARBs
How do you Dx DVT?
duplex ultrasound, plethysmography, NOT Homan’s sign
complications of venous insufficiency?
BONUS: how do you Dx venous insufficiency
high risk for DVT and venous stasis ulcers, cellulitis, and infection
BONUS: Hx, doppler ultrasound, photoplethysmography, air plethysmography
diagnosis of CAD
Lipid panel, blood glucose, EKG, CRP
how do we diagnose an MI??
What are some good tests for POST MI?
12 lead EKG, troponin, CK-MB, Patient Hx
Post: Echocardiogram and angiogram, thallium scan, stress test
Name the S/S of Left and Right Sided HF!!
Bonus: What are we monitoring for?
Left: pulmonary congestion, SOB, cough w/ blood-tinged sputum, activity intolerance
Right: dependent/pitting edema (can reduce at night), Ascites, increased peripheral venous pressure, enlarged spleen and liver, JVD
BONUSS - if on digoxin monitor for electrolyte imbalances (hypokalemia and hypercalcemia) and toxicity effects, edema progression, respiratory complications, cardiac monitoring
What are the ways to prevent DVT and how do we treat it??
how do you prevent AND treat venous insufficiency?
treatment: compression therapy, positioning, skin and wound care, possible surgical procedures, avoid leg trauma
prevention: regular ambulation, avoid prolonged sitting/standing, compression stockings, avoid tight clothing and crossing legs, elevation of legs
What is good diet education for someone with CAD, HTN, Angina, etc.?
DASH diet, low salt, low fat, avoid dairy, prioritize whole foods, fiber, and hydrate!
you have a patient post MI, what are you monitoring more? What interventions can you do to make the room a good healing environment? how would you educate your patient? Is it normal for the patient to feel pain?
high risk of another MI or stroke occurring, cardiac monitor, rest periods, no straining, stool softener indicated, decrease anxiety, decrease stimulation/visitors, pain should be 0, smoking cessation/diet/lifestyle changes, monitor VS, don’t over do it