Exam 2 Coronary Artery Disease Flashcards
Abnormal accumulation of lipid, or fatty substances, and fibrous tissue in lining of arterial blood vessel walls
Block and narrow vessels- reduce blood flow to heart muscle
Progresses over many years- build up of plaque narrowing walls
Atherosclerotic lesions most often occur where vessels branch
Atherosclerosis
Abnormal ______________of lipid, or fatty substances, and _________tissue in lining of arterial blood vessel walls
Abnormal accumulation of lipid, or fatty substances, and fibrous tissue in lining of arterial blood vessel walls
Block and narrow vessels- __________blood flow to heart ______
Block and narrow vessels- reduce blood flow to heart muscle
Progresses over ______years- build up of plaque _________walls
Progresses over many years- build up of plaque narrowing walls
Atherosclerotic ________most often occur where ________branch
Atherosclerotic lesions most often occur where vessels branch
Lipids and fatty tissues build up and narrow and reduce blood flow to the heart this is what causes systems like angina or they don’t have an s/s and will come in and have an MI
Plaque buildup in the vessels
Most will have symptoms and take meds for angina and then have an MI
Atherosclerosis
If thrombus forms and obstructs blood flow leads to _____ coronary syndrome which may lead to MI
If thrombus forms and obstructs blood flow leads to Acute coronary syndrome which may lead to MI
According to site and degree of narrowing as well as obstruction of blood flow
Blood flow decrease is usually progressive causing inadequate blood supply to heart muscle- Ischemia- causes Angina Pectoris
Angina is usually caused by significant atherosclerosis
If blood supply decrease is enough and for long enough irreversible damage and cell death may occur.
Over time damaged heart tissue is replaced by scar tissue and there are levels of dysfunction.
May result in low cardiac output and heart failure may occur
Decrease in blood supply may even cause heart to abruptly stop beating (sudden cardiac death)
Clinical manifestations
According to site and _______ of narrowing as well as __________ of blood flow
According to site and degree of narrowing as well as obstruction of blood flow
Blood flow decrease is usually ___________causing inadequate blood supply to heart muscle- Ischemia- causes ________Pectoris
Blood flow decrease is usually progresses causing inadequate blood supply to heart muscle- Ischemia- causes Angina Pectoris
_________is usually caused by significant atherosclerosis
Angina is usually caused by significant atherosclerosis
If blood supply ________ enough and for long enough _____________ damage and cell death may occur.
If blood supply decrease is enough and for long enough irreversible damage and cell death may occur.
Over time __________heart tissue is replaced by ____ tissue and there are levels of dysfunction.
Over time damaged heart tissue is replaced by scar tissue and there are levels of dysfunction.
May result in ________cardiac output and heart failure may occur
May result in low cardiac output and heart failure may occur
____________in blood supply may even cause heart to abruptly stop beating (sudden cardiac death)
Decrease in blood supply may even cause heart to abruptly stop beating (sudden cardiac death)
Chest pain cuz blood flow is decreased
Angina is caused by insignificant buildup
Once tissues dies it will not work anymore
Heart failure my occur with atherosclerosis
Clinical manifestations
Most common- chest pain
Some are totally asymptomatic
May present with varying sx other than chest pain- epigastric distress, pain in jaw, left arm
Dyspnea
Nausea, palpitations, numbness
May just have sudden cardiac event
Clinical manifestations for not getting enough oxygen to the heart
Clinical manifestations for not getting enough oxygen to the heart
Most common- chest pain
Some are totally asymptomatic
May present with varying sx other than chest pain- epigastric distress, pain in jaw, left arm
Dyspnea
Nausea, palpitations, numbness
May just have sudden cardiac event
Widow maker – no s/s and then they have a mi and ppl don’t come back
Some are asymptomatic
Elderly will have different signs
Clinical manifestations for not getting enough oxygen to the heart
Family history- woman before 65 or man before 55
Increasing age
Gender (men earlier than women)
Race (higher in African American)
Risk factors Non modifiable:
Risk factors
Non modifiable:
Family history- woman before 65 or man before 55
Increasing age
Gender (men earlier than women)
Race (higher in African American)
Hyperlipidemia
Tobacco use
Diabetes
HTN
Obesity
Physical inactivity
Metabolic syndrome
Alcohol
Modifiable Risk factors
Modifiable Risk factors
Hyperlipidemia
Tobacco use
Diabetes
HTN
Obesity
Physical inactivity
Metabolic syndrome
Alcohol
High lipids can change
Ldl – low density lipoprotein are the bad clo.
If total is elevated you are also at a higher risk
risk factors
Control cholesterol
HDL good cholesterol over 40 for males/ over 50 for females
LDL bad cholesterol under 100 (less than 70 for very high risk patients)
Total cholesterol of less than 200
Triglycerides less than 150
Exercise and diet can help control these levels
Stop the smoking affects the arteries
Prevention
Prevention
Control cholesterol
HDL good cholesterol over 40 for males/ over 50 for females
LDL bad cholesterol under 100 (less than 70 for very high risk patients)
Total cholesterol of less than 200
Triglycerides less than 150
Exercise and diet can help control these levels
Stop the smoking affects the arteries
Diet
Weight loss
Cessation of tobacco use
Increased physical activity
Manage HTN
Before they get to the angina point start get up and walk around to help prevent
Cholesterol
cholesterol
Diet
Weight loss
Cessation of tobacco use
Increased physical activity
Manage HTN
Before they get to the angina point start get up and walk around to help prevent
a wide variety offruits and vegetables
whole grains and products made up mostly of whole grains
healthy sources of protein (mostly plants such as legumes and nuts; fish and seafood; low-fat or nonfat dairy; and, if you eat meat and poultry, ensuring it is lean and unprocessed)
liquidnon-tropical vegetable oils
minimally processed foods
minimized intake of added sugars
foods prepared with little or no salt
limited or preferably no alcohol intake
heart diet
heart diet
a wide variety offruits and vegetables
whole grains and products made up mostly of whole grains
healthy sources of protein (mostly plants such as legumes and nuts; fish and seafood; low-fat or nonfat dairy; and, if you eat meat and poultry, ensuring it is lean and unprocessed)
liquidnon-tropical vegetable oils
minimally processed foods
minimized intake of added sugars
foods prepared with little or no salt
limited or preferably no alcohol intake
Fish oil capsules – otc
Zocor (simvastatin)
Lipitor (atorvastatin)
Cholesterol lowering agents
Cholesterol lowering agents
Fish oil capsules – otc
Zocor (simvastatin)
Lipitor (atorvastatin)
inflammatory marker for cardiovascular risk. Liver produces this protein to stimulus such as injury. People with diabetes and those who are likely to have cardiac event may have high levels.
Increase when there is inflammation somewhere in the body
crp
crp
inflammatory marker for cardiovascular risk. Liver produces this protein to stimulus such as injury. People with diabetes and those who are likely to have cardiac event may have high levels.
Increase when there is inflammation somewhere in the body
Troponinis a type of protein found in the muscles of your heart.
Troponinisn’t normally found in the blood.
Elevates in 2- 6 hours – might change after labs are drawn
Peaks within 12
Troponin I
troponin I
Troponinis a type of protein found in the muscles of your heart.
Troponinisn’t normally found in the blood.
Elevates in 2- 6 hours – might change after labs are drawn
Peaks within 12
Found in heart not blood but if heart function ____________ then troponin will be found in blood
Found in heart not blood but if heart function decreases then troponin will be found in blood
Other isoenzymes that are measured in blood test- elevate after MI
CK and CK-MB
CK and CK-MB
Other isoenzymes that are measured in blood test- elevate after MI
_______– metabolic profile – are enterocytes
CBC – will tell them if something else is going on
CXR – always do a chest _______to see heart and lungs
BMP – metabolic profile – are enterocytes
CBC – will tell them if something else is going on
CXR – always do a chest xray to see heart and lungs
Episodes of pain or pressure in chest
Need exceeds demand
Discomfort- agonizing
ANGINA SUBSIDES WITH NITROGLYCERIN OR REST
NITRO X 3 one every 5 minutes for chest pain if unrelieved call 911
Angina
Angina
Episodes of pain or pressure in chest
Need exceeds demand
Discomfort- agonizing
ANGINA SUBSIDES WITH NITROGLYCERIN OR REST
NITRO X 3 one every 5 minutes for chest pain if unrelieved call 911
Chest pain sit down put legs up and take three times and 5 mins in-between
True angina it will go away with rest and nitro
Elderly don’t have same s/s might be short of breath or confusion
Elderly don’t feel the same way as younger patient
Angina
Angina
Chest pain sit down put legs up and take three times and 5 mins in-between
True angina it will go away with rest and nitro
Elderly don’t have same s/s might be short of breath or confusion
Elderly don’t feel the same way as younger patient
May not exhibit typical pain
Dyspnea may be presenting symptom
Sometimes no symptoms
Medications used cautiously in elderly due to increased risk of adverse reactions
Elderly
Elderly
May not exhibit typical pain
Dyspnea may be presenting symptom
Sometimes no symptoms
Medications used cautiously in elderly due to increased risk of adverse reactions
Patient history
Ecg showing ischemia (t wave inversion)
Stress test – stress heart and see response
Diagnosis of angina
Diagnosis of angina
Patient history
Ecg showing ischemia (t wave inversion)
Stress test – stress heart and see response
Objectives- decrease 02 demand and increase 02 supply
Stents/ CABG – going in and opening back up
Medications:
Nitroglycerin- sl tab or spray under tongue or in cheek should ideally relieve pain in 3 minutes for PRN use. Different routes including capsules, topical patches, IV.
Medical Management of Angina/CAD
Medical Management of Angina/CAD
Objectives- decrease 02 demand and increase 02 supply
Stents/ CABG – going in and opening back up
Medications:
Nitroglycerin- sl tab or spray under tongue or in cheek should ideally relieve pain in 3 minutes for PRN use. Different routes including capsules, topical patches, IV.
Beta blocker: metoprolol- reduce incidence of recurrent angina, infarction and mortality.
Calcium channel blocker- Norvasc- used for patients not responsive to beta blockers
Antiplatelets- prevention of platelet aggregation Anticoagulants- prevention of thrombus formation
Aspirin: 81-325 mg daily
Lovenox: LMWH- sq monitor for s/s of internal bleeding.
Oxygen: to meet demands
Medical Management of Angina/CAD
Medical Management of Angina/CAD
Beta blocker: metoprolol- reduce incidence of recurrent angina, infarction and mortality.
Calcium channel blocker- Norvasc- used for patients not responsive to beta blockers
Antiplatelets- prevention of platelet aggregation Anticoagulants- prevention of thrombus formation
Aspirin: 81-325 mg daily
Lovenox: LMWH- sq monitor for s/s of internal bleeding.
Oxygen: to meet demands
_______ Obtain a 12-lead ECG within 10 minutes of report of chest pain.
ecg
Oxygen
Pain assessment
Vital signs, pulse ox PQRST (find out what the patient was doing when pain came on)
continuous heart monitoring and pulse ox
EKG (ECG)
Chest xray
Saline lock (often 2)
NTG prior to arrival x how many and did it work?
Labs (troponin, CK, CKMB, BMP, CBC, CRP
ER monitoring management/ unknown chest pain
ER monitoring management/ unknown chest pain
Oxygen
Pain assessment
Vital signs, pulse ox PQRST (find out what the patient was doing when pain came on)
continuous heart monitoring and pulse ox
EKG (ECG)
Chest xray
Saline lock (often 2)
NTG prior to arrival x how many and did it work?
Labs (troponin, CK, CKMB, BMP, CBC, CRP
