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210 Ch. 28
Coronary Vascular Disorders
| Question | Answer |
|---|---|
| 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
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