Wk 4 Flashcards
Coronary heart disease
Describes the effect ps of a reduction or complete obstruction of blood flow through coronary arteries due to narrowing from atherosclerosis and or thrombus
Slow and degenerative
Manifests as chest pain due to angina
Causes arrhythmia and heart failure
Risk factors of CVD
Smoking hypertension DM Dyslipidemia Family hx Age 45 male 55 female Chronic kidney disease Obesity diet
Angina pectoris
Syndrome of CHD characterised by crushing central chest pain
Pain from physical exertion and stress due to increased workload
Different types of angina
Stable: predictable, not worse
Unstable: more pain, unpredictable,
Variant: spasm, may be no disease
Diagnosis of angina
Typical: suc stern all chest discomfort, onset with exertion or emotional distress, relied with rest or nitroglycerin
Atypical: 2 of above criteria
Noncardiac chest pain: 1 criteria met
Signs and symptoms of angina
Pain is progressive or very sudden Retro sternal pain Radiating pain to left or right shoulder Occasional pain in neck and jaw SOB Increased Har
Diagnosis of unstable angina
Typical angina: increased in severity or duration
Has onset at rest or at a low level of exertion
Unrelieved by nitroglycerin
Non typical angina: first episode with usual activity, prolonged pain at rest
MI
Irreversible myocardial necrosis from an abrupt blockage and cessation of blood flow
Thrombosis, atherosclerotic plaque, coronary artery spasm
May develop cardiogenic shock
Mi signs and symptoms
Severe crushing pain Pain in left arm, jaw and back SOB pulmonary oedema Cold clammy Unconscious Cardiac arrest
Signs to help diagnose acute MI STzeMI/NSTEMI
Ischaemia symptoms that last longer than 30 mins
Diagnostic ECG changes
Serum cardiac marker troponin levels
Avute MI
LAD: left ventricle and septum, high risk heart failure, shock, death
Circumflex: left ventricle, lateral and posterior wall, arrhythmia
RCA: inferior wall of left and right ventricle, AV node and SA node
Cardiac arrhythmia
Group of conditions in which the heartbeat is irregular, too fast or too slow
Main types: extra beats, supraventricular tachycardia, ventricular arrhythmia, Brady arrhythmia
Dues to problems with electrical conduction system of heart
Cardiac pacing: trancutaneous pacing
Temporary means of pacing a patients heart during medical emergency
Pulses of electric current through chest to contract the heart
Hypotensive crisis
All tissues and organs require oxygen and glucose, low BP can be tolerated by some
Common causes of chest pain:
Angina, mI Gastric Muscular skeletal Aneurysm Pleural
Heart failure
Impairment of pumping ability of heart due to damage.
Increased workload due to hypertension, or malfunctioning heart valve - most common cause is hypertension due to atherosclerosis IHD
Types of heart failur
Right side
Left side
CCF congestive cardiac failure can be both
Hypertensive crisis
Systolic 180 diastolic 110 is hypertensive crisis May have headaches and dizziness Retinal damage, Breathlessness Pulmonary oedema
Nursing management of cardiac patient
ABCDE Determin problem Reduce myocardial workload Optimise CO Detect complication and initiate Tx Pain relief: where is it, what make it worse, what alleviates it, worse when you eat, what scale
Cardiac lab tests
Enzymes are catalysts found in different cells of body
Troponin is highly cardiac specific protein in 2 forms
Trop I: within 4 hrs elevated for 2 weeks
Trop T: more sensitive shows small amounts of damage
Acute management of ACS
ABCDE
MONA:
morphine: reduces pain and anxiety, careful with hypotension, hypovolemia, resp depression
oxygen: ACS patients often experience hypoxaemia, limits ischaemic myocardial damage
nitroglycerin: dilates coronary vessels, reduces systemic vascular resistance and preload,
aspirin: irreversible inhibition of platelet aggregation
Nursing care of cardiac patients
Bed rest Light diet Medication: anti-arrhythmia, pain, anti-coagulation Patient education Rehab and continuing support Inotropes Pacing Cardio version Intra aortic balloon pump
Inotropes
Alter stretch of cardiac and other smooth muscle fibres
Stimulates sympathetic nervous system and alters movement of ions
Alpha adrenergic receptors: vasoconstriction of smooth muscle
Beta receptors: vasodilation and heart rate and contractility increase
Intra-aortic balloon pump
Designed to increase coronary blood flow and decrease after load
Secondary prevention disease management
Blood pressure: beta blockers and ACE inhibitors,
Lipids: maximise use of statins
Diabetes: control blood sugar
Patient education: in hospital, discharge, outpatient, rehab
Smoking cessation: meds and counselling
Physical activity:
Diet
Medication checklist for ACS
Anti platelet agent I.e. Aspirin
Lip lowering agent statin
Anti hypertensive: B blocker, ACE-I
ACS includes
Unstable angina UA
NSTEMI
STEMI
The cardio vascular system
Heart and pulmonary and systemic circulatory system
Main function: transport O2 to tissues from lungs
Transport CO2 from tissues to lungs
Nutrient, waste product transportation
Transport hormones
Transport and radiation of heat
