Exam 2

Rises throughout life

Rises until age 50 then levels off or falls

Isolated Systolic Hypertension

Prior to age 50

After age 50

Systolic less than or equal to 140/Diastolic<90

Systolic<140/Diastolic greater than or equal to 90

Isolated Diastolic Hypertension

Isolated diastolic hypertension

Avoid long appointments, morning appointments are better, reduce anxiety, anxiolitic or nitrous may be indicated, avoid sudden changes in chair position, use the cardiac dose of anesthetic containing epinephrine

0.04mg of epinephrine

0.018

2

Thickening of the inside of arterial walls

Accumulation of lipid plaques

Injury to arterial intima (disturbed blood flow @ bending points or bifurcations), Atheroma formation (LDLs enter injured area, form extracellular pools of lipids, macrophages engulf lipids and form foam cells), Inflammatory process prompts migration of smooth muscle cells, fibrous cap is formed and may rupture

often propted by physical effort, predictable, reproducible, consistent over time

New onset of pain, or change in pain duration, intensity, frequency, or onset factors

Stable Angina

5-15 minutes

>15 minutes

Decrease cardiac load and decrease oxygen demand by dilating venous & arterial systems

Systolic is >100 mmHg

3

3-5 minutes

Antiplatelet therapy for angina

75-325 mg/day

Many pts do not report on MHX and will self-medicate

Angina is brief, associated with elevated BP, and can be relieved with Nitroglycerine, Myocardial infarctions are long, BP is decreased or normal, and nitroglycerine does NOT relieve pain

Stop Tx, Call EMS, Place pt in comfy position, administer O2, administer nitroglycerine (if systolic >100), administer 325 mg aspirin (have pt chew it)

Myocardial Infarction

Stress or Pain

Experienced MI w/in the last 30 days, unstable angina, unable to meet 4 METs, BP>180/110

Defer elective tx

a unit of O2 consumption. 1 MET=3.5mL/kg/min at rest

Ability to climb a flight of stairs

Complex clinical syndrome that results in an inability of the ventricle to fill with and eject blood (Represents the end stage of many of the cardiovascular diseases

Cardiac arrest, cerebrovascular accident (stroke), and myocardial infarction

Coronary heart disease, cardiomyopathy, hypertension, valvular & congenital heart disease, arrhythmias, pulmonary hypertension, pulmonary embolism, and endocrine disease

Evaluate risk, identify heart failure, determine if HF is compensated (no symptoms) or decompensated (symptomatic), if decompensated, discuss tx risk with Dr prior to elective care

Due to antiplatelet drugs

DO NOT use vasoconstrictor or epinephrine

Digitalis,Lanoxin, Lanoxicaps, Digicaps

Supine chair position is intolerable

Respiratory Emergencies

Sudden drop in blood pressure when pt stands after reclining

Raise chair up slowly, remain in upright position for 2-3 minutes before dismissing client, measure BP before leaving chair

Supine Position, ensure airway is open, measure BP, if >80/60 mmHg, pt can stand

Beta Blockers

Calcium Channel Blockers

Angiotensin-converting enzyme Inhibitors (ACE-Inhibitors)

Angiotensin Receptor Blockers (ARBS)

HMG-CoA Inhibitors or Hyperlipidemic Agents

Cause loss of fluid, reduce blood volume

Electrolyte disturbance, dehydration, orthostatic hypotension, xerostomia

Thiazide Diuretics, Loop Diuretics, and Potassium Sparing Diuretics

Not Fully Understood

Hydrochlorothiazide or HCTZ

Act on the distal tubule of the kidney, inhibits NaCl reabsorption, Increases urination, and potassium loss

Hypokalemia (low potassium), Hyperglycemia, hyperlipidemia, and hyperuricemia ( high uric acid, calcium, and sodium, and lowered magnesium)

Loop Diuretics

Furosemide (Lasix)

Inhibit reabsorption of NaCl in the loop of Henle

Severe potassium loss and orthostatic hypotension

Potassium Salts

Antagonist of aldosterone which inhibits sodium reabsorption and potassium excretion

Spironolactone (Aldactone), Triamterene

Constricts vessels of periphery

Monitors function of A1 and prevents excessive vasoconstriction

Makes Heart Beat (Stimulates SA node)

Vasodilates Lungs, Bronchodilates, Gluconeogenesis

Decrease Cardiac Output, HR, Contractility, and Myocardial Oxygen Demand

Beta 1 only

Beta 1 and Beta 2

Atenolol (Tenormin), Metoprolol (Lopressor or Toprol)

Propanolol (Inderal)

-olol drugs

Bradycardia, first dose syncope, If discontinued abruptly=Heart Attack risk, Long term NSAIDS diminishes effectiveness of Beta blockers, Orthostatic Hypotension, Depression & decreased Sexual FX

Renin is secreted, Renin converts to angiotensinogen to angiotensin I, angiotensin I is converted to angiotensin II by ACE

Non-Productive Dry Cough, Orthostatic Hypotension, Burning Mouth Syndrome, Angioedema, Hyperkalemia, and Altered Taste

Calcium Channel Blockers

Increases vasodilation by relaxing vascular smooth muscle, decreases O2 demant by decreasing ventricular filling and heart workload, DILATES VEINS AND LARGE ARTERIES

Severely Low BP (especially when taken with viagra), flushing, lightheadedness, and syncope

Alcohol and Hot Weather

Vitamin K antagonist that blocks synthesis of factors VII, IX, and X

Coumadin

Atrial fibrillation, myocardial infarction prevention, stroke, and deep vein thrombosis

Bleeding (do NOT take w/aspirin), and Narrow TI

INR

A way to standardize prothrombin time (PT)

The time for a blood plasma sample to clot following addition of tissue factor III

They are known to inhibit the extrinsic pathway

11-15 seconds

0.8-1.2

2.0-3.0

>5 indicates bleeding risk and <0.5 indicates risk of excessive clotting

arrhythmias can cause blood to pool in the cardiac chambers which can create a clot (thrombus)

Warfarin, Xarelto, and Pradaxa

Digoxin

A cardiac glycoside used to enhance cardiac contractility

Arrhythmias and Heart Failure

Causes a slower, more forceful heart beat

Has a very low Therapeutic Index (High chance for toxicity)

Elderly, Hypothyroidism, Renal Insufficiency, Dehydration, Hypokalemia, Hypomagnesemia, and hypocalcemia

Headache, Nausea, Vomiting, Hypersalivation, Altered Vision & Color Perception, Fatique, Malaise, Drowsiness, and Arrhythmias

Antihypertensive, Diuretic, Loop

Edema or volume overload

Furoscix or Lasix

Antihypertensive, Diuretic, Thiazide

Edema or general volume overload due to heart failure, various forms of renal dysfunction, or corticosteroid or estrogen therapy

Orthostatic Hypotension upon standing after tx

Antihypertensive, Diuretic, Potassium Sparing, Mineralocorticoid (aldosterone) Receptor Antagonist

Competes with aldosterone for receptor sites in the distal renal tubules, increasing NaCl and water excretion while conserving K and H ions. May block the effect of aldosterone on arteriolar smooth muscles as well

Anticoagulant, Vitamin K Antagonist

Warfarin inhibits the reactivation of Vitamin K and depletes the functional vitamin K reserves, therefore reducing clotting factors.

Myocardial Infarction: Reduces risk of systemic embolism after MI

Increased risk of bleeding, mouth ulcers, and taste disturbance

Tenormin

Antianginal Agent, Antihypertensive, Beta-Blocker (Beta-1 Selective)

Competatively blocks response to beta-adrenergic stimulation, slectively blocks beta-q receptors with little to no effect on beta-2 receptors except at high doses

Tx of Chronic, Stable, Angina

Atrial Fibrillation/Flutter and maintenance of ventricular rate control

Angiotensin-Converting Enzyme (ACE) Inhibitor; Antihypertensive

Heart Failure weduced ejection fraction, Chronic Hypertension, and ST-elevation myocardial infarction

Dry, Hacking Nonproductive cough, Stevens-Johnson Syndrom, Dysgeusia, Xerostomia, and Orthostatic Hypotension

Antianginal Agent, Antiarrhythmic Agent (Class IV), Antihypertensive, Calcium Channel Blocker, Nondihydrophyridine

Inhibits Ca from entering "slow channels" and produces the relaxation of coronary smooth muscle. Increases myocardial O2 and slows automaticity and conduction of the AV node

Tx of chronic, stable, vasospastic, and unstable angina; Atrial fibrillation control and ventricular rate control; management of hypertension; prophylaxis of supraventricular tachycardia

Erythema Multiforme and Stevens-Johnson Syndrome; Gingival Hyperplasia

Antianginal Agent; Hypertensive; Calcium Channel Blocker, Dihydropyridine

Inhibits Ca from entering "slow channels" and produces relaxation of coronary vascular smooth muscle; increases myocardial O2 delivery in pts with vasospastic angina; Directly acts on vascular smooth muscle to produce peripheral arterial vasodilation reducing peripheral vascular resistance and BP

Tx of symptomatic chronic stable angina, vasospastic angina, and chronic hypertension

Gingival hyperplasia, orthostatic hypotension, and erythema multiforme

Diovan

Angiotensin II Receptor Blocker; Antihypertensive

Produces direct antagonism of the angiotensin II receptors. Displaces angiotensin II from the angiotensin I receptor and lowers BP by antagonizing AT I-induced vasoconstriction

Heart failure w/ reduced ejection fraction; chronic hypertension; post-myocardial infarction

Atorvaliq or Lipitor

Antilipemic Agent; HMG-CoA Reductase Inhibitor

Heterozygous familial hypercholesterolemia; homozygous familial hypercholesterolemia; prevention of atherosclerotic cardiovascular disease

Digitek, Digox, Lanoxin, Lanoxin Pediatric

Antiarrhythmic Agent; Cardiac Glycoside

Inhibits the Na/K ATPase pump in myocardial cells to increase intracellular Na which promotes Ca influx and increases contractility for tx of heart failure; Directly suppresses the AV node conduction to increase effective refractory period and decrease conduction velocity for tx of supraventricular arrhythmias

Atrial fibrillation or artial flutter control; Heart failure weduced ejection fraction

Use vasoconstrictors w/caution due to risk of cardiac arrhythmias

Antianginal Agent; Extravasation Antidote; Vasodilator

Produces a vasodilator effect on peripheral veins and arteries to reduce cardiac oxygen demand by decreasing preload

Treatment or prevention of angina pectoris

Antiarrhythmic Agent, Antimalarial Agent

Decreases myocardial excitability and conduction velocity by decreasing Na influx

Plavix

Antiplatelet Agent, P2Y12 Antagonist

Tx of acute coronary syndrome and myocardial infarctions

Irreversibly inhibits platelet aggregation

Aspirin in combination with clopidogrel is used to prevent clotting after stent placement. Premature discontinuation of combination antiplatelet therapy increases risk of myocardial infarction and/or death

Injury to the endothelial surface results in a rough surface where masses form. Transient bacteremia occurs and microorganisms adhere to the mass and multiply. Bacterial masses shed continuously and produce a systematic bacteremia

Fragments of mass break off and embolize=stroke or pulmonary embolism

Fever, New Heart Murmur, Positive Blood Culture

<2 weeks from initial bacteremia in 80% of cases

Palatal, buccal petechiae, petechiae on extremities, osler's nodes, splinter hemorrhages of nail beds, nail clubbing

Only for pts who are likely to experience the worst outcomes(death) of infective endocarditis

Prothetic Cardiac Valve, Previous Infective Endocarditis, Congenital Heart Disease, Cardiac Trasplantation Recipients

Unrepaired cyanotic CHD, including palliative shunts and conduits; completely repaired CHD w/prosthetic material or device during first 6 months after procedure; repaired CHD wesidual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device

2g

2g

100mg

500 mg

Nonvalvular or intravascular devices (pacemakers, artificial hearts, shunts, conduits, pathces, stents, grafts, filters, catheters)

Fast and convenient, easier to use on self, more accessible for caregivers w/o medical experience

Tends to not give accurate readings

Blockage/Clot w/in the blood vessels where brain tissue damage occurs

Blood vessel within the brain ruptures=bleeding w/in and around brain tissue

Hypertension, older than 75, diabetes, heart failure, history of strokes, smoking tobacco, coronary atherosclerosis

DIfficulty speaking or understanding speech, temporary dimness or loss of vision(usually in 1 eye), Dizziness, Unsteadiness, or Sudden Falling, Paralysis or Weakness on one side of the face

BEFAST

B=Balance, E=EYes, F=Face, A=Arms, S=Speech, T=Time

"mini-stroke", brief blockage of blood flow to the brain, does not usually cause long-term damage, warning sign of future strokes

Atrial Fibrillation

Ventricular Tachycardia & Ventricular Fibrillation

Irregular heartbeat (fast or slow), Irregular Rythms; Anxiety or Heart Palpitations; Syncope, Dizziness, or Feeling Faint; Congestive Heart Failure; Tinnitus or Visual Changes

Quinidine, Propanolol, Amiodarone, and Verapamil

Hypertension, Stroke, Obesity, and Metabolic Syndrome

Mallampati III and IV; Attrition, Tooth Pain, Headache; Macroglossia; High Vaulted Palate; Xerostomia

Identification, Custom Fit Oral Appliances, Risk Assessment

Used to evaluate a pt's risk of sleep apnea?

Uvula, Soft Palate, and Faucial Pillars are completely visible

Uvula, Soft Palate, and Faucial Pillars are Visible, but partially obstructed

Only the Uvula and Soft Palate are partially visible; pillars are completely obstructed

Only the hard palate is visible; soft palate, uvula, and pillars are completely obstructed