Coronary Vascular Disorders
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| 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
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| 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
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| 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
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| Myocardial Infarction MI clinical manifestations? | Acute coronary syndrome ACS
man: pain, pallor, dizzy, impending doom, elephant on chest
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| MI findings on: ECG changes? lab tests? | ECG: Twave inverted
lab: check troponin & CK-MB
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| Define Angina pectoris | chest pain by myocardial ischemia, or cardica muscle deprived of O2
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| Risk factors for CAD | fam hx, incr age, men earlier than women, race(AA), incr LDL, smoking, HTN, DM, obesity
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| Optimal lipid values | LDL: <70 for high risk/<100
Total: <200
HDL: >60
Triglyceride: <150
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| Cholesterol Meds | Statins: block chol synthesis, SE: muscle pain, see liver fx,
Nicotine Acids: Niacins, supplements, SE: flushing, liver, not for gout pt
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| More Chol meds | Fibric Acids: incr HDL, not w/ statin, liver, can incr LDL
Bile Acid Seques: bind chol adn incr breakdown, supplement
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| more chol meds | Chol absorption inhibitor: Zetia
SE: athralgia, abd pain
Omega 3: decr TG
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| What is different with aging person and Angina pectoris | may only show dyspnea as presenting s/s.
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| 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
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| 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
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| what is nsg intv for beta blocker | ECG/BP/HR monitored after med.
SE: depression/fatigue/impotence
Not stop abruptly
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| 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
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| Antiplatelet meds | aspirin, Plavix
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| 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
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| ACS-Acute Coronary Syndrome is? | MI
unstable angina
NSTEMI: non ST elevation MI
STEMI: ST seg elevation MI
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| 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)
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| Presenting s/s for ACS | chest pain sudden and continue despite med or rest
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| 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.
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| What are the three ceatine kinase isoenzymes | CK-MM(muscle), CK-MB(heart muscle), CK-BB(brain)
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| 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
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| what is main medical mgmt for MI | reduce myocardial O2 demand and incr O2 supply w/ meds, O2, bed rest
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| what is pharmacologic therapy for MI | aspirin, nitro, morphine(decr pain/anxiety/preload/afterload), IV beta-blocker/ACE inhibitors...heparin, not NSAIDS..some thrombolytics
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| Invasive Coronary Artery Procedures...all PCI's | PTCA, intracoronary stent implantation, atherectomy, brachytherapy
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| Describe PTCA | balloon-tipped catheter used to open blocked coronary vessels and resolve ischemia to improve blood flow
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| After PTCA a stent is needed, describe | To prevent restenosis(treated area closes off) and metal mesh to provide support to vessel
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| Describe atherectomy | remove atheroma or plaque from coronary artery by cutting, shaving, grinding
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| Describe brachytherapy | radiation put close to lesion.
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| 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
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