test 3 Flashcards
why is left ascending artery the widow maker
supplies to left ventricle. If left ventricle doesn’t get enough oxygen… deadly.
Major causes of CAD
atherosclerosis- cholesterol plays a major role, as well as endothelial injury causing obstruction
what does a high CRP indicate
inflammation. typically elevated in CAD patients
collateral circulation
small arteries are built around the blocked artery in CAD, but they don’t deliver much oxygen and are only temporary solution, as chronic ischemia will soon occur
non modifiable risk for CAD
age, gender, genetics, ethnicity, family history
modifiable risk factors of CAD
Lipid levels, HTN, smoking, physical inactivity, obesity, diabetes, metabolic syndrome, psychological states, substance abuse
modifiable risk factors of CAD
Lipid levels, HTN, smoking, physical inactivity, obesity, diabetes, metabolic syndrome, psychological states, substance abuse
common symptoms in CAD
edema, clubbing, chest pain with exertion, dizziness, nausea, dysrhythmias, low o2 sat
- diabetes patients may not feel chest pain or any pain as there nerves could be damaged
CAD diagnostics
Lipid panel, cholesterol, A1C, ECG, stress test, echocardiogram, chest x ray, bruits
drugs for CAD
> antihypertensives (beta blockers- lol, CCB- pine, Ace inhibitors - pril). monitor bradycardia and hypotension
> antianginals (nitroglycerine)
> lipid lowering (statins -monitor liver damage and myopathy)
> decrease cholesterol absorption - Ezetimibe (zetia)
> anticoagulants (heparin, warfarin) monitor for bleeding and thrombocytopenia (low platelets)
Coronary artery bypass graft (CABG)
take artery/vein from other place in body and attach to heart
2 wound- chest and where it was harvested
assess platelets, perfusion assessment of all organs, wound care, pain
Go into depression screening- link between getting CABG and depression
PTCA (percutaneous transluminal coronary angioplasty)
balloned catheter supresses plaque, allowing more space for blood to flow. stent may also be placed to prevent it from happening again
angina
intermittent chest pain usually occurring with the same pattern and intensity over period of time usually caused by CAD.
not enough oxygen. we want to decrease o2 demand and/or increase oxygen supply
happens when artery is 70% blocked or left main artery is 50% blocked
risk factors for angina
same as CAD, but oral contraceptives are added as well as menopausal women
short acting nitrates
dilates peripheral and coronary blood vessels
- given sublingually or by spray
can take up to 3 doses; 5 mins apart
- for angina
long acting nitrates
to reduce angina incidence
side effects- headaches, orthostatic hypotension
stable angina diagnostics
chest x ray
12 lead ecg
lab studies
echocardiogram
exercise stress test
EBCT or CCTA (test that look for plaque using IV contrast)
cardiomyapthies
diseases that directly affect myocardial structure or function
- makes it hard for blood to be delivered to body
primary: idiopathic, only partially affected muscle
secondary- caused by known primary disease
can be ischemic - MI (reduced EF), CAD
or nonischemic - dilate, hypertrophic, restrictive
ejection fraction
Percentage of blood and volume left ventricle pushes out, normal is 55% and above
preload
volume coming into ventricle
increased in hypervolemia, regurgitation of valves
diuretics can help
afterload
resistance left ventricle must overcome to push blood
increased in HTN or vasoconstriction
- creates more workload
vasodilators can help
hypertrophic cardiomyopathy
thickened left ventricular wall, becomes stiff
- contraction isn’t weakened, but filling is impaired
can be genetic, or can happen in athletes
blood backs up into lungs
dilated cardiomyopathy
enlargement of left ventricle
- most common one
poor systolic function
decreased EF
as disease progresses, atrial enlargement
blood stays in LV… worry about clots
no specific cause,,, alcohol, epstein barr, radiation
restrictive cardiomyopathy
rigid ventricular walls: impaired filling and stretch
- least common type
etiology unknown
EF may be normal
heart tissue replaced by fibrosis. could lead to HF or dysrhythmias
signs/symptoms of cardiomyopathies
angina, SOB, fatigue, HF, irreg rate, edema, pulm congestion, enlarged liver, sleepiness, cough, loss of appetite, syncope
cardiomyopathies diagnosis
chest x-ray
echocardiogram
ECG
Cardiac MRI
blood test: BNP (secreted due to stretching of ventricle) renal/liver function
cardiomyopathy meds and med management
nitrates- decrease preload bc it opens veins
diuretics- decrease fluid
ACE inhibitor- Decrease resistance in artery so L vent doesn’t have to work as hard, decreasing afterload
Beta blockers for neurohormones
antidysrhythmics
anticoagulants
reduce symptoms, slow progression, prevent clots, surgeries, meds, safety, control edema, control fatigue, manage indigestion and nutritional issues (GI is slowed). manage stress
low sodium diet, no alcohol, avoid diet pills and cold meds
what regulates valvular diseases
SNS- fight or flight- arteries constrict
hormones- epinephrine, NE, angiotensin
histamine - inflammation
what is a valvular disorder
disturbance in blood flow that eventually results in damage to tissues
the #1 cause is atherosclerosis, but can also be from raynaud’s, buerger disease, smoking, diabetes, hyperlipidemia, inflammation, HTN, obesity and age
peripheral arterial disease (PAD)
progressive narrowing and degeneration of arteries in upper and lower extremities, typically from atherosclerosis
typically goes unnoticed for a long time until symptoms appear in 60s-80s
symptoms- intermittent claudication (muscle pain that resolves w rest), paresthesia (due to lack of blood flow), thin, shiny, taunt skin, loss of hair on legs, absent or diminished peripheral pulses, pain aggravated by limb elevation, leg pain, pallor
diagnosed by doppler, ABI, angiography, duplex imaging
common sites of PAD
Iliac artery
femoral artery
popliteal artery
tibial artery
peroneal artery
PAD complications and care
complications can include poor wound healing, wound infection, tissue necrosis, ulcers, amputation
avoid HTN, stop smoking, manage hyperlipidemia and diabetes, exercise, eats fruits and veggies and low cholesterol, fat and salt
Meds-
vasodilators - ramipril (altace) : specific to PAD. improved blood flow and walking distance
antiplatelets
cilostazol and pentoxifylline- helps intermittent claudication
surgery- balloon angioplasty, bypass with vein or sympathetic graft
main goal: improve arterial perfusion
- evaluate by skin color, temp, pulse
thromboangiitis obliterans
also called Buergers, a inflammatory disorder of small/medium arteries/veins in upper or lower extremities
- common in men under 45 with history of smoking
ischemic ulceration in fingers, autoimmune markers in lab
interventions- stop smoking, avoid cold temps, walk, antibiotics if ulcers infected, sympathectomy, bypass, pain management
raynauds phenomenon
vasospastic small cutaneous arteries, common in fingers in toes in women ages 15-40.
triggered by exposure to cold, emotional upsets, tobacco and caffeine use
causes color changes of ears, nose, toes, fingers, - thick skin, brittle nails, small hole ulcers
2 phases:
vasoconstrictive- skin white then blue. feeling of coldness but skin numb
hyperemic phase- throbbing, aching, swelling . because of vessels open and blood returns quickly
wear warm clothes, avoid temp extremes, no smoking, avoid caffeine, avoid vasoconstriction meds
peripheral venous disease (PVD)
Blood isn’t returning to heart well, from incompetent valves or inadequate pumping
symptoms- cool, brown skin, edema, ulcers, pain and redness around vein, pulses may be decreased or normal. deep muscle tenderness. risk for clots.
elevate legs above heart, take anticoagulants, avoid extreme temps, monitor pulses, avoid sitting/standing for long periods
venous ulcers
type of PVD caused by venous infufficency. causes breakdown of RBC releasing hemosiderin. Fibrous tissue replaces skin.
chronic inflammation, edema, eczema, leathery skin, typically above medial malleolus (ankle), pain, wound may end up in bone causing osteomyelitis
wear compression, do wound care, good nutrition, antibiotics, pentoxifylline (wbc activation drug), skin graft
varicose veins
dilated superficial veins
primary cause- pregnancy, obesity, heart disease, family history
secondary- injury
could be congenital
may have pain after prolonged standing, itching
use compression and elevation
most common cause of HF in women
HTN
