Cardiovascular system part 2 Flashcards
Cardiac Evaluation- How well is this patients heart working?
-Past medical history
-general medical health
-physical evaluation
-ECG
-Type of sx planned
Role of Medical Consultant- Good communication essential
-Medical clearance prior to sx
-Review available patient data, history, and his/her examination
-Communicate severity and stability of the patients cardiovascular status- and vet clearance in writing / faxed
-determine if patient is in optimal medical condition, given context of surgical illness
Diseases of the cardiovascular system
“Cardio”
-Angina (chest pain)
-Myocardial infarction (MI- heart attack)
-Congestive heart failure (CHF)
-Valve damage
-cardiac dysrhythmias
“Vascular”
-Hypertension (high BP)
-Low BP
-cerebrovascular accident (CVA- Stroke)
What parts of “cardio” leads to what diseases (plumbing pump circuitry)
- The Plumbing: Diseases of the coronary arteries leads to angina pectoris
- The pump: Diseases of the myocardium and valves leads to congestive heart failure (CHF) and valve damage and malfunction
- The Circuitry: Diseases of the conducting system leads to irregular heart beats- dysrhythmias
Cardiac diseases- Ischemic heart disease
-Definition: Ischemia is a restriction in blood supply, generally due to partial or complete occlusion of the blood vessels, with resultant damage or dysfunction of tissue.
-Insufficient blood flow to heart muscle from narrowing of coronary artery may cause chest pain, narrowing caused by plaque in coronary artery
Classification of Ischemic Heart disease usually results in __ and this encompasses ___ and ___.
classification of ischemic heart disease usually results in acute coronary syndrome and this encompasses angina pectoris and myocardial infarction
Acute coronary syndrome sequence of disease
-early plaque begins. plaque is made up of fat cholesterol calcium and other substances found in blood
-significant plaque begins to partially occlude arteries walls. when plaque partially occludes blood flow to muscle result is angina
-thrombus- plaque beginning to rupture. Plaque can crack off which causes blood clot
-Infarction- thrombus totally occludes coronary artery blocking blood flow
-results in death/necrosis of muscle/results in heart attack (MI)
Angina pectoris definition
Definition: A primary symptom of coronary heart disease which occurs when myocardial oxygen demand exceeds supply.
-chest pain that occurs in coronary heart disease caused by inadequate oxygenation of cardiac muscle
Angina pectoris
-crushing substernal pain (under sternum/middle chest)
-pain radiating to jaw, arm, back
-caused by ischemia (lack of blood supply to heart)
-if ischemia is relieved and blood supply is restored, angina should resolve
angina - pathophysiology
-starts in coronary arteries by build up of plaque
-available space for blood to flow is narrowed
angina pectoris- diagnosis
diagnosis- history
-when was the last attack?
-how frequently do the attacks occur?
-what exercise level leads to the attacks?
-angina pectoris associated with pain during g exertion
Acute coronary syndrome - treatment
-early plaque + significant plaque= angina
-tx is focused on restoring oxygen to heart muscle remember MONA
-Morphine is given to relive pain
-Oxygen is given to minimize O2 delivered
-Nitroglycerin is a med that dilates arteries to increase blood flow to heart
-Aspirin is given to thin blood
Angina pectoris - treatment
If Angina occurred during intraoperatory treatment would be to
-terminate surgery
-suction, pack surgical site
-100% O2 by mask
-semi recumbent positio.
-loosen clothing
-nitroglycerin sublingually (tablet or spray)
-monitors (BP, HR, EKG, Pulse Ox)
-Nitroglycerin 2nd and 3rd dose q 5 min prn
- If no relief after 3rd dose assume MI and call 911
Myocardial Infarction - the second component of the acute coronary syndrome
Definition: Necrosis or death of heart muscle precipitated by decreased oxygenation from partial or complete blockage of blood flow in the coronary arteries
- Area of infarction with death of the myocardial tissue
Myocardial infarction signs and symptoms
-crushing chest pain not relieved by nitroglycerin
-pain radiating to the arm shoulder or jaw
-sweating, pallor (pale)