TOPIC 4 - cardiac system Flashcards
stages of atherosclerosis
- damage to endothelium
- fatty streak
- fibrous plaque
- complicated lesion
what causes endothelial injury
hypertension, tobacco use, hyperlipidemia, hyperhomocystemia, diabetes, infections, toxins
what happens in the fatty streak phase
lipids accumulates and migrates into smooth muscle cells
what happens in the fibrous plaque stage
collagen covers the fatty streak
vessel lumen is narrowed
blood flow is reduced
fissures can develop
what happens in the complicated lesion stages
plaque rupture
thrombus formation
further narrowing or total occlusion of vessel
factors contributing to the growth and extent of collateral circulation
inherited predisposition to develop new blood vessels
presence of chronic ischemia
non modifiable risk factors for CAD
age, gender, ethnicity, family hx, genetics
major modifiable risk factors
hypertension, tobacco use, elevated serum lipids, physical inactivity, obesity
contributing modifiable risk factors
DM, metabolic syndrome, psychologic states, substance abuse
clinical manifestations of CAD angina
chronic and progressive
greater O2 demand than O2 supply = myocardial ischemia
how much do arteries need to be blocked in order to be considered CAD
blocked 70% or more
50% or more for left main coronary artery
clinical manifestations of CAD causing chronic stable angina
intermittent chest pain that occurs over a long period with same pattern of onset, duration, and intensity of symptoms
few minutes in duration
ST depression and/or T wave inversion
controlled with drugs
pressure, heaviness, discomfort in chest (squeezing, heavy, tight, suffocating) not sharp or stabbing
dyspnea or fatigue
what provokes CAD
physical exertion, stress, or emotional upset
pain at rest is unusual
if angina is not treated, what can it turn into
MI
locations of where pain may be felt with angina
substernal, mid sternum, epigastric, intrascapular
can radiate to jaw, neck, shoulders, and arms
cardiac lab tests
coagulation - PT, INR, aPTT : clotting time
cardiac enzymes (CK-MB, troponin, BNP) : will be high when the heart is in distress
lipid panel (cholesterol, triglyceride, HDL, LDL) : fat floating in blood
digoxin : amount of med in the blood
d dimer : fibrin left over after a clot has formed
CRP : inflammation
diagnostic tests for cardiac
chest x ray, 12 lead ECG, labs, echocardiogram, exercise stress
interventions for CAD
oxygenation, nitro tabs, aspirin (up to 325), morphine
drug therapy
anti platelets, nitrates, ACE inhibitors, ARBS, beta blockers, calcium channel blockers, lipid lowering
coronary revascularization
PCI (percutaneous coronary intervention)
CABG (coronary artery bypass graft surgery)
two types of stents
bare metal stents or drug eluting stents
primary causes of in stent restenosis
overgrowth of intimal lining within the stent
what medications follow stent placement
anti platelet drugs
before and after angiogram procedure policies
before - NPO, premedication, consent, nursing assessment
after - vitals, surgical site assessment, bedrest and movement
complications for PCI
bleeding for catheter insertion site
infection
allergic reaction
damage to artery
damage to kidneys
irregular heartbeat
educate patient to report any feelings of
fever, chills, increased pain, redness, swelling, bleeding, drainage, coolness, numbness, tingling, chest pain, pressure, nausea, vomiting, sweating, dizziness, fainting
hypertension classification
normal : above 120/ above 80
elevated : 120-129/ 80
stage 1 : 130-139/80-89
stage 2 : greater than 140/greater than 90
does primary or secondary hypertension have a known cause
secondary
risk factors for HTN
Age
Alcohol
Tobacco use
Diabetes mellitus
Elevated serum lipids
Excess dietary sodium
Gender
Family history
Obesity
Ethnicity
Sedentary lifestyle
Socioeconomic status
Stress
