Perfusion Flashcards
What causes Angina?
Reduced coronary blood flow. Identified by a identifiable event. Relieved by rest
Types of Angina (3)
Stable: caused by physical exertion, stress, or exposure to cold. most common.
prinzmetal (variant): caused by coronary vasospasm
Unstable: Caused by transient formation and dissolution of a blood clot.
What does decreased coronary blood flow cause?
Vasospasm, fixed stenosis (althersclerosis), thrombosis (blood clot)
What does increase need for O2 cause?
Increased heart rate, increased contractility, increased preload/afterload
What are the clinical manifestations of myocardial infarction?
sudden, continuous chest pain that lasts 15-20 mins.
pain that radiates to shoulder, neck, arms, jaw
chest pain that gets worse
What is the pathopysiology of myocardial infarction?
plaque formation –> plaque rupture –> endothelial cell injury and inflammation –> decreased blood supply and increased O2 demand –> myocardial ischemia –> myocardial cell necrosis
Ischemia Definition
Blood flow is restricted or reduced
Myocardial Ischemia Signs & Symptoms
BF to portion of cardiac muscle is completely blocked.
angina, hypoxia, tachycardia, extra heart sound (S3)
Acute Coronary Syndrome
Unstable angina, NSTEMI, STEMI
Difference between CAD, angina, and heart attack
CAD: plaque builds up in an artery
Angina: plaque makes it harder for blood to get through an artery
Heart Attack: plaque cracks and a blood clot blocks the artery
CAD Risk Factors
Age, gender, race, ethnicity, family history, DM, hyperlipidemia, HTN, smoking, inactivity, obesity, unmanaged stress
Electrocardiogram
Performed and interpreted within 10 min. Most common. Repeat ECG every 10-15 minutes if first time with angina
Tropinin
Protein found in muscles of heart.
hs-cTn should be <14 if >14 ICU
Check troponin at 0-2-6 hours
Echocardiogram - Normal EF
Checks how heart chambers and valves are pumping blood
Normal EF is 50-70%
Stress Echocardiogram
Treadmill test and echocardiogram. Dobutamine test for pt. who cannot excercise
Nuclear scan-myocardium perfusion imaging
shows how well blood flows to the heart.
3-part test
lexiscan dilates BV
CAD Treatment Goals
Relieve chest pain, reduce extent of myocardial damage, maintain cardiovascular stability, manage risk factors
Statins
Lower cholesterol by increasing LDL excretion from circulation
Nitrates
Treat angina. Produce coronary artery and peripheral vasodilation. Take 3.
Beta Blockers
Manage stable angina. “lol” suffix. Blocks the effect of epinephrine.
Non-Pharmocological Therapy (2)
- Percutaneous Coronary Intervention prev. known as angioplasty w/ stent
- Coronary Artery Bypass Grafting - use veins or artery to create connection to construct a detour around blocked portion of artery
What is a good diet for somebody with CAD?
Low-fat diet rich in antioxidants. Foods containing bioflavinoids. Supplement C, E, B6, B12, Folic Acid
What is HTN a risk factor for?
CHD, heart failure, stroke, renal failure
Elevated BP category
120-129, <80
Stage 1 HTN
130-139 or 80-89
Stage 2 HTN
> 140 or >90
hypertensive crisis
BP > 180/120
HTN risk factors
age, ethnicity, smoking, high salt intake, health problems, inactive lifestyle, alcohol, high stress, obesity
HTN complications
Stroke, heart failure, sexual dysfunction, vision loss, heart attack, kidney disease
Primary HTN symptoms
Usually asymptomatic
headache, confusion, nausea/vomiting, visual distrubances (most common), nocturia
Treating HTN - Diuretics
First drug of choice. Thiazide. Watch K+ levels
Treating HTN: Beta Blockers
metoprolol, atenolol. For newly diagnosed pt.
Treating HTN: ACE inhibitors
lisinopril, benazepril, Block angiotensin, which causes BV to open
Treating HTN: Angiotensin 2 receptor blockers
losartan, valsartan
Treating HTN; Calcium Channel Blockers
diltiazem, amlodipine. block CA from entering smooth muscle cells of heart.
Treating HTN: Alpha Blockers
not common. doxazosin, prazosin. reudce the arteries resistance
Treating HTN: alpha 2 receptor agents
clonidine, methyldopa.
Treating HTN: combined alpha and beta blockers
carvedilol, labetalol
vasodilators
last effort. hydralazine. for HTN emergency
Drug regime for HTN
1 antihypertensive medication given at low dose and slowly increased until optimal BP reached.
What is a good diet for somebody with HTN?
Low calorie, low fat, low sodium
What is preload?
Stretch of vesicle. Amount of blood in vesicles at end of distole
What is afterload?
Relaxation. The resistance left ventricle must overcome to circulate blood.
Left Sided Heart Failure
Prevents delivery of oxygenated blood. Main cause of right sided heart failure. There are 2 types: systolic heart failure, diastolic heart failure
Left sided heart failure symptoms
- paroxysmal nocturnal dyspnea (most common)
- cough,
- pulmonary congestion: cough, crackles, wheezes, blood tinged sputum, tachapnea
- restlessness
- confusion
- tachycardia
- exertional dyspnea
- fatigue
- cyanosis