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CAD- coronary artery disease narrowing of lumen of coronary arteries
progression of atherosclerosis plaque damage to endothelium->increased endothelium permeability->infiltration of cholesterol into myocardium->cholesterol build-up + collagen-> platelet aggregate on top->RBC aggregate=clot
stable plaque small, hard fatty core, thick fibrous cap
unstable plaque large, soft fatty core, thin fibrous cap
CAD risk factors age, heredity, obesity, blood values, DM, HTN, smoking, sedentary lifestyle, male, post menopausal women
CAD risk factors- lab values increased serum cholesterol (over 200), increased triglycerides (over 200), increased LDL (over 130-biggest threat), decreased HDL (less than 40 for men, less than 50 for women), total cholesterol/HDL ratio over 4.5
CAD clinical manifestations No symptoms until 75% occluded (collateral circulation forms), angina pectoris (chest pn, pressure, squeezing in chest), myocardial infarction (blood flow to section of heart occluded. leading cause of sudden death)
angina ischemic pn of the myocardium, "chest pn", pn above the waist
angina etiology 90% caused by atherosclerosis
angina S&S burning, squeezing, tightness in chest, pn btw shd blade, pn into neck, down L or R UE, N&V, anxiety, duration:ave 3 min, <15 ok, >15 unstable, >30 min MI
types of angina patterns unstable, stable, chronic
stable angina with exertion, increased stress
unstable angina more frequent, lasts longer, less responsive to meds (nitroglycerin), at rest, at night, unpredictable
chronic angina long hx of cardiac problems, post MI
angina rx nitroglycerine: vasodilator -methods:usually sublingually, sometimes topically. sedatives
myocardial infarction (MI) coronary artery occlusion causing necrosis of myocardium, medical emergency, most often affects L ventricle
MI S&S burning, squeezing, tightness in chest, pn btw shd blade, pn into neck, down L or R UE, N&V, anxiety, indegestion, shortness of breath, sweating, women:fatigue, N&V, SOB, jaw pn, silent:DM, when:early AM, btw Thanksgiving & New Years, periodontal dx
MI healing inflammation -> scar
CAD dx EKG, cardiac enzymes over 72 hrs (measures cardiac troponin I&T & creatine kinase (CK-MB), coronary angiogram:cardiac cath, echocardiogram, holter monitor, ex tolerance test, stress test
CAD rx prevention diet, exercise, stop smoking, manage HTN, manage DM, pharmocologic (antilipids, statins-antiplatelet, ASA)
CAD rx sx PTCA + stents: percutaneous transluminal coronary angioplasty, "balloon angioplasty". CABG: coronary artery bypass graft (saphenous vein-mammary artery-CABG x(# of bypassed arteries)
CAD rx meds Nitro, betablockers, ace inhibitors, diuretics, calcium channel blockers
nitro for angina 3 doses in 10-15 min (every 5 min) don't give more than 3 doses, more than 15 min call 911
anti HTN betablockers, ace inhibitors
betablockers usually end in "ol"-side effects- decreased endurance, keep abt a 3 on Borg's scale, fatigue, lethargy, hypotension & may mask signs of hypoglycemia
ace inhibitors end in "pril"-these & angiotinsin blockers (end in sartan"-good to decrease blood pressure-side effects-dry cough
diuretics lasix-may have to stay close to bathroom-increased urination, increased risk of falls @ night & dehydration and weakness
calcium channel blockers usually end in "il" or "pine"- side effects- peripheral edema & hypotension
atrial fibrillation/arrhythmias prevalence:2.66 million people have a fib. is most common type of arrhythmia
atrial fibrillation/arrhythmias risk factors HTN, CHF, DM, hyperthyroidism, drug abuse & advanced age
atrial fibrillation/arrhythmias complications stroke- most common significant complication, light-headedness, HF if persistent & severe. the rx has it's own complications
atrial fibrillation/arrhythmias meds anti-arrhythmics (amiodarone-pulmonary, thyroid, and ocular toxicities, drug interactions, heart block. multaq-dronedarone-rhythm. sotalol-rate/rhythm. CCB-rate.) blood thinners-do not rx a fib-used to prevent likelyhood of stroke
types of blood thinners coumadin (warfarin), xarelto (rivaroxaban), pradaxa (dabigatran)
digoxin used in heart failure & atrial fib, cleared by kidneys, numerous drug interactions, digoxin toxicity
digoxin toxicity nausea/vomiting/anorexia/confusion/weakness/ electrolyte abnormalities/death
IV anitcoagulants rapid on/off switch for use around sx or procedures. Heparin-most common-prevention & rx of DVT/PE while hospitalized-new start anticoagulant pt that may undergo sx-coumadin bridging. Bivalirudin & argatroban
subcutaneous anitcoagulants lovenox (enoxaparin), arixtra (fondaparinux)-prevention & rx of DVT/PE while hospitalized-coumadin bridging therapy-less intensive monitoring & can be performed at home with little training
PO anitcoagulants Warfarin (gold standard for comparing blood thinners), Xarelto, Pradaxa
anitcoagulants side effects bleeding-minor bleeding: gum bleeding, nose bleeding, bruising, heavier menstrual bleeding. major bleeding: gastrointestinal bleeding, intracranial hemorrhage, retroperitoneal hematoma. heparin induced thrombocytopenia (HIT/HITT). purple toe syndrome
hyperlipidemia increased risk of heart dx including MI & stroke. statins are the main class of drugs used to rx. lower LDL, lower triglyceride levels, increase HDL
hyperlipidemia side effects mm pain/ mm weakness, rhabdomyolysis-by products of skeletal mm destruction-damages kidneys. greapefruit juice can alter the effects of statins
cardiovascular dx processes that can easily impact a PTs work reduced stamina, weakness, fatigue/SOB, drug therapy can be beneficial to PTs work by reducing these
how drugs for cardiovascular dx can negatively impact PT bradycardia/hypotension, easy bruising/increased bleed risk, mm pn, reduced stamina
CAD rx cardiac rehab pt education + exercise + lifestyle modification
phase I cardiac rehab begins w/ IP & goes thru abt 4 wks-active ex (little warm up, amb 20 min, cool down). we will work on self-care & getting home (progressive amb)-precautions & contras-self monitoring, RPE important
phase II cardiac rehab from 4-12 wks- OP- monitored program-EKG- monitoring common, DR protocol (warm up, aerobic, light resistive & cool down)ex session 15 min-1 hr, target RPE is 10
phase III cardiac rehab lifelong maintenance
CAD complications Arrhythmias, CHF, shock, emboli, cardiac tamponade, pericarditis
CAD arrhythmias PVC (premature ventricular contraction), ventricular tachycardia (3 or more PVC's in a row), ventricular fibrillation (occurs in almost 50% of cardiac arrest)
cardiac tamponade life threatening, damage to heart, pericardial space filled w/fluid, also cardio myopathy
pericarditis fluctuating sharp pn
CAD prognosis depends on size & location of MI, previous MI, complications in 1st 24 hrs leads to CCU monitoring, age, other proglems, results of stress test
phase I Inpatient cardiac rehab MET-based activity, deep breathing, cough w/splint, bed mob, active ex (add 1 ex/day, AROM, NO resistance, isometric), progressive amb: 1st x 2min, add 30 sec/amb per day
phase I outpatient cardiac rehab cont active ex as warm-up for amb, Prog amb-wk 1 5minx4- wk 2 10min x3- wk 3 15 minx 2- wk 4 20 min x1. treadmill or bike test before phase II
phase I pt edu cardiac rehab diet, meds, driving, shower (no bath x 1 mon), monitor incisions (keep clean), watch for fever, weigh daily (2-4 lb gain in 2 days red flag), balance activity w/rest, elevate LE's w/rest, avoid crowds, no smoking, no sex 2-4 wks
phase I cardiac rehab monitor: EKG: ck w/RN:arrhythmias, PR:max rest 100 BPM, max ex 120 BPM, max increase 20 BPM, return to RHR < 5 min, BP:no decrease from rest SBP, no increase >25 mmHg SBP, O2 Sat:keep O2 on if ordered, RPE
phase I cardiac rehab monitor/guidelines: Ex log, talk test, take own PR, no extreme weather or terrain (no hot or cold or hills), strolling (good shoes)
phase I cardiac rehab contras to ex HR beyond guidelines, arrhythmias, excessive coughing, SOB, fatigue, faintness/dizziness/ confused, pale, claudication pn, angina, excessive sweating, N&V, wait 1 hr after eating, no amb if clearly upset (can do light stuff)
Created by: jessigirrl4
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