Cardiac

Variety of pathologic conditions that obstruct blood flow through the arteries that supply the heart (coronary arteries)

fatty deposits/plaques

Arteriosclerosis- narrowing/hardening of arteries: aging

Atherosclerosis- fatty deposits/plaques

Arteriosclerosis- narrowing/hardening of arteries: aging

Arteritis

Coronary Artery Spasm

Coronary thrombosis- clot produces occlusion

Embolus

Coronary Arteries

Hyperlipidemia

Increased lipid levels in the blood results in:

Atherosclerosis

Accumulation of fatty materials, clotting factors, Ca++, and fibrous tissue within the arterial walls

Plaque (atheromas) form

Lumen becomes narrowed

Blood supply obstructed to the myocardium

Progression of atherosclerosis

Usually develop near the origin and bifurcation of the main coronary arteries

Left coronary artery more often affected

First effect is localized; then more diffuse

Manifestations of myocardial ischemia do not occur until tissues blood supply is reduced by 60-75%

Angina

Myocardial Infarction•          Sudden Death

At rest, myocardial blood flood maintained despite considerable coronary artery narrowing

If myocardium has increased metabolic needs: physical activity

Needs not met d/t this narrowing

Symptoms result from insufficient supply of O2 to myocardium

Since insufficient O2- convert from aerobic to anaerobic metabolism

Byproduct: lactic acid

Initiate sensory receptors leads to PAIN

One of the coronary arteries or its branches suddenly b/c occluded

Caused by coronary thrombosis, vasoconstriction of the arteries, or sudden atherosclerotic changes (plaque rupture)

Area deprived of O2

Myocardial tissue dies

Myocardial Infarction

Age (>65 yo)

Sex (Male until after Menopause)

Race (African American)

Family History

Hyperlipidemia (↑ LDL)

High fat diet

HTN

DM

Obesity (central abd)

Smoking

Physical inactivity

Pt history- manifestations exhibited

EKG- changes seen during chest pain but return to baseline

Holter monitoring

Coronary angiogram (Cardiac Catheterization

Stress Test

Rest

O2

Monitor for dysrhythmias

Sublingual Nitroglycerin

Sublingual Nitroglycerin

• Other forms of Nitroglycerin- long term prevention of Angina
•      Nitro-Bid/Isordil- po

• Beta Adrenergic Blocking Agents (“Beta Blockers”)
•       Inderal (propranolol); Tenormin (atenolol)-  “olol”

• Calcium Channel Blockers
•      Procardia (nifedipine); Calan, Isoptin (verapamil)

Minimize precipitating events

Smoking cessation

Engage in regular exercise

Wt reduction

Avoid caffeine

Regular medical followup