Medical and Surgical Management of CVD Flashcards
ACE inhibitor
- captopril, enalopril, lisinopril
- inhibit conversion of angiotensin I to angiotensin II
- decreases Na retention and peripheral vasoconstriction in order to decrease BP
Angiotensin II receptor blockers
- losartan
- blocks binder of angiotensin II at the tissue/smooth muscle level, decreasing blood pressure
Nitrates
- nitroglycerin
- decrease preload through peripheral vasodilation, reduce myocardial oxygen demand, reduce chest discomfort
- may also dilate coronary arteries, improve coronary blood flow
Beta-1 Adrenergic blocking agents
- atenolol, metoprolol, propanolol
- reduce myocardial demand by reducing heart rate and contractility
- control arrhythmias, chest pain
- reduce blood pressure
Calcium channel blocking agent
- Diltiazem, amlodipine
- inhibit flow of calcium channel ions, decrease heart rate, decrease contractility, dilate coronary arteries, reduce BP, control arrhythmias, chest pain
Antiarrhythmics
- alter conductivity, restore normal hear rhythm, control arrhythmias, improve cardiac output
Digitalis
- cardiac glycosides
- increase contractility and decreases heart rate; mainstay in the treatment of CHF
Aspirin
decreases platelet aggregation
- may prevent MI
Diuretics
- decrease myocardial work (reduce preload and after load)
- control hypertension
- Tranquilizers
- decrease anxiety, sympathetic effects
Hypolipidemic agents
- 6 major cholesterol lowering drugs
- reduce serum lipid level when diet and weight reduction are not effective
Activity restriction for acute MI
- Activity can be increased on the acute MI has stopped (peak in cardiac troponin levels)
- Limit activity to 5 METs or 70% of age predicted HRmax for 4-6 weeks following MI
Acute heart failure activity restriction
- oxygen demand should not be increased in patients in acute or decompensated heart failure
- once they have been medicated managed and no longer display signs of acute decompensation, their activity can be gradually increased while monitoring hemodynamic response to activity
Percutaneous transluminal coronary angioplasty
- under fluoroscopy, surgical dilation of a blood vessel using a small balloon-tipped catheter inflated inside the lumen; relieves obstructed blood flow in acute angina or acute MI; results in improved coronary blood flow, improved L ventricular functional, anginal relief
Intravascular stents
- an endoprosthesis (pliable wire mesh) implanted during angioplasty to prevent restenosis and occlusion in coronary or peripheral arteries
- may be coated with slow release medication to prevent more plaque build up (drug-eluting stent, DES)
Coronary artery bypass graft (CABG)
- surgical circumvention of an obstruction in a coronary artery using an anastomosing graph (saphenous vein, internally mammary artery)
- multiple grafts may be necessary
- results in improved coronary blood flow, improved left ventricular functional, anginal relief
Transplantation
used in end-stage myocardial disease
Transplantation - heteroptics
involves leaving the natural heart and piggybacking the donor heart
transplantation - orthotopic
involves removing the diseased heart and replacing it with a donor heart
major problems post-transplantaiton
rejection, infection, complications of immunosuppressive therapy
Ventricular assist device
- an implanted device the improves tissue perfusion and maintains cardiogenic circulation
- used with severely involved patients
Thrombolytic therapy
- administered for acute MI
- medications activate body’s fibrinolytic system, dissolve clot, and restore coronary blood flow
