RT Book, Section
A1 Reed, Brent N.
A1 Watson, Kristin
A1 Ramani, Gautam
A2 DiPiro, Joseph T.
A2 Yee, Gary C.
A2 Posey, L. Michael
A2 Haines, Stuart T.
A2 Nolin, Thomas D.
A2 Ellingrod, Vicki
SR Print(0)
ID 1182429545
T1 Assessment of the Cardiovascular System
T2 Pharmacotherapy: A Pathophysiologic Approach, 11e
YR 2020
FD 2020
PB McGraw-Hill Education
PP New York, NY
SN 9781260116816
LK accesspharmacy.mhmedical.com/content.aspx?aid=1182429545
RD 2024/04/19
AB KEY  CONCEPTS  Many  cardiovascular  disorders  develop  over  years  to  decades.  Evaluation  of  the  patient  with  or  at  risk  for  cardiovascular  disease  (CVD)  must  therefore  include  a  comprehensive  patient  (or  caregiver)  interview  to  identify  modifiable  and  nonmodifiable  risk  factors  for  CVD.  Along  with  other  key  information  (eg,  vital  signs,  laboratory  values),  these  data  can  be  used  to  determine  an  individual  patient’s  risk  for  future  cardiovascular  events.  Changes  in  the  frequency,  duration,  and  severity  of  cardiac-related  symptoms  (eg,  ischemic  chest  pain,  dyspnea)  are  essential  to  the  assessment  of  CVD  and  often  guide  the  urgency  of  intervention  as  well  as  the  specific  pharmacologic  strategies  selected.  A  comprehensive  patient  interview  can  also  be  useful  for  discerning  CVD  from  noncardiac  disorders  that  share  similar  symptomology.  Obtaining  an  accurate  blood  pressure  measurement  is  paramount  to  the  evaluation  and  treatment  of  several  cardiovascular  disorders.  Guidelines  for  appropriate  measurement  technique  include  recommendations  on  patient  preparation  and  position,  cuff  and  stethoscope  use,  and  blood  pressure  documentation.  Several  cardiovascular  disorders,  such  as  heart  failure  (HF)  and  peripheral  arterial  disease,  warrant  physical  examination  of  areas  that  are  more  distal  from  the  heart,  including  the  neck  (eg,  carotid  arteries,  jugular  venous  pressure,  abdominojugular  reflux)  and  lower  extremities  (eg,  peripheral  pulses,  edema).  Abnormal  findings  can  prompt  further  evaluation  or  alterations  in  pharmacologic  therapy.  Auscultation  of  the  chest  provides  key  information  on  valvular  structure  and  function.  Abnormal  heart  sounds  can  be  used  to  guide  the  need  for  further  evaluation.  Two  key  cardiac-specific  laboratory  tests  are  cardiac  troponin  and  brain  natriuretic  peptide  (BNP).  Elevations  in  cardiac  troponin  may  indicate  the  presence  of  a  myocardial  infarction  and  can  be  used  to  guide  both  pharmacologic  and  nonpharmacologic  interventions.  A  normal  BNP  concentration  in  a  patient  with  dyspnea  excludes  the  presence  of  HF  whereas  elevations  are  correlated  with  disease  severity  as  well  as  long-term  morbidity  and  mortality.  An  electrocardiogram  (ECG)  records  the  pattern  of  electrical  activity  across  the  heart  and  each  segment  corresponds  to  an  event  in  the  cardiac  cycle.  The  ECG  provides  an  electrical  map  of  the  heart,  which  can  be  used  to  locate  areas  of  ischemia  or  other  pathology.  Alterations  in  the  ECG  such  as  QT-interval  prolongation  can  be  drug-related  and  may  place  patients  at  risk  for  arrhythmias.  Stress  testing  remains  the  most  common  initial  strategy  for  evaluating  chest  pain  suspicious  for  myocardial  ischemia.  The  two  main  modalities  for  testing  are  inducing  stress  via  exercise  or  the  administration  of  a  pharmacologic  agent  such  as  dobutamine  or  adenosine.  The  information  provided  by  a  stress  test  is  often  combined  with  echocardiography  and  radionuclide  myocardial  perfusion  imaging.  Echocardiography  uses  sound  waves  to  create  an  image  of  the  heart,  providing  important  information  on  the  structure  and  function  of  heart  valves  and  chambers.  Although  a  transthoracic  echocardiogram  (TTE)  is  less  invasive  and  provides  the  key  information  necessary  for  most  clinical  decisions,  a  transesophageal  echocardiogram  (TEE)  may  be  required  to  visualize  structures  located  in  posterior  areas  of  the  heart  (eg,  mitral  valve,  left  atrial  appendage).  Left  heart  catheterization  (LHC)  is  an  invasive  procedure  in  which  a  catheter  is  inserted  into  a  large  artery  and  ...