Cardiac Medical Patient Flashcards by Paula Brasen

Def atherosclerosis

Fatty deposits that harden over time

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Major cause of CAD

Atherosclerosis

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Etiology of CAD

Focal deposits of lipids and cholesterol within intimal walls of artery

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Name the theories of atherogenesis (7)

Endothelial injury
lipid infiltration
aging
thrombogenic
vascular dynamics
capillary hemorrhage
lipid metabolic

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Endothelial injury theory

Endothelium is injured by HTN, HLD, chemical irritants
Platelets and other clotting factors form
Lesions assoc super imposed thrombus develops

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Lipid infiltration theory

Lipids from circulation enter and accum in smooth muscle cells
Mechanical/ inflammatory trauma
Lipoproteins become trapped and damage occurs
Endothelial permeability compromised

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Aging theory

Atherosclerosis happens in everyone and is more prevalent in older people

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Thrombogenic theory

RBCs, lipids, and platelets accum in the intima of arteries
Micro thrombi form
Plts aggregate

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Vascular dynamics theory

Mechanical factors (HTN, incr intraluminal pressure) lead to altered membrane perm —> lipid infiltration

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Capillary hemorrhage theory

Lipids accum in plaques as a result of capillary hemorrhage

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Lipid metabolic theory

Low density lipoproteins migrate into arterial wall, accum, and lipids are deposited

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Stages of CAD (4)

Fatty streaks
Raised fibrous plaques
Complicated lesion
Collateral circulation

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3 most significant risk factors for CAD

Elevated serum lipids
Smoking
HTN

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Cholesterol lowering meds (6)

Statins
- Lipitor, Crestor, zocor
Fibrin acids
- tricor, lopid
Bile acid sequestrans
- quest ran
Cholesterol absorption inhibitors
- Zetia
Omega 3
- fish oils, flax seeds
Red rice

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What do u need to monitor for with chol meds

Hepatic fx

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Def angina pectoris

Ischemia of coronary muscle that temporarily compromises tissue and is caused by an imbalance bx O2 supply and O2 demand

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Def MI

Myocardial O2 demand exceeds supply

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At is the primary cause of angina

Narrowing of coronary arteries by atherosclerosis

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Angina precip factors

Phys exertion
Strong emotions
Consumption of heavy meals
Temp extremes
Smoking
Sexual activity
Stimulants ( caffeine, cocaine)

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Types of angina (4)

Stable / classic
Unstable
Prinzmetal
Nocturnal

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What is Stable angina

Angina that occurs with occurs with consistent onset, duration, and intensity
Usually induced by activity
EKG shows ST segment depression

Unstable angina

Unpredictable
Occurs with little - no activity
A/w incr stenosis and multivessel disease
May have spasm

Prinzmental angina

Occurs at rest or sleep
Due to spasm of coronary artery
EKG shows transient ST elevation
Pain may be relieved by some exercise or may go away on its own

Nocturnal angina

Occurs at night whether sleeping or not
Occurs when lying down
Relieved by sitting up

Angina dx studies and why

``` CBC to r/o anemia CRP shows inflammation Homocysteine shows damage to arterial lining Lipoproteins Resting EKG EKG stress test Radionuclide imaging Radionuclide ventriculography Cardiac cath Positron emissions tomography (PET scans) ```

What meds are given for angina

``` BB CCB Ace inhib Anti lipids Anti plt Folic acid B vit complex ```

Angina mgmt (4)

``` Percutaneous coronary interventions Percutaneous transluminal angioplasty Cardiac cath Intra coronary stent Coronary artery bypass graft Trans myocardial revascularization ```

Complications to angina mgmt

``` Hemorrhage at site Hematoma at site Retro peritoneal bleeding Pseudo aneurysm Renal ```

Def pseudo aneurysm

Out pocketing of blood

Pathophys of MI

Plaque rupture Plt aggregation at site Activation of exposed platelets cause expression of glycoproteins I A/ b (bond fibrinogen)

What dose of aspirin do u give an MI PT

160-325 mg

Def cardiogenic shock

Failure of heart to pump blood adequately to meet O2 demands

When does cardiogenic shock occur

When the heart loses contractile power

What can cause cardiogenic shock

Cardiomyopathy Severe valvular dsfx Ventricular aneurysms

Clinical manif of cardiogenic shock (10)

``` Confusion Restlessness Low BP < 80 Oliguria < 30 mL / hr Cold and clammy Weak and threads pulse Dyspnea, tachypnea, cyanosis Dysrhythmias Chest pain Decr bowel sounds ```

Cardiogenic shock interventions

Incr CO O2 Maintain tissue perfusion

Potential complications of pericarditis

Pericardial effusion | Cardiac tamponade

Causes of pericarditis (9)

``` Infection Auto immune ct disease Hypersensitivity states Neoplastic conditions Radiation Trauma Renal failure Tb Idiopathic ```

Pericarditis clinical manif

``` Atypical chest pain Pain on inspiration Fever Incr WBC, CRP, ESR pericardial friction rub ```

Pericarditis tx

Pericardiocentesis Steroids in severe cases NSAIDS monitor for decr CO

Def pericardial effusion

Accum of fluid in the pericardial sac

Def cardiac tamponade

Restriction of heart fx due to fluid in the pericardial sac

Pericardial effusion/ tamponade clinical manif

``` Ill defined chest pain/ fullness Pulsus paradoxis Engorged neck veins Labile or low BP SOB ```

Cardinal signs of cardiac tamponade

Falling systolic BP Narrowing pulse pressure Rising venous pressure Distant heart sounds

Pericardial effusion and tamponade interventions

Pericardiocentesis | Pericardotomy

Low doses of dopamine is used for ...

Renal perfusion

High doses of dopamine

For BP

What does the med Primacore do?

Reduces workload of the heart

Diuretics decrease ________

Preload

Name the 4 inotropes

Dobutamine Dopamine Digoxin Primacore

Mi meds (10)

``` Diuretics Inotropes Vasodilators Ace inhib Arbs BB Aldosterone inhibitors BNP hydra lazing Nitrates ```

Iv diuretics

LASIx Bumex Edecrin