Ischemic Heart Disease Flashcards
What happens with sudden cardiac death?
Death within 1 hr of onset of Sx. (20-25% of pts)
Must have CPR & defibrillation within 10 minutes for any chance of survival. (still will likely have cognitive deficit)
What is chronic stable angina associated with?
Myocardial O2 demand (HR is the key)
What makes it chronic STABLE angina?
Well established level of onset
easily can predict activities that will provoke symptoms
Able to reduce by dec activity or taking NTG.
When is angina UNSTABLE?
Positive S/S at rest. Not related to myocardial O2 demand.
Clinical cues to presence of unstable angina
Angina at rest, at lower levels of activity
Changes in frequency
Evidence of loss of myocardial reserve (drop in BP, increase HR at previously well tolerated levels of activity)
What EKG changes are there with a STEMI?
ST segment elevated. Can have T-wave changes. Electricity not moving through the ventricle like it should indicating dead cells there. (32% all ACS)
Complications with STEMI during acute stay
Poor activity tolerance, pt anxiety.
Arrythmias
What is distinctive about NSTEMI?
No Q wave changes. Coronaries not completely blocked. Ischemia > 30 min
What is infarction?
Immediate loss of ability to perform contractile work. There will be abnormal contraction patterns.
Challenges to treating MI
Fear, Activity tolerance, PLOF, Environment PTA, dietary/exercise changes.
What do they do with Left Heart Catherization (LHC)
Go thru femoral (or brachial artery) thru aorta find the blockage in the heart, and inflate balloon to push plaque to the side. Place stent. This is more diagnostic.
What info is obtained with LHC?
Occlusion, stenosis, restenosis, thrombosis.
Heart chamber size
Heart muscle contraction performance (EF)
Heart and lung BP
What are the 2 types of stents used with Percutaneous Coronary Intervention (PCI)
Drug eluding & bare metal
How long must you take plavix with the 2 different types of stents?
Drug eluding 1 yr (better at preventing restenosis)
Metal 30 days
What ways can they gain access with CABG?
Median sternotomy Minimally invasive (go tru the ribs, only works with single bypass from LIMA to LAD)
What materials can they use for grafting with CABG?
Saphenous vein, radial artery, LIMA
What are the standard sternal precautions?
No shoulder flexion > 90
No pushing/pulling with UE
No lifting > 10 lbs
(in general avoid things that stretch the wound)
How long are sternal precautions in place for?
6-8 weeks
Where is the most common location for dehiscence?
Over the xiphoid process.
What will an ischemic disease pt tend to look like demographically?
Overweight, have diabetes/htn/high cholesterol, SMOKER, more men (40-50) than women (50-60)
What tests might you be aware of with someone post cardiac surgery?
ECHO, ECG
Labs: cardiac enzymes
What will you observe in your eval post op?
HR, BP, UE/LE strenght, activity tolerance, pain, gait, coordination, tone, balance
Acute intervention post op
Gait training (stairs, activity tolerance), HR monitoring (shouldn't be > 20 bpm above resting) EDUCATION (energy conservation, precautions) LE ROM (keep mobility - if saphenous vein graft)
What are common MI warning signs?
- pressure, fullness, - squeezing in center of chest
pain in throat, neck back, jaw, shoulders, arms - lightheadedness, dizziness, diaphoresis, pallor
- symptoms unrelieved by NTG, antacids, rest
What are uncommon MI warning signs?
- unusual chest pain, stomach or abdominal pain
- continuous midthoracic or interscapular pain
- isolated R biceps pain
- unexplained intense anxiety, weakness, fatigue
breathlessness
