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Test1_Chapter 26D

Perfusion/CAD

QuestionAnswer
what cause atherosclerosis ? Plaque formation (atheromas) ; Precipitated by lipoproteins and fibrous tissue ; Inflammation and injury to endothelial cells lining the artery ;
what cause endothelial cells lining the artery? Excessive pressures (hypertension) ; Toxins in cigarette smoke ; Infections ; Hyperlipidemia
what is Myocardial Ischemia? Oxygen supply is inadequate to meet metabolic demands
what cause Myocardial Ischemia? Myocardial workload ; Coronary perfusion ; Blood oxygen content
Coronary Perfusion Atherosclerosis ; Thrombosis ; Vasospasm ; Poor perfusion pressure
what cause Poor perfusion pressure? Low preload ; Hypotension ; Dehydration ; Hypertrophy ;
coronary arteries perfuse when? systolic or diastolic? diastolic
what cause Myocardial Workload? Rapid heart rate (decreased filling times); Increased preload (i.e.CHF); Increased afterload (i.e. htn) ; Increased contractility (meds, increased metabolism) Increased metabolic demands (fever, hyperthyroidism, infection)
what change blood Blood Oxygen Content? Reduced atmospheric oxygen pressure altitude : Carbon monoxide poisoning ; Impaired gas exchange: CHF, pneumonia, PE ; Low RBC and hemoglobin content : Anemia Blood loss
what happen if When myocardial workload increases and supply of blood and oxygen fails ? cellular metabolism switches from an efficient aerobic process to anaerobic metabolism. Lactic acid accumulates and cells are damaged
how long after the blood flow is restored with oxigen content will be fix problem? , aerobic metabolism and contractility are restored and cellular repair begins. Continued ischemia results in cell necrosis and death (infarction).
1when is considered Chronic ischemic heart disease ? Stable angina ; Vasospastic angina ; Silent myocardial ischemia
1 when is considered Acute coronary syndrome? Unstable angina ; Myocardial infarction
1 how often they happen to men and women Chronic ischemic heart disease; Acute coronary syndrome Chronic ischemia heart disease occurs more often in women. Acute coronary syndromes occurs more often in men.
1Non modifiable risk factor
1Stable angina Stable occurs with a predictable amount of activity or stress
1 Untable angina Unstable occurs with increasing frequency and severity; it may occur at times unrelated to activity or stress; So the guy who used to get angina when he mowed the lawn, now gets angina while sleeping. Unstable may last 20 minutes or longer indicating th
1 location of Chest pain in Angina substernal or precordial (across the chest wall). May radiate to neck arms shoulders or jaw.
1Quality of Chest pain in Angina tight, squeezing, constricting, or heavy sensation. May also be described as burning, aching, choking, dull or constant
1Associated manifestations of angina : Dyspnea, pallor, tachycardia, anxiety and fear, nausea, vomiting, dizziness.
1Atypical manifestations of angina Indigestion, epigastric pain, back pain, vomiting, fatigue, arm heaviness, “just don’t feel right”
1Women frequently present with atypical symptoms of angina? indigestion or nausea and vomiting and upper back pain.
what pattern angina pain usually occurs ? a crescendo – descrescendo pattern (increasing to a peak and then gradually decreasing) and lasts 2 – 5 minutes. Generally it is relieved by rest.
1 what percent of Narrowing of a vessel show significant 50% is significant
1what percent of Narrowing of a vessel show symptom have 70% or more narrowing will cause symptoms
1Medications for CAD? Nitrates, calcium chanel bloker, beta blocker, aspirin
1how is Nitrates used? what is the dose? what it used for? Sublingual ntg 1/150 or 0.4 mg q 5 minutes x3 Used to treat and prevent anginal attacks
1Beta Blockers used for what? Block cardiac stimulating effects of epinephrine?
1Calcium channel blockers used for what? Reduce myocardial oxygen demand, ; Increase myocardial blood and oxyge ;n suypply Potent coronary vasodilators
1Aspirin used for what ? Low dose aspirin is often prescribed to reduce the risk of platelet aggregation and thrombus formation.
1 what cause the chest pain? Lactic acid released from ischemic cells stimulates pain receptors, causing chest pain.
1what happen if Plaque Rupture? Exposed lipid core of the plaque stimulates ; platelet aggregation ; Extrinsic clotting pathway is stimulated ; Thrombin is generated; Fibrin is deposited ; Formation of clot severely impairs or obstructs blood flow ; Myocardial cells become ischem
1 what is s/s of Cardiac tamponade ? Tachycardia, hypotension, decreased urine output, increased CVP, JVD, muffled heart tones
what happen if increased concentration of catecholamines? The increased concentration of catecholamines causes increases in the heart rate and contractility. It also increases automaticity of cardiac tissues and the risk of dysrhythmias. Additionally, there is vasoconstriction and hypertension.
what cause by Methamphetamine? same as catecholamines
Manifestations of Acute
Myocardial Infarction? Sudden and usually not associated with activity Crushing, pressure, heavy, squeezing Substernal / radiating Lasts more than 20 min and is not relieved by rest or ntg
Complications of AMI Dysrrhythmias ; Pump Failure ; Cardiogenic shock ; Infarct extension ; Structural defects ; Pericarditis/Dresslers syndrome ;
Emergency Cardiac Drugs: Amiodarone ; Lidocaine; Epinephrine,Atropine
dose for Amiodarone? 300 mg IVP Followed by 150 mg IVP V – fib/V-tach
Lidocaine dose? Lidocaine 1.5 mg/kg IVP V-fib/V-tach
epinephrine? 1:10,000 Solution 1 mg in 10cc IVP For V fib/ asystole Pulseless Electric activity
Created by: jhrobins99