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210 Ch. 28

Coronary Vascular Disorders

Coronary Artery Disease clinical manifestations? prevention? Leading cause of death in US by artherscloerosis Mani: Ischemia, Angina pectoris, sudden cardiac death pre: diet/excercise, meds, no smoke, manage htn/DM, hotility
Angina pectoris? types? clinical manifestations? atherosclerosic disease(plaq and inner layer under get necrosis adn break off) type: stable(predictable, pain w/ exertion unstable: unpred, pain/rest/sleep variant: longer chest pain rest man: behind sternum, radiate, dur<5m, relief w/ nitro/rest
nsg mgmt wtih angina pectoris meds: nitro q 5m up to 3x O2 @ 2L NC reduce anxiety prevent pain with morphine(reduce O2 demand on heart) Priotity: O2/nitro/morphine
Myocardial Infarction MI clinical manifestations? Acute coronary syndrome ACS man: pain, pallor, dizzy, impending doom, elephant on chest
MI findings on: ECG changes? lab tests? ECG: Twave inverted lab: check troponin & CK-MB
Define Angina pectoris chest pain by myocardial ischemia, or cardica muscle deprived of O2
Risk factors for CAD fam hx, incr age, men earlier than women, race(AA), incr LDL, smoking, HTN, DM, obesity
Optimal lipid values LDL: <70 for high risk/<100 Total: <200 HDL: >60 Triglyceride: <150
Cholesterol Meds Statins: block chol synthesis, SE: muscle pain, see liver fx, Nicotine Acids: Niacins, supplements, SE: flushing, liver, not for gout pt
More Chol meds Fibric Acids: incr HDL, not w/ statin, liver, can incr LDL Bile Acid Seques: bind chol adn incr breakdown, supplement
more chol meds Chol absorption inhibitor: Zetia SE: athralgia, abd pain Omega 3: decr TG
What is different with aging person and Angina pectoris may only show dyspnea as presenting s/s.
What is goal for Angina pectoris reduce O2 demand of myocardium, incr O2 supply w/ nitrates, which reduces O2 consumption, relieves pain. Dilates vv, so less blood return to heart, preload decr. SE: decr BP
What do beta blockers do? "olols", block beta-adrenergic sympathetic stimulation to heart = decr rate, slow impulses, decr BP, decr contractility to decr O2 demand, bronchoconstriction
what is nsg intv for beta blocker ECG/BP/HR monitored after med. SE: depression/fatigue/impotence Not stop abruptly
What do CCB do? decr SA/AV node conduction = decr HR/contractility, relax vessels, decr BP, incr coronary aa perfusion, incr O2 supply by dilating smooth muscles Amlodipine(Norvasc)/diltiazem
Antiplatelet meds aspirin, Plavix
Anticoagulation meds Heparin: IV unfractionated which is monitored by aPTT to be at 2/2.5 x normal aPTT value. Low-mol wt: Lovenox and eliminate need to monitor aPTT
ACS-Acute Coronary Syndrome is? MI unstable angina NSTEMI: non ST elevation MI STEMI: ST seg elevation MI
Three important descriptions are used to id an MI 1. type(NSTEMI,STEMI 2. location of injury to vent wall(ant,inf,post,lat) 3. point in time process of infarction (acute,evolving,old)
Presenting s/s for ACS chest pain sudden and continue despite med or rest
What are some typical ECG changes to point to MI Twave inversion, ST seg elevation, abnormal Qwave....with two elevated ST seg is indicative of MI(STEMI), returns to normal in recovery.
What are the three ceatine kinase isoenzymes CK-MM(muscle), CK-MB(heart muscle), CK-BB(brain)
What cardiac enzymes help detect MI and how long do they last? CK-MB: peaks in 24h Myoglobin: peak in 12h Troponin: elevated for 3wk
what is main medical mgmt for MI reduce myocardial O2 demand and incr O2 supply w/ meds, O2, bed rest
what is pharmacologic therapy for MI aspirin, nitro, morphine(decr pain/anxiety/preload/afterload), IV beta-blocker/ACE inhibitors...heparin, not NSAIDS..some thrombolytics
Invasive Coronary Artery Procedures...all PCI's PTCA, intracoronary stent implantation, atherectomy, brachytherapy
Describe PTCA balloon-tipped catheter used to open blocked coronary vessels and resolve ischemia to improve blood flow
After PTCA a stent is needed, describe To prevent restenosis(treated area closes off) and metal mesh to provide support to vessel
Describe atherectomy remove atheroma or plaque from coronary artery by cutting, shaving, grinding
Describe brachytherapy radiation put close to lesion.
Surgical Procedures: Coronary Artery Revascularization blood vessel is grafted to an occluded coronary art so blood can flow beyond occlusion, called bypass graft...use saphenous vv
Created by: palmerag