-
Collateral Circualation
the body compensate for atherosclerosis
-
Homocysteine level
- family predisposation for plaque development
- b vitamin help reduce
-
A1c should be below what?
7
-
Echocardiogram
Ultrasound, looks at valves and blood flow
-
Beta Blockers should be contridicted in patients with what?
Asthma
-
Cardiac Catheterization diagnostic
- Allergic to shellfish?
- Informed consent
- check creatine level
- After:
- Check BP, HR, bleeding
- Legs straight for 46 hours
-
Carry's Lipids away from vessels (GOOD)
HDL'S
-
More Cholesterol and carry to vessels (Bad)
LDL'S
-
Carry both bad and triglycerides (very bad)
VLDL'S
-
Atrovastiatin
prevastatin
simvastatin
rosuvastatin
Statins
-
What do statins do?
Side effects
Nursing considerations
- Block the sythesis of cholesterol and increase LDL receptors in the liver
- Decreases LDL
- Decreases Triglycerids
- Increases HDL
Rash, GI disturbances, elevated liver enzymes
Monitor liver enzymes and creatine kinase 3-6 months LFT if increased liver enzymes.
-
Niacin
What does it do?
Side effects
Nursing considerations
- Water soluable B vitiams inhibits synthesis and secretion of VLDL and LDL
- Decreases LDL and Triglycerides
- Increases HDL
Flushing and pruitius in upper torso and face, GI disturbances, N&V, Can elevate homocysteine levels
- Take NSaid or aspirin 30-60 min before given to reduce redness and take with food
- Treat elevated homocysteine levels with folic acid
-
Cholestyramine (questran)
What type is it?
What does it do?
Side effects?
Nursing considerations?
- Bile-Acid Sequstrants
- eliminates cholesterial via bile, decreases ldl and cholesterol
Unpleasant taste, gi disturbances
- interferes with absorption of digoxin, tthiazide diuretics, warfarin, some antibodics
- Don't take with Coumadin!
-
Primary reason for stable angina
insufficient blood flow is narrowing of coronary arteries by atherosclerosis
-
For ischemia to occur in the heart, how much stenosis is in the coronary artery disease?
75%
-
What factors would determine a MI instead of stable angina?
- accompanied by N&V
- If more than 3-5 min
- EKG change
-
Medical Management of Stable angina
ABCDE
- A- Aspirin and Anti-anginals
- B- Beta blocker and blood pressure
- C-Cholesterol and Cigerettes
- D- Diet and Diabetes
- E-Education and Exersice
-
Antiplatelet agent
Aspirin
-
Adenosine Diphosphate Receptor antagonists
- Clopidogrel (Plavix)
- Agrivates platelet formation
- Alternative to Aspirin
-
Nitrates
- Vasodialation
- Decreases preload and afterload
- Watch for othostatic hypotension
-
Atenolol
carvedilol
Metoprolol
What are they?
Action?
Side effects?
Nursing considerations
- Beta-blockers
- Inhibits sympathetic nervous stimulation of the heart, reduce both HR and Contractility, Decreases afterload
- Watch for hypotension because masks signs, bradycardia, hypotension, wheezing, GI, ED
- Don't give to a patient with asthma
-
Norvasc
Cardizem
Calan/Isoptin
Classification
Action
Side effect
Consideration
- Calcium channel blockers
- Prevnts calcium entry into vascular smooth muscles cells
- Conronary and peripheral vasodilation
- Decreases HR and Contractility
- Monitor digoxin levels because it could lead to toxticity
-
Catopril
Enalapril
-ril's
- Ace inhibitor
- Decreases endothelial dsyfunction
Hypotension, dizziness, hyperkalemia, acute renal failure, angioedema
Aspirin and NSAIDs may reduce drug effectivness. Dont use with k+ sparing diuretics
-
Heparin
Classification
Action
- Unfractionated heparin
- Prevent converision of fibrinogen to fibrin and prothrombin to thrombin
-
Lovenox
- Low-molecular-weight heparin
- enhances effect of antithrombin III
- Inactivates activated factor x ant thrombin
- prevents fibrinogen conversion into fibrin
-
Tissue plasminogen activator (tPA; alterplase (Activase))
- Fibrinolytic therapy
- breaks up fibrin meshwork in clots
- used only in st-segment-elevation MI
-
Post stent
Nursing intervention
- bedrest anywhere 6-24 hours
- Will be on anticoagulants or rheomacrodex
- Monitor vitials including cardiac monitoring
- assess for kidney function because dye
- avoid showering for 24 hours and bath for a few days
-
Guidelines for nitrates
Take one then in 5 min take 2nd in 5 min take 3rd if no relief call 911.
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