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\author{Maria K (mkravatz)}
\pdfinfo{
  /Title (pt-management-and-problems-of-the-cv-system-part-1.pdf)
  /Creator (Cheatography)
  /Author (Maria K (mkravatz))
  /Subject (Pt Management \& Problems of the CV System - Part 1 Cheat Sheet)
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        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
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    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{Pt Management \& Problems of the CV System - Part 1 Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{Maria K (mkravatz)} via \textcolor{DarkBackground}{\uline{cheatography.com/71404/cs/18105/}}}
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  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}Maria K (mkravatz) \\
  \uline{cheatography.com/mkravatz} \\
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Published 2nd December, 2018.\\
   Updated 2nd December, 2018.\\
   Page {\thepage} of \pageref{LastPage}.
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  %\includegraphics[width=48px,height=48px]{dave.jpeg}
  Measure your website readability!\\
  www.readability-score.com
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\begin{multicols*}{3}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Physiological Changes with Age}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Cardiac Valves}}: stiffen, calcify, degenerate = expect murmurs ("swish")} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Conduction System}}: coronary arteries get poor blood = necrosis, arrhythmias; lose pacemaker cells, lose conduction, fat in SA node, coming from ectopic muscle} \tn 
% Row Count 6 (+ 4)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Left Ventricle}}: atrophies, stiffens, enlarges, becomes less distensible, dec. SV \& CO, dec. EF, most noticeable w/ physical activity} \tn 
% Row Count 9 (+ 3)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Aorta \& Large Arteries}}: thicken, stiffen, less distensible = pumps harder ( inc. HR) \& inc. systemic vascular resistance} \tn 
% Row Count 12 (+ 3)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Baroreceptors}}: located in carotid arteries; help regulate BP; less sensitive w/ age; most noticeable w/ position changes} \tn 
% Row Count 15 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Framingham Heart Study}} (1948): {\emph{Landmark study done in Framingham, MA looking at cardiac risk and what we can do-{}-modifiable \& non-modif. risk factors}}  \newline - 5,209 subjects (mean age 47) \& offsprings  \newline - Established the CV risk profile!}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{p{0.4977 cm} p{0.4977 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Assessment: Psychosocial}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{Ask about...} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Occupation?}}} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Insurance?}}} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Support system?}}} \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Pets at home?}}} \tn 
% Row Count 5 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Hobbies that may help?}}} \tn 
% Row Count 6 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{* Patients won't get better if they're stressed!}  \tn 
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Column Break}}  \tn
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% Row Count 0 (+ 0)
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\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Assessment: Modifiable \& Non-Modif. Risk Factors}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{\{\{bb\}\} MODIFIABLE RISK FACTORS} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Age}}: symptoms start by 40yo, unlikely to survive MI if \textless{}30yo b/c collateral circulation} \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Ethnicity}}: more prevalent in non-Hispanics, death rate higher in African Amer. (HTN)} \tn 
% Row Count 5 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Heredity}}: HTN, inc. lipids, DM, obesity} \tn 
% Row Count 6 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Gender}}: men \textgreater{} women until menopause, childbearing women have 25\% chance, women \textgreater{}40yo \& after menopause \textgreater{} men (r/t heart size \& collateral circulation)} \tn 
% Row Count 10 (+ 4)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{\{\{bb\}\} NON-MODIFIABLE RISK FACTORS} \tn 
% Row Count 11 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{BP}}: biggest problem = insidious - take meds if needed} \tn 
% Row Count 13 (+ 2)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{HLD}}: goals - {\bf{total cholesterol}} \textless{} 200; {\bf{HDL}} \textgreater{} 50, {\bf{LDL}} \textless{} 70 - take meds if needed} \tn 
% Row Count 15 (+ 2)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{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.} \tn 
% Row Count 20 (+ 5)
% Row 9
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{DM}}: r/t early atherosclerosis, inc. thickening of blood} \tn 
% Row Count 22 (+ 2)
% Row 10
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Physical Inactivity}}: "new smoking", exercise inc. collateral circulation} \tn 
% Row Count 24 (+ 2)
% Row 11
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Obesity}}: extra burden on heart} \tn 
% Row Count 25 (+ 1)
% Row 12
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\mymulticolumn{1}{x{5.377cm}}{{\bf{Personal Factors}}: stress, psych. response} \tn 
% Row Count 26 (+ 1)
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\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Collateral circulation}}: {\emph{inc. angiogenesis; adding vessels to supply cardiac circulation}} \newline  \newline {\bf{Obese}}: BMI \textgreater{}30 / {\bf{Morbid Obese}}: BMI \textgreater{}45  \newline {\bf{Super Morbid Obese}}: BMI \textgreater{}65}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\begin{tabularx}{5.377cm}{X}
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Assessment: Subjective \& Objective Data}}  \tn
% Row 0
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\mymulticolumn{1}{x{5.377cm}}{\{\{bb\}\} SUBJECTIVE DATA (History of Symptoms)} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Chest Pain}}: (activity w/) onset? location? severity? type? precipitating factors? other Sx? may c/o nausea, indigestion \{\{nl\}\} - Causes: {\emph{cardiac}} (myocardial), {\emph{pulm.}}, {\emph{m/s}}} \tn 
% Row Count 5 (+ 4)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Dyspnea or SOB}}: often assoc. w/ left side heart pain, dec. perfusion, orthopnic} \tn 
% Row Count 7 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Palpitations}}: usually PAC, c/o rapid HR = dec. EF \& CO (caffeine)} \tn 
% Row Count 9 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Fatigue}}: mild to severe, may attribute to getting older (compare to daily activity)} \tn 
% Row Count 11 (+ 2)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Extremity Pain}}: arm (may be R), jaw} \tn 
% Row Count 12 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Syncope}}: if issue w/ CO} \tn 
% Row Count 13 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Weight Gain}}: fluid, daily wt, anasarca} \tn 
% Row Count 14 (+ 1)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{\{\{bb\}\} OBJECTIVE DATA} \tn 
% Row Count 15 (+ 1)
% Row 9
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{General Appearance}}: AAOx3?, posture \{\{nl\}\} - Restlessness assoc. w/ change in O`2`} \tn 
% Row Count 17 (+ 2)
% Row 10
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Vital Signs}}: BP? HTN \textless{} 130/80, check BP bilat., may see a paradoxical change in BP} \tn 
% Row Count 19 (+ 2)
% Row 11
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Heart Sounds}}: S`1`, S`2`; may hear S`3` \& S`4`, murmurs, clicks} \tn 
% Row Count 21 (+ 2)
% Row 12
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Cyanosis \& JVD}}: pallor; JVD = R-sided HF (cor pulmonale), seen w/ OSA; = give Lasix} \tn 
% Row Count 23 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Subjective Data}}: Ask for chief complaint (usually CP), PMH, current health  \newline - Dehydrated = lose H`2`0 \& electrolytes  \newline  \newline {\bf{Objective Data}}:  \newline {\bf{Pulse Pressure}}: {\emph{SBP - DBP; normally 30-40}}  \newline - {\bf{Closer (\textasciitilde{}20)}}: r/t vasc. resistance = dec. CO \& SV  \newline - {\bf{Widened (\textasciitilde{}40)}}: r/t slow HR, atherosclerosis, inc. w/ age}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\begin{tabularx}{5.377cm}{X}
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Diagnostic Studies}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{\{\{bb\}\} SERUM CARDIAC ENZYMES (SERUM MARKERS) OR CARDIAC BIOMARKERS} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Troponin}}: {\emph{GOLD STANDARD OF CP}}; appears 2-4 hr after damage to myocardial muscle, inc. further depending on damage} \tn 
% Row Count 5 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{CK-MB}}: r/t cardiac muscle; detected 2-4 hr after damage, elevated 72 hr max} \tn 
% Row Count 7 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{CK-MM}}: r/t skeletal muscle} \tn 
% Row Count 8 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{CK-BB}}: r/t brain tissue} \tn 
% Row Count 9 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Myoglobin}}: byproduct of muscle breakdown, appears in 2-4 hr, then dec.; affects kidneys; rhabdomyolysis} \tn 
% Row Count 12 (+ 3)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{BNP}}: r/t stretch of heart; correlates + w/ HF; secreted by ventricles r/t stress} \tn 
% Row Count 14 (+ 2)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{CRP}}: non-specific inflammatory marker; correlates + w/ atherosclerosis; good for determining severity of disease process} \tn 
% Row Count 17 (+ 3)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Myeloperoxidase}}: leukocyte enzyme r/t plaque instability and enzyme production} \tn 
% Row Count 19 (+ 2)
% Row 9
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Ischemia Modified Albumin}}: circulating albumin touches ischemic tissues} \tn 
% Row Count 21 (+ 2)
% Row 10
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Homocysteine}}: get from eating meat (in amino acids), linked to disease development} \tn 
% Row Count 23 (+ 2)
% Row 11
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Serum Lipids}}: correlates + w/ intravascular plaques} \tn 
% Row Count 25 (+ 2)
% Row 12
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{\{\{bb\}\} COAGULATION STUDIES} \tn 
% Row Count 26 (+ 1)
% Row 13
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Unfractionated Heparin}}: if elevated, give protamine sulfate} \tn 
% Row Count 28 (+ 2)
% Row 14
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{APTT}}} \tn 
% Row Count 29 (+ 1)
% Row 15
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{PT/INR}}: if elevated, give vitamin K} \tn 
% Row Count 30 (+ 1)
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\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Why do coagulation studies?}} {\emph{To know if pt is anti-coagulated in case of procedure}}  \newline  \newline {\bf{Antidotes}}  \newline {\emph{ Coumadin = vitamin K \newline }} Many newer generation anti-coagulants don't have antidotes! = Give cryoprecipitate}  \tn 
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{More Diagnostic Studies}}  \tn
% Row 0
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\mymulticolumn{2}{x{5.377cm}}{\{\{bb\}\} OTHER} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
{\bf{EKG}} & shows issues r/t heart rhythm; 12-lead EKG w/ age 40yo+ \tn 
% Row Count 4 (+ 3)
% Row 2
\SetRowColor{LightBackground}
{\bf{Telemetry}} & continuously monitoring EKG, ambulatory \tn 
% Row Count 6 (+ 2)
% Row 3
\SetRowColor{white}
{\bf{Holter Monitor}} & ambulatory type, pt takes it home \& writes down what they do to compare it to the rhythm \tn 
% Row Count 10 (+ 4)
% Row 4
\SetRowColor{LightBackground}
{\bf{X-Ray}} & shows enlargement, fluid; pulmonary edema r/t CHF? \tn 
% Row Count 13 (+ 3)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{\{\{bb\}\} STRESS, NUCLEAR, \& ULTRASOUND TESTS} \tn 
% Row Count 14 (+ 1)
% Row 6
\SetRowColor{LightBackground}
{\bf{Exercise Stress Test}} & look at BP and HR w/ inc. exercise and inc. myocardial O`2` demand \tn 
% Row Count 17 (+ 3)
% Row 7
\SetRowColor{white}
{\bf{Nuclear Perfusion Imaging}} & stress test \& blood flow through the heart \tn 
% Row Count 19 (+ 2)
% Row 8
\SetRowColor{LightBackground}
{\bf{Echocardiogram}} & shows wall movement, overall ventilatory performance; can tell how badly heart was damaged \tn 
% Row Count 23 (+ 4)
% Row 9
\SetRowColor{white}
{\bf{TTE}} & 2-D \tn 
% Row Count 24 (+ 1)
% Row 10
\SetRowColor{LightBackground}
{\bf{TEE}} & 3-D (better) \tn 
% Row Count 25 (+ 1)
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Serum Electrolytes \& the Heart}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{K}} & {\bf{biggest electrolyte r/t heart}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
 & {\emph{Hypokalemia}}: inc. electrical instability, a fib, digoxin toxicity \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
 & {\emph{Hyperkalemia}}: P-wave issues, bradycardia, asystole, ventricle issues; give Kayexalate, insulin (IVP 10 units) + D`50`; give Lasix \tn 
% Row Count 7 (+ 4)
% Row 3
\SetRowColor{white}
{\bf{Na}} & {\bf{r/t CHF}} \tn 
% Row Count 9 (+ 2)
% Row 4
\SetRowColor{LightBackground}
 & {\emph{Hyponatremia}} \tn 
% Row Count 10 (+ 1)
% Row 5
\SetRowColor{white}
 & {\emph{Hypernatremia}} \tn 
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% Row 6
\SetRowColor{LightBackground}
{\bf{Ca}} & {\emph{Hypocalcemia}} \tn 
% Row Count 13 (+ 2)
% Row 7
\SetRowColor{white}
 & {\emph{Hypercalcemia}} \tn 
% Row Count 14 (+ 1)
% Row 8
\SetRowColor{LightBackground}
{\bf{Mg}} & {\emph{Hypomagnesemia}} \tn 
% Row Count 16 (+ 2)
% Row 9
\SetRowColor{white}
 & {\emph{Hypermagnesemia}} \tn 
% Row Count 17 (+ 1)
% Row 10
\SetRowColor{LightBackground}
{\bf{P}} & {\emph{Hypophosphatemia}} \tn 
% Row Count 18 (+ 1)
% Row 11
\SetRowColor{white}
 & {\emph{Hyperphosphatemia}} \tn 
% Row Count 19 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Insulin}}: {\emph{K follows glucose into cells}}}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}


% That's all folks
\end{multicols*}

\end{document}