Cardiac

• RCA- right coronary artery. perfuses RA, RV, inferior LV +/- SA +AV nodes (block heart rhythm block
• LCA- left coronary artery. 2 major branches
• - LAD (left anterior descending artery)- perfuses LV, anterior septum, and apex
• - L circumflex- perfuses LA, lateral & posterior LV +/- SA & AV nodes
• ** 75% of blood flow to heart is during diastole
• feeds the body during systole
• important- chest pain- control time in which heart can perfuse itself

• #1 cause of death in US
• > 25 million adults diag with hear dx
• 45% MI- those > 65
• > 50% deaths= females
• women dying from this

• Atherosclerosis- plaque formation in vessels- dec blood supply
• vasospasm- cant let blood thru
• dec O2 supply- think pt w/bronchitis
• inc O2 demand- anything that makes your heart work more

• Endothelial injury
• Inflammatory process
• -monocytes
• - fatty streaks
• 1. Inflammation
• - smoking, HTN can cause injury to the endothelial
• smooth muscle cell proliferation (grow more)
• - atheromas/plaques
• 2. Plaque formation
• - form plaque - build up narrowing
• Rupture
• platelet aggregation
• 3. thrombosis formation- risk for stroke
• - unstable smoking, htn inc lipid- platelets try to fix rupture in vessels0 form clot thrombosis

heart can build up new vessels to get blood where it needs to go- tissues going on for a long time. angioplasty can make this go away

• Hx- risk factors
• nonmodifiable
• - heredity-
• - age men 45 women 55
• - gender- males
• - ethnicity- african american inc mortality
• Modifiable
• - ** smoking
• - ** high chol
• - ** HTN
• - obesity, sedentary
• - DM, stress, drugs (illicit drug cocaine) vasocontrition
• metabolic syndrome
• - CA, P, Cerbral vascular p. 729

• Lipoproteins - helps to move non-soluble water
• - chol- 12 hr fasting
• - HDL "good"
• - LDL/VLDL- goal = <130mg/dl
•    - gets stuck in artery
• you need this in your body

• Homocysteine
• - elevation leads to inhibition of anticoagulation and endothelial damage (Amino acid deviaritive, eleb helps CAD progress)

• rates of diagnosis and death rising
• inc after menopause
• AA mortality 70% higher
• strong genetic link
• DM= 7x more CV events- they are at extreme risk
• HTN= greater risk also
• Smoking- inc risk

• Pain- varies greatly **
• - more generalized
• - heaviness, squeezing mid back, arm, shoulder
• - palpitations or fleeting pain
• - antacids may relieve
• - MI pain- neck, back, arm, shoulder, jaw
• - elderly w/DM may not have any pain- neuropathy
• EKG- may not have classic changes

• risk assessment- non v modifiable risk factors Look at these things
• ETT- more false (+) in women excerise tolerance test- stress test lots of false + chest pain but may not be
• cardiac cath- most reliable **

• Diet
• exercise- FITT
• - Frequency 5 times a week
• - Intensity- moderate
• - type- cardio
• - time- 30 mins/day
• Control HTN
• Control DM
• Control HLD
• Smoking cessation
• Control modifiable risk factors. Meds too
• Diet and exercise

• lifestyle modification
• total fat < 25-35% total calories
• Cholesterol < 200mg/dl
• high fiber- good for the heart- more fruits veggies less fat
• low sodium- 2-3g
• avoid caffeine