BSN 2144 Theory: LEARNING ACTIVITY #4 Cardiovascular Health Challenges: Hypertension, Coronary Artery Disease, Myocardial Infarction Ends

In view y demonstrate a beginning knowledge of the risks for cardiovascular health challenges including: hypertension, coronary artery disease and myocardial infarction y y y y y y y y y y y y y y age gender high blood pressure smoking physical inactivity unhealthy diet obesity diabetes mellitus mental health alcohol use use of certain medications hereditary or family history ethnicity or race

describe the manifestations of acute, life threatening cardiovascular conditions y y y y y y y y y y fatigue abdominal obesity- increased risk of developing cardiovascular disease fluid retention irregular heartbeat dyspnea pain tenderness in calf legs dizziness, light-headedness altered neurological function leg pain

Answer the following questions: a) What are the patterns of hypertension? y High blood pressure y Secondary hypertensions caused by other conditions affect the kidneys, arteries, heart or endocrine

Risk for stroke, myocardial infarction (heart attack),heart failure, aneurysms of the artery, peripheral arterial disease and is a cause of chronic kidney disease.

b) Why this is called the silent killer? Hypertension is asymptomatic until it becomes severe and target-organ disease has occurred. It can damage the kidneys; increase the risk of blindness and dementia. c) What are the risk factors for hypertension? y Age- BP increase with age y Alcohol- excessive alcohol is associated with hypertension. Alcohol should be limited for people with hypertension. y Cigarette smoking- increase risk of cardiovascular disease. y Diabetes mellitus- common in diabetics, complications more severe. y Elevated serum lipids- risk factors for atherosclerosis. y Excess dietary sodium- should be limited, can decrease the efficacy of certain medications. y Sex -more prevalent in men, in young and middle adulthood age, then after 55y it becomes more prevalent in women. y Family history y Obesity y Ethnicity y Sedentary lifestyle y Socioeconomic status stress d) How it is typically diagnosed? y Lab tests o Urinalysis o Blood chemistry (K, Na, and creatinine) o Fasting glucose o Fasting total cholesterol and high density lipoprotein cholesterol, lowdensity lipoprotein cholesterol and triglycerides o Electrocardiogram (ECG or EKG) Assess urinary albumin excretion in clients with diabetes Monitoring BP-home BP, ambulatory BP monitoring and every 3-6 months once BP is stabilized Nutritional therapy- restrict NA, reduce weight, restrict cholesterol and saturated fats, maintain adequate intake of K, CA and Mg, regular, moderate physical activity, cessation of smoking, moderation of alcohol consumption, antihypertensive drugs.

y y y

e) What would you expect to find on physical examination of a patient with hypertension? y y y y y y Fatigue Reduced activity tolerance Dizziness Palpations Angina Dyspnea

f) What are the risk factors for coronary artery disease (CAD)? y y y y y y y y y y y y y y age sex ethnicity smoking high blood pressure high cholesterol diabetes family history psychosocial factors peripheral artery disease obesity lack of fruit and vegetable intake alcohol consumption inactivity

g) What complications could arise from having CAD? y y y y Chronic stable chest pain syndromes Heart failure Ventricular fibrillation Death

h) What are the patterns of symptoms for angina and unstable angina? y Chest pain y Radiating pain i) What diagnostic tests are commonly associated with these diagnoses? y ECG y Serum cardiac markers y Coronary angiography

j) What are common complications to watch for? y y y y y y y y Chest pain Dysrhythmias Heart failure Cardiogenic shock Papillary muscle dysfunction Ventricallr aneurysm Pericarditis Dressler s syndrome

k) What is a myocardial infarction? Myocardial infarction occurs as a result of sustained ischemia, causing irreversible myocardial cell death (necrosis). MI s frequently occur secondary thrombus formation. When thrombus develops, perfusion to the myocarsium occolusion is halted, resulting in necrosis. Contractile functions of the heart stop in the necrotic areas. The degree of altered function depends on the area of the heart involved and the size of the infarction. Most MI s involve some portion of the left ventricle. l) What are the common locations for occlusion? y y y m) y y y y Coronary arteries Descending arteries Circumflex coronary artery

How do the arteries occlude? Blood clots Ruptured plaque Hardening of arteries Debris that flows downstream from narrow carotid arteries

n) How are stable angina, unstable angina and myocardial infarction differentiated?
Stable Angina Asymptomatic Chest pain that occurs intermittently over a long period with the same pattern of onset, duration, and intensity of symptoms. Indigestion or burning Unstable Angina Chest pain that is new in onset Occurs at rest or during sleep Mycaridal Infarction Sustained ischemia Irreversible cell death

Has a worsening pattern

MI process takes time

sensation of in epigastric region. Radiating pain. Pain usually last a few minutes (3-5) and then subsides. Can be controlled with medication

May develop with client with chronic stable angina Easily provoked by minimal or no exertion

(approx. 20 min. before cell death occurs. Damage could occur in more than one location in the heart