Cardio Flashcards
Coronary Arteries
Supplies oxygen and nutrients to the heart
They are pumps
Most popular place to build plaque: circumflex branch
Coronary system requires oxygenated blood
Cardiac Terms
Cycle: One complete heart beat (PQRST)
Cardiac output: Amount of blood ejected in one minute (HR X Stroke Volume)
Stroke volume: Amount of blood ejected with each contraction. Effected by preload, after load and contractility.
Preload: Degree of stretch before contraction. Frank Starling law.
After load: Amount of tension the ventricle must develop to open valves. Major determinant = arterial BP
Contractility: Vigor strength, or intensity of cardiac muscle contraction. Digoxin- increases contractility
Cardiovascular Disease
Major (#1) cause of death in the US: Used to be a man’s disease. After menopause, prevalent in women.
Coronary Artery Disease (CAD) is most common
- Begins with atherosclerosis
- Asymptomatic
- Stable angina- heart pain, SOB, rest helps it go away
- Unstable angina- heart pain SOB, rest doesn’t help
- Myocardial Infarction- crushing chest pain, arm pain, jaw pain, SOB, sweating (particularly with men). Women: jaw pain, nausea, no warning at all.
Coronary Artery Disease
- Atherosclerosis is an abnormal accumulation of lipids and fibrous tissue due to inflammation in the vessel wall
- Soft deposits of fat start to build up and harden
- Can occur in any artery in the body
- No s/s at first, then as it continues, s/s show
- The Atheromas (Plaque) protrude into the lumen of the vessel, narrowing it and obstructing blood flow
- Prefers coronary artery because of their shape
- A thrombus may form and further obstruct the flow, leading to a myocardial infarction or sudden death
Risk factors for CAD:
Non-modifiable factors: Age, gender and ethnicity, Family and genetics, Dad and brother- before 55, Mother and sister- 65, Puts you at risk
Modifiable major factors- all fixable: Elevated serum lipids - Increase HDL with exercise - Lower LDL with diet, cut back on simple carbs - Can fix with medicine Hypertension tobacco use - 1 pack a day increases chances of an MI 6 times physical inactivity Obesity Diabetes- keep sugar under control Metabolic Syndrome- lose weight Psychologic states (stress)- decrease stress Homosysteine- not getting enough B vitamins, destroying epithelial cells in vessels, get more B vitamins Radiation therapy to the chest Substance abuse- meth, cocaine
Other factors
- Sleep apnea- low oxygenation, increases bp and strain on the heart
- Elevated C-reactive protein- c-reactive protein tells us there is inflammation somewhere in the body
Risk factor cluster: obesity, diabetes, low HDL- cleans up vessels, high LDL- distrupts the body’s ability to dissolve clots
Complicaitons: Angina - Elderly may not recognize this - Ischemia somewhere in the heart- low oxygenation - Teach patient to sit down!
Myocardial Infarction: tissue died
Heart Failure- the pump isn’t pumping like it should
Arrhythmias- heart is not beating the way it should
Management:
Health Promotion:
- Identification/ Management of high risk people: Physically inactive, obese, high cholesterol, HTN, DM
Procedures
Cardiac caths
Angioplasty- balloon with stent placement- wire cage goes over the balloon and the ballon is taken out while the cage stays
Coronary artery bypass surgery- take a vessels from somewhere and bypass the plug
***PCTA- percutaneous transluminal coronary angioplasty- go into the vessel itself and look for
Prevention:
Lifestyle changes:
exercise more (2x a week)
Nutrition therapy
- High fiber (TLC diet), food groups with vitamins C&E (help with inflammation), folic acid, B6, B12, soy products (no soy if you have a thyroid problem) and limiting fats except the omegas 3/6- limit 6 more than 3)
- Low saturated fat
- Low red meat
- No whole milk, no cheese, slow down on eggs and butter
- Slow down on alcohol and carbs
Early diagnosis can stop the progression
Management - Drugs:
Cholesterol lowering drug therapy
- Drugs that restrict lipoprotein production
- Drugs that increase lipoprotein removal
- Drugs that decrease cholesterol absorption
- Pravastatin
Alternatives:
Fish and fish oils
Flax and flaxseed oil- Omega 3 with fiber
Other dietary sources of Omega 3s- walnuts, canola, soy, olives
Supplements to reduce BP/Cholesterol
ALA, Artichoke, barley, beta-sitosterol, psyllium- metamusal, cocoa, Co Q10, garlic, oat bran
VLDL- LDL inhibitors
- Niacin , fibric acid derivatives
- Our ability to dissolve clots will go away if our LDL is high
Antiplatelet therapy
- Low dose aspirin, Plavix
- Natural agents- Niacin- can buy at health food store and it will open up the blood vessels DO NOT TAKE WITHOUT PERMISSION FROM DOCTOR
- Beta Blockers
- Nitroglycerin- vasodilator – relieves chest pain because it opens the vessel to give oxygen to that particular area – comes in cream- WEAR GLOVES, sublingual, patch, tabs
- Angiotensin-converting enzyme inhibiters & angiotensin II receptor blockers
- Want to manage the plaque which is lipoproteins and cholesterol
Lifestyle changes:
Stop smoking- constricts blood vessels and causes more workload on heart
Control the BP- keep around 120 systolic
Cholesterol control- LDL: lower than 100 HDL: above 40 for men about 50 for women
Keep diabetes under control
Keep moving
Eat healthy- low fat, low cholesterol
Maintain a healthy weight
Manage stress- breathing exercises
Regular check-ups- some people at risk don’t have any s/s so it’s important to get regular check ups.
Athersclerotic Progression
- Begins with damaged epithelium
- Next: fatty streak with lipid core formation- around age 15- can reverse at age 15 with healthy diet
- Next: Fibrous plaque- wall begins to thicken, occurs around age 30
- Lastly: Complicated lesion- Clots, leakage
- As atherosclorosis advances, the thrombus enlarges, O2 rich blood becomes inadequate so collateral circulation starts to form
Diagnostics for CAD
Electrocardiogram (ECG)
- Holter monitoring- walk around with it for 24 hours to a month, detects your heart
- ***you may not see a heart attack happening in the moment. Cannot count on ECG for MI until damage has been done
- Echocardiogram- shows weakened areas of heart
- Stress test- treadmill or drug, will have ECG during this time so that it shows what it is doing. The goal is to stress the heart and its blood supply enough that if there is underlying disease ischemia EKG changes will develop
- Cardiac cath or angiogram- see vessels of the heart and can blow it up to widen the part that is plugged off and smash the cholesterol into the vessel and place stent. If less than 70% occluded, they won’t place stent. Data obtained includes:
- hemodynamic pressures: arterial and left ventricle
- ventricular gram (dye injected into the left ventricle)
- multiple views of the right coronary artery
- multiple views of the left coronary artery
- Gives many views of the artery/ventricle
Limitations - Can only measure lumen size
- ***Not predictive of plaque state (ie rupture)
- Invasive: need consent form
- Heart scans (CT)
- Magnetic Resonance Angiography (MRA)- Goes into arteries with dyes
Cardiac Catheterization
Invasive procedure used to measure cardiac chamber pressures and assess patency of the coronary arteries- need consent form
Requires ECG and hemodynamic monitoring; emergency equipment must be available
Assessment prior to test; allergies (especially to dyes), blood work (routine, CBC, Electrolytes)
Assessment of patient after procedure: circulation, potential for bleeding, potential for dysrhythmias
Activity restrictions- if go through the femorals
Patient education before & after procedure
Watch for bleeding or hematomas building up
Invasive Coronary Artery Procedures
PTCA compresses atheroma and stretches coronary artery
Coronary artery stent is inserted after PTCA to keep vessel open
Atherectomy is removal of atheroma
Brachytherapy inhibits smooth muscle cell proliferation by placing radioisotope close to lesion
Transmyocardial laser revascularization: burns a channel into but not through the muscle
Angiogenesis- new blood vessels begin to grow around the blockage as a bypass (collateral circulation)
Coronary artery revascularization- utilizes another vein to bypass (building artificial collateral circulation around the area) diseased coronary artery
- Complications include: MI, dysrhythmias, and hemorrhage
- Post-op care focuses on wound care, progressive activity- will not let them lay in the bed because they will get weaker , and nutrition
Post op teaching
Signs and symptoms of infection ( temp >100.4)
Pain management
Activities to avoid ( driving, lifting >5 lbs)
Lifestyle modification
Symptoms to report to the surgeon( weight gain, SOB, swelling, drainage…)
Home med actions dosages and side effects
