Title Pathophysiology Signs & Symptoms Diagnosis Treatment
Coronary Artery Disease CAD (Any disorder that causes narrowing or occlusion in Coronary artery). ** Leading cause of death in the US. Q25seconds someone in the US has a CAD related incident. Risk Factors: NONMODIFIABLE: age, gender, heredity, & race. MODIFIABLE: hypertension, tobacco smoking, Type 2 diabetes, obesity, sedentary lifestyle, stress, drug use (esp. cocaine). Smoking Cessation & avoid 2 nd hand smoke. BP less than 140/90. LDL less than or = to 100mg/dL. HDL greater than or = 40mg/dL. 30 mins physical activity 3- 4x/week. Arteriosclerosis (Narrowing & hardening of arteries) A buildup of lipids, collagen, & smooth muscle cells narrows the lumen of the vessel. 3 types: atherosclerosis, calcific sclerosis, & arteriolar sclerosis. ATHEROSCLEROSIS is fatty deposits on inner lining of vessel wall. Fat deposits (plaque) accumulate in the vessel as person ages. Foam cells- large amounts of lipids.
Angina Pectoris (Chest pain, Most common symptom of Myocardial ischemia is temporary inadequate blood & oxygen supply Squeezing pain under sternum radiates to left shoulder. (Pain may Patients with hypertension or Diabetes mellitus have Increase blood supply to affected area. Administer oral dose of CH 21 Occlusive Disorders & Heart Failure
CAD) to the myocardial tissues. Angina occurs when this is temporary and is known as stable. Unstable angina is part of a condition called acute coronary syndrome. Stable angina occurs during exertion and less with rest. radiate to right shoulder, jaw, or ear). If client experiences an ischemic attack with no angina it is called SILENT MI. These symptoms include chest pressure, restlessness, shortness of breathe, numbness or tingling in arms or shoulders, fatigue, & dizziness. Person may state they feel funny. Prinzmetals angina caused by coronary artery spasms that occurs at rest. higher risk. Dx based on health Hx, lab tests, and stress test. Thallium scan, or coronary arteriogram. 162-325mg crushed aspirin or aspirin to be chewed because it prevents platelet aggregation or vasoconstriction. O2 @2-4L/min. Nitro tabs to increase O2 supply. If pain is not relieved by nitroglycerin then give morphine sulfate 2-4mg IV push. Morphine can be repeated every 5-15 mins until pain is under control. **Side effect of nitroglycerin is hypotension (patient should be sitting or lying down when medication is given) & headaches. PTCA can be done if only one artery is involved. **Intracoronary Stent (tiny metal tube with holes in it) implanted into vessel to prevent vessel from collapsing and keep plaque CH 21 Occlusive Disorders & Heart Failure
against vessel wall. Acute Coronary Syndrome (term for all signs & symptoms of sudden myocardial ischemia) The more susceptible p to myocardial infarction & sudden death. Unstable Angina occurs at rest or with minimal exertion. Tachycardia, diaphoresis, nausea, & dizziness. Pt. may have Tachycardia, tachypnea, hypertension or hypotension, decreased O2, cardiac dysrhythmias. Women with ACS may experience indigestion, palpations, nausea, numbness in hands, fatigue rather than chest pain. Cardiac biomarkers, ECG recordings. Myoglobin is first biomarkers to rise with myocardial damage. Abnormal Q wave indicates MI or past MI. MONA: Morphine Sulfate, Oxygen, Nitroglycerin, and Aspirin. Myocardial Infarction (Obstruction in coronary artery, resulting in necrosis (death) to tissues supplied by the artery) ** Most common cause is atherosclerosis. Obstruction usually caused by plaque, thrombus, or embolism. Area most commonly affected is the left ventricle. HF or Stroke by also occurs. Great anxiety, Impending Doom. Frequently cold & clammy. MEN: feelings of chest heaviness or tightness that progress to a severe gripping pain in lower sternal area. Pain occurs in arm, neck, back, and epigastric area. The rest or nitroglycerin does not relieve pain and client becomes ECG tracings, Cardiac biomarkers values, & radioactive isotope scan, ECG Stress test has less diagnostic value with women than men. ** Cardiac troponin I & myoglobin. Troponin found in cardiac cells, when cells are damaged they show elevated level. O2 via Venturi Mask or nasal cannula. Morphine Sulfate IV for Pain. Nitrates IV or Sublingual for pain. SL may provide immediate relief. One tab SL nitro given Q5mins up to 3xs. Thrombolytic therapy is sometimes used within 3-6 hours of MI to dissolve clot- blocking artery. Bed CH 21 Occlusive Disorders & Heart Failure
short of breath, diaphoretic, and anxious. Pulse irregular rapid and weak with low B/P. skin pale & turns cyanotic. WOMEN: Upper abdominal pain, heartburn, nausea, dyspnea, lethargy, fatigue, dull pain, anxiety, chest pain. Women may have symptoms on the back or left side of chest with numb, tingling, burning, stabbing, and sensation. Rest for 24 hours, progress to chair. Diet of less than 30 grams of fat/day. Regular exercise, 30 mins 5 days/week.
** Carry nitroglycerin at all times, 0.4mg q5 mins (up to 3) in 15 minutes. Call 911. ** African American men & women ages 45-74 have higher rate of CAD deaths, than men or women of other races. ** Beta Blockers: (Lopressor, Toprol, Metoprolol) Increase diastolic time, & increase coronary perfusion. ** Calcium Channel Blockers: (Cardizem & Norvasc) coronary artery dilation, & prevent vasospasm. ** Antiplatelet agents: (Aspirin, Plavix) Decrease preload & afterload. ** Lipid Altering Agents (Zocor, Lipitor, Crestor) Monitor liver function test. ** Niacin: Hot flashes & pruritus; take aspirin 30 mins- one hour before drug & after food. ** Giving Meds IM increases CK blood levels. Therefore IM meds are usually not given to patients with angina, ACS, or an MI.