Cardiovascular Disorders

Atherosclerosis

Atherosclerosis
Risk factors
Non-modifiable
Gender Genetics Age Culture/Ethnic

Atherosclerosis
Modifiable Risk Factors
Smoking Hyperlipidemia Hypertension Diabetes Obesity Sedentary lifestyle Stress Psychosocial
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Notes
Psychosocial-type A personality aggressive, compulsive, perfectionism, Diabetes encourages plaque formation. Changes to microvascular (collateral circulation) makes wall sticky and encourages clot formation platelet aggregation Smoking is proportional to amount of cigarettes smoked. Catecholomine release causes tachycardia, increase in blood pressure. Vasoconstriction of coronary arteries. Platelet adhesion Smoking also decreases oxygen and increases carbon monoxide. Diabetics tend to have higher ldl and vldl levels. Sedentary lifestyle increases lipids, helps to lower blood sugar. Reduces stress and lowers blood pressure. Stress increases catecholomines, increase heart rate,. Catecholomines are epinephrine, norepinephrine and dopamine

Atherosclerosis
Coronary arteries arise from the coronary sinus from the base of the Aorta Provide nutrients to cardiac muscle CAD
Obstruct blood flow to the heart muscle Lumen is obstructed Causes ischemia Supply of nutrients does not meet demand
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Notes
Ischemia- decreased blood supply to an organ

Atherosclerosis
Symptoms are related to the amount of obstruction Death may occur if left untreated

Angina Pectoris
Angina-spasmodic, cramp like, choking feeling Pectoris-chest/ Breast area Decreased blood supply when more oxygenated blood is needed
Cold Stress Exertion Anxiety
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Notes
Cold causes vasoconstriction

Angina Pectoris
Unstable
Occurs at rest

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Angina Pectoris
Signs and Symptoms
Pain
Chest, back, jaw, throat, left arm, shoulder, neck

Dyspnea Anxiety Apprehension Diaphoresis nausea

Symptoms in women may appear differently than in men

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Notes
Heaviness or tightness to chest, feels like indigestion, denial, squeezing, Women-palpitations, chest discomfort during rest, pain in abdomen,

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Angina Pectoris Treatment

Usually can be relieved by rest since pain is caused by temporary lack of oxygen supply to the heart Assess vital signs Administer oxygen Check ECG monitor Nitroglycerin SL X 3, 5 minutes apart PRN
Vasodilator

Angina Pectoris can be a precursor to an MI Notify MD if Nitroglycerin is not effective, this could be a sign of MI
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Notes
Always check blood pressure prior to administering nitroglycerin since it is a vasodilator Causes headache due to vasodilation of cerebral vessels/ warn patient Tell story of pt in room 259

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Angina Pectoris
Assessment
Subjective
Pain- assess location, intensity, radiation, duration, precipitating factors What reliefs the pain? Have the episodes of pain increased? Is the pain becoming more severe

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Angina Pectoris
Objective Data
Look for signs the patient may be in pain such as rubbing elbows or chest Note any changes in vital signs such as tachycardia, increase in blood pressure Diaphoresis Anxiety Pale

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Angina Pectoris
Diagnostic Tests
ECG
Rhythm changes or elevation

Holter Monitor Exercise Stress Test Thallium Scanning PET Coronary Angiography
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Notes
Make sure students know that a patient maintains a journal during a holter monitor

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Angina Pectoris
Medical Management
Control Symptoms Daily Aspirin Vasodilators Beta-adrenergic blocking agents Calcium channel blocking agents Nitroglycerin SL

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Angina Pectoris
Surgical Interventions
Angioplasty (PTCA) Stent Placement CABG

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Angina Pectoris
Surgical Interventions

PTCA (Percutaneous Transluminal Coronary Angioplasty

Invasive Sterile technique Performed by Cardiologist Sign consent for CABG due to potential for complications Done under Fluoroscopy Need sedation Assess for allergy to iodine, shellfish, contrast Femoral or Brachial artery is used to cannulate the coronary arteries Complications include hemorrhage, vessel closure, need for surgery, MI,

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Angina Pectoris
Treatment
Coronary Stent Placement
Expandable, meshlike structure Designed to help hold the arterial wall open Need to have anticoagulant therapy Sedation usually given Assess for allergy to shellfish, iodine, contrast

Complications include hemorrhage at insertion site, injury to arterial wall, dysrhythmias, emergency surgery, stent thrombosis, acute MI Hospital stay for 1-3 days
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Angina Pectoris
Treatment
CABG (Coronary Artery Bypass Graft) Surgical management Veins from legs or internal mammary artery is used Patient requires at least one night stay in ICU and about 5 days in the hospital Cardiac rehabilitation is usually ordered afterward Patient should not use a trapeze bar
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Notes
Internal mammary is preferred since this is more like an artery. Veins need to be turned inside out due to valves Internal mammary artery lasts longer (15 years)

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