Unit 4- CVS Flashcards
Structure of the heart
4 chambers, need patent blood vessels for optimal flow, need competent valves for one way flow
A functoining heart has
optimum flow, healthy vessels.
Plaque build up
fatty streak, established legions,
Coronary artery disease
coronary arteries deliver constant supply of blood to the heart muscle. Start to develop fatty plaque which leads to restriction of blood flow to the heart. Eventuality that restriction is what causes a MI.
atherosclerosis develops in 3 phases
fatty streak, fibrous plaque, complicated lesion. Takes years to develop.
Chronic endothelial injury
caused by hypertension, tobacco use, hyperlipidemia, diabetes, infection, damage to endothelium
Fatty streak
lipid accumulate and migrate into smooth muscle cells
Fibrous plaque
collagen covers the fatty streak, vessel lumen is narrowed blood slow is reduced, fissure can develop
complicated lesion
plaque rupture, thrombus formation, further narrowing or total occlusion of vessel
non modifiable risk factors for CAD
age, genetics, sex, family
modifiable risk faactors for CAD
metabolic syndrome, hyperlipidemia, hypertension, heart failure, smoking, sedentary lifestyle, obesity, elevated lifestyle, elevated BMI, Diabetes, Stress, cocain and meth, elevated homocysteine
Subjective questions
fatigue, indigestion, leg swelling, poor wound healing, smoking, drinking, med Hx, fam hx, diet, VS
Lab test to do for CAD
Diabetes, LDL/HDLm C-reactive protein, stress test, ECHO, ECG, LIpids, CBC, THyroudm CRP, Hemoglobin A1C
HDL
good cholesterol for healthy, high portion of protein, transports cholesteril to liver for excretion, beneefits effect on arterial wall. Can be increased by physical exercise. Benefits on arterial wall
LDL
Bad or lousy cholesterol. Low portion of protein to lipid ratio, harmful effects, affinity to arterial wall
Homocysteine
an amino acid. Vit B12-3 and folate break down and other chemical in the body. High level could mean deficiency. Without treatment it puts people at risk for homocysteine, increased risk for dementia, heart disease, stroke. Can damage arterial walls.
stress test AKA the treadmill stress test
Excerise treadmill test evaluates the Cardiovacular response to physical vital signs, continous ECG, physican present
What are you looking for in a treadmill test
HR, BP, MI, expertise duration, Symptoms pronlong, arrythmias
Nuclear stress test
uses radioactive dye and an imaging machine to create picture showing the blood flow to your heart. sjowing areas of blood flow or damaging in your heart. The test usually involves injecting radioactive dye, then taking two sets of images of your heart.
Cardiac ECHO
shape, size, movement of heart walls, fluid, valve disease, HF, invasive
ECG
The cardiac cycle (PQRST) captures electrical activity of the heart from different angles
P wave
atria are depolarizing (contracting)
QRS
Ventricles are depolarizing (contracting) atria are repolarizing (recharging) can not see that
ST segment
Should be isoelectric (flat)
T wave
Ventricles are depolarizing (recharing)
Depolarization
The movement of ions across the cell membrane, sodium, potassium and calcium channels, casuses contraction of the cardiac cells/muscles
Depolarization
Cardiac cells are at rest, no electrical activity, relaxation of cardiac cells/muscles
Pharm therapy for CAD
Atrovastatin (lipitor) Metoprolol, SAS
disease process of Angina
vasospasm, fixed stenosis thrombus, decreased coronary blood flow.
Increased heart rate, contracility, afterload, preload, increased oxygen consumptoms
When the O2 demand is greater then O2 supply
What makes Oxygen demands higher
CIA, HTN, Med, Genes, smoking, alcohol
Stable angina
caused by isthmi, chest pain, relieved by rest
-Chronic, same pattern, brief, usually exercise induced, goes away with rest
Unstable angina
Ischmia: chest pain, 1st episode, change in pattern
-Chronic that changes, occurs at rest, dosen’t always go away at rest, may need meds
Subjective data
heart burn, preessure, substernal ache, squeezing, suffocating, choking
Location of pain during angina
Midternal, left shoulder and down the arms, neck and arms, Under jaw, down left arm, epigastric radiating to neck, jaw, and arms, intrascapular
Nursing management for angina
O2 sats over 95, Meds, monitor pain and BP, Diagnostic tests
Diagostic tests for angina
12-lead ECG, Echo, Chest X ray, exercise stress test, CTA
Angina chnages in an ECG
decreased blood flow due to narrowing of the coronary arteries by artherosclerosis. Pain subsides hwen the precipitating factos is released.
for ischmia to occur
the artery is usually 75% or more stenosed
If an ECG shows ST segment depression then it is
URGENT
Cardiac catherization coronary angiography
diagnostic.. PCI. balloon angioplasty, stent
First line med for angina
Nitrates, causes bvasodilation improving blood flwo through the vessels
How to take nitroglycerine
1st dose, wait 5 mins, 2nd wait 5 mins, 3rd dose wait 5 mins. No releif call 911. Proper delivery is important. Ensure client is sitting when taking nitro or their BP may drop. Make sure to monitor BP between so they dont bottom out.
Nitro patch
worn 12 hours if angina occurs daily apply in am, if nightly apply pm. Client can take spray before exercise. Can cause headaches, dizziness, hypotension
What meds should you stay away from when taking nitro
erectile disfunction
Second most common med used for angina
Beta Blocker. Decreases BP, Decreases myocardial contractility, HR, and BP, therefore decreasing the myocardinal oxygen demands. ex. Metoprolol, atenolol, carvedilol.
third line for angina
CCB: for people who can’t handle BB Decreases O2 demand (decreased peripheral resistnace, after load and decrease HR) and increase O2 supply
ex. Amlodipine or verapamil
4th line med for BB
ASA, Plavix (need a higher dose for stent)
What is acute coronary syndrome
When ischmia is prolonged and is not immedietly reversible, acute coronary syndrome develops. Unstable angina, Non ST segment-elevation myocardial infarction, ST segment elevation MI
Disease process of acute coronary syndrome
deterioration of a once stable plaque, stimulates platelet aggregation and thrombus formation NSTEMI
Results in:
1.Partial occlusion of coronary artery
2. total occlusion of coronary artery STEMI
MI
Results of sustained ischmia causing irreversible myocardinal cell death (necrosis)
how long does it take for necrosis full thickness to occur
5-6 hours
Objective assessmet for MI
ABC, Vitals, cardiac, respiratory, PVS
risk for MI
Sex, genetics, fam hx, smoking, exercise, weight/diet/high BMI, HYperlipidemia, hypertension, uncontrolled diabetes
Nursing management for MI
M:morphine
O:oxygen
N: nitrates
A:asprin
-monitor sats, IV access, 12-lead ECG, baseline blood work, cardiac markers
Nursing managment for MI (clotting)
Antiplatelet, anticoagulant, Aspirin/plavix/together, heparin, fibrinolytic, rTPA, TNK
Nursing managemnet diagnostic tests
Bloodwork, ECG, Angiogram, angioplasty, stent
Signs and symptoms of cardiac ischmia
ACS, ST elevation, Biomarkers, STEMI
No ST elevation
Biomarkers
unstable angina
Biomarkers
NSTEMI
What happens to ST in stable angina
ST depression
What happens to ST in NSTEMI
No ST elevation, +/- ECG changes
What happens to ST in STEMI
ST elevation
what are Cardiac markers
protein are relased from necrotic heart, proteins that are released when there is cell death, lytes, Na, K
What are the cardiac markers
troponin I and T, CKMB, Myoglobin, C reactive protein CRP
Cardiac troponin
Most commonly used fpr biomarkers. It has the highest known sensitivity. It enter through your blood stream soon after a heart attack. It also stays in your blood stream days after.
Creatinine kinsase
This enzyme can also be measured several times over a 24 hour period. It will usually at least double if youve had a heart attack. But because levels of CK can go up in many other condition (this is not specific)
CK-MB
Subtype of CK. It is more sensitive for heart attack. Rises 4-6 hours after a heart attack. But goes back to normal 4-6 days after. IT helpful when a healthcare provider is trying to figure out whther your recent chest pain was a heart attack.
myoglobin
This is a small protein that stores oxygen it is measured occasionally. Myoglobin is sometimes measured in addition to tropinin to help diagnose
Thrombolysis
Enzymatic digestion of thrombus to open lumen
Percutaneous transluminal coronary angioplasty
physical disruption of plaque to open lumen. Placement of a stent to prevent reocclusion
Coronary artery bypass grafting (CABG)
Surgicala placement of a new conduit to bypass occlusion. Reduces chest pain, heart attacks
Surgical revascularization
new pathway from aorta to myocardium
Heart healthy diet
low sodium, low fat, high fibre
Nursing managemnet cardiac rehab
exercise, sex, return to work
Nursing management health teaching
A: anti platelet, abtianginal, ACE
B: Beta Blocker, blood pressure
C: Cholestrol, cigarettes
D: Diet, diabetes
E: Education, exercise
F: Flu vaccine
Women and MI
- uncomfortable pressure, fullness, lasting or go and some
- Pain or discomfort in one or both arms, the back, jaw or stomach
- Shortness of breath or without discomfort
- Other signs such as breaking out in a cold sweat, nausea, lighheaded
WOmen are more likely to experience back pain, SOV, n and vomiiting, jaw pain
