-
stenosis
- -valve disorder
- -valve is stiff and the opening is small
-
regurgitation
- -valve disorder
- -insufficient valve, does not close properly
-
right heart
receives blood from body and pumps it through pulmonary artery to the lungs where it picks up fresh o2
-
left heart
receives o2, pull blood from the ungs and pumps it through the aorta to the body
-
-
what is the normal pacemaker of the heart
SA node
-
av node
bundle of his
perkinje fibers
normals
-
what is CAD
- -blood vessel disease
- -atherosclerosis
- -hardening of the arteries
-
why is CAD the silent killer
- -asymptomatic for a while
- -progressive
-
CAD manifestation
chronic stable angina
-
what is the more serious manifestation of CAD
-ACS(acute coronary syndrome)
-
whats are the manifestations of ACS
- -unstable angina
- -MI(NSTEMI and STEMI)
-
name this disease
slow gradual narrowing of the coronary arteries that supply the blood and o2 to the heart
CAD
-
stages of athersclerosis
- fatty: lipid filled smooth muscle, tx that lowers LDL may reverse
- Fibrous plaque: progressive changes in endothelium of arterial wall. collegen covers fatty streaks, narrowing the lumen
- complicatied lessions: platelet accumulate creating thrombus, total occlusion
-
what is collateral circulation
when plaque blocks normal flow, arteries bypass occlusion
-
when is collateral circulation most likely to occur
when blockage occurs over a long period of time
-
collateral circulation factors
- -inherited predisposition to develop new blood vessles
- -presence of chronic ischemia
-
what is considered healthy cholesterol
HDL's
-
what do HDL's do
carry lipids away so an increase in HDL's is desireable
-
CAD levels indicating risk
- serum cholesterol: >200
- triglyceride: ≥150
- LDL: >160
- HDL: <40(men) <50(women)
- Fasting BG: ≥100
-
CAD BP risk indicators
- ≥ 140/90
- if over 60, the goal is less than 150/90
-
what do you watch for during metabolic syndrome if pt has CAD
glucose
-
who is more at risk for phyc risk factors
type a
-
what is elevated homocysteine
- -CAD
- -produced by the breakdown of essential amino acid methione
- -damage inner line of blood vessel
- -plaque build up
- -increase clots
-
dug therapy for CAD
- - lipid lowering agents(use statins which inhibit synthesis of cholesterol in the liver)
- -antiplatelets( aspirin, Plavix, berlenta)
-
define angina
- -chest pain
- -it is the clinical manifestation of MI
- -narrowing of 1 or more arteries from athersclerosis
-
angina is caused by
-increase in demand for o2 or decrese supply of o2
-
what to asses with angina
- health hx
- pain(PQRST)
- vitals
- assucltate
- periph circulation
-
what does PQRST stand for
- precipitating event
- quality
- radiation
- severity
- time of onset
-
possible locations of chest pain
- left arm
- jaw
- back
- epigastric
- neck
- shouldere
- sub sternal
-
types of angina
- silent ischemia
- microvascular angina
- prinzmetal
- chronic stable
- unstable
-
what is silent ischemia
- -angina
- -no s/s
- -diabetics d/t neuropathy
-
what is microvascular angina
chest pain that occurs in the absence of significant CAD or coronary spasm of a major coronary artery
-
in microvascular angina chest pain is r/t
- -myocardial ischemia
- -physical exertion
-
what is prinzmetal angina
spasm of coronary artery
-
prinzmetal angina
occurs
tx
triggers
- at rest
- nitro, Ca chan blockers
- smoking and increased levels of substance abuse
-
what is chronic stable angina
chest pain that occurs intermittentally over a long period of time with similar pattern of onset, duration and intensity of s/s
-
chronic stable angina
where is pain
provoked by
relived by
- epigastric
- exertion
- rest or nitro
-
diagnostics for CAD and chronic stable angina
- -EKG
- cxr
- stress test
- ECHO
- EBCT
- Cardiac cath
- LABs
-
what does ekg monitor
heart rythm
-
what does cxr show
size of heart
-
what does stress test evaluate and what meds to hold
- -evaluates hearts response to stress
- -hold beta blockers
-
what is an ECHO
ultra sound of the heart
-
what is the EBCT
measures calcium calcification
-
what is cardiac cath
- -dye into vessles
- -radiation and IV
- -Id circulation and blockage
-
what drug should you hold if pt is getting dye
metformin
-
chronic stable angina tx
- antiplatelet
- anticoagulant
- ACE and ARBS
- BBlocker
- BP control
- stop smoking
- cholesterol management
- Ca2+ chan blockers
- cardiac rehab
-
chronic stable angina main ponit
-
define ACS
when ischemia is prolonged and not immediately reversable
-
define unstable angina
- -unpredictable
- -pain at rest or with minimal exertion
- -easily provoked
- -RESISTANT TO NITRO
- -fatigue
-
what is MI
- abrbt stoppage of blood flow through a coronary artery from a thrombus caused by platlet aggregration
- -HEART ATTCK
- -CELL DEATH
-
s/s of MI
- "sitting on my chest"
- SNS s/s: diaphoretic, high BP
- cool, clamy, ashen
- no blood flow, bp tanks, low urine, crackles
- n/v
- fever
-
what is the priority for MI
open vessles and save the heart
-
STEMI
- -an MI
- -caused by occlusive thrombus
- -st ELEVATION
- -emergent
- -open artery w/in 90min
-
NSTEMI
- caused by non occlusive thrombus
- -NO st elevation
- -non emergent to cath lab
- -markers are (+)
-
complications of MI
- DYSRYTHMIAS
- -HF
- -cardiogenic shock
- papillary muscle dysfunction
- LV aneurysm
- ventricular spetal wall and LV free wall rupture
- pericarditis
- dressler syndrom
-
cardiogenic shock
- MI complication
- o2 and nurtients are inadequate
-
papillary muscle dysfunction
- MI complication
- if near pap muscle you will hear a new murmur near apex
-
left ventricular aneurysm
- complication of MI
- buldge out during contraction
-
ventricular spetal wall and LV free wall rupture
- complication of MI
- new loud systemic murmer
-
pericarditis
- MI complication
- inflammation
- chest pain w/ inspiration
-
dressler syndrom
- MI complication
- pericarditis and fever
-
diagnostics for UA and MI
- EKG is #1
- serum cardiac biomarkers
- coronary angiography
- stress test
-
what are serum cardiac markers
released into the blood from necrotic heart muscle after an MI
-
what are serum cardiac markers used to determine
-
what are the serum cardiac markers
- CK- rises after 6 hours
- CKMB- specific to myocardial cells, >4-6% of total CK
- Troponin- greater specificity to MI, 4-6 hour increase after MI onset
- Myoglobin- w/in 2 hours, peak 3-15hrs, lacks cardiac specificity
-
troponin levels
- (-) <0.5
- suspicious 0.5-2.3
- (+) >2.3
-
myoglobin levels
- male: 15.2-91.2
- femalw: 11.1-57.5
-
SA node is = to which wave
P wave
-
-
-
T wave inversion =
ischemia
-
-
ST elevation and T wave inversion =
infarction
-
what is PCI
- evaluates coronary arteries
- cath lab
- for confirmed STEMI
-
what is done in PCI
- angioplasty(balloon)
- stent
-
what is the first line of treatment for MI
PCI
-
-
goal of PCI
open artery w/in 90 min of ED arrival
-
when would you use thrombolytic therapy
- when PCI is not available
- chest pain for less than 12 hrs
- EKG shows STEMI
- no bleeding contraindications
-
types of fibrinolytic therapy
retavasel(rpa), alteplase(tpa), tenecteplase(tnkase)
-
what is CABG
- graphing veins to create new vessles
- requires sternoectomy(open chest)
-
indications that a pt may need a CABG
- -failed medical management or PCI
- -left main CAD
- -3 vessel disease
- -not a candidate for PCI
-
post op care for CABG
- -icu 24-36hrs
- -drug
- -hemo status
- -monitor bleeding
- -chest tube
- -dysarythmias are common
- -neuro checks
- -wound care
- -early mobilization
- cough and deep breath
-
TX for pt with angina
- balance o2 supply demand
- M-morphine(vasod)
- O-oxygen
- N-nitroglycerin(vasod)
- A- aspirin(antiplatelet)
-
Nitroglycerine
route
dose
SE
- -mostly sublingal but sometimes iv, PO or paste
- -give 1 dose q5 min x3
- -vital q5 min
- -HA, tingling, flushing, dizzy, hypotension
-
what do you need to know about pt meds before you give nitro
if theey take Viagra, Cialis or other meds
-
what will you teachpt about nitro
ligh sensitive, 6mo experiation, don't chew
-
what is the acronam for blood flow through heart
tissue paper my assests
- tricuspid
- pulmonic
- mitral
- aortic
|
|
