Cardio Flashcards Preview

Med Surg 3 > Cardio > Flashcards

Flashcards in Cardio Deck (9)
Loading flashcards...
1
Q

Coronary Arteries

A

Supplies oxygen and nutrients to the heart

They are pumps

Most popular place to build plaque: circumflex branch

Coronary system requires oxygenated blood

2
Q

Cardiac Terms

A

Cycle: One complete heart beat (PQRST)

Cardiac output: Amount of blood ejected in one minute (HR X Stroke Volume)

Stroke volume: Amount of blood ejected with each contraction. Effected by preload, after load and contractility.

Preload: Degree of stretch before contraction. Frank Starling law.

After load: Amount of tension the ventricle must develop to open valves. Major determinant = arterial BP

Contractility: Vigor strength, or intensity of cardiac muscle contraction. Digoxin- increases contractility

3
Q

Cardiovascular Disease

A

Major (#1) cause of death in the US: Used to be a man’s disease. After menopause, prevalent in women.

Coronary Artery Disease (CAD) is most common

  • Begins with atherosclerosis
  • Asymptomatic
  • Stable angina- heart pain, SOB, rest helps it go away
  • Unstable angina- heart pain SOB, rest doesn’t help
  • Myocardial Infarction- crushing chest pain, arm pain, jaw pain, SOB, sweating (particularly with men). Women: jaw pain, nausea, no warning at all.
4
Q

Coronary Artery Disease

A
  • Atherosclerosis is an abnormal accumulation of lipids and fibrous tissue due to inflammation in the vessel wall
  • Soft deposits of fat start to build up and harden
  • Can occur in any artery in the body
  • No s/s at first, then as it continues, s/s show
  • The Atheromas (Plaque) protrude into the lumen of the vessel, narrowing it and obstructing blood flow
  • Prefers coronary artery because of their shape
  • A thrombus may form and further obstruct the flow, leading to a myocardial infarction or sudden death

Risk factors for CAD:

Non-modifiable factors: Age, gender and ethnicity, Family and genetics, Dad and brother- before 55, Mother and sister- 65, Puts you at risk

Modifiable major factors- all fixable: 
Elevated serum lipids
- Increase HDL with exercise 
- Lower LDL with diet, cut back on simple carbs 
- Can fix with medicine 	
Hypertension	
tobacco use
- 1 pack a day increases chances of an MI 6 times 	
physical inactivity
Obesity
Diabetes- keep sugar under control
Metabolic Syndrome- lose weight 
Psychologic states (stress)- decrease stress 
Homosysteine- not getting enough B vitamins, destroying epithelial cells in vessels, get more B vitamins 
Radiation therapy to the chest
Substance abuse- meth, cocaine

Other factors

  • Sleep apnea- low oxygenation, increases bp and strain on the heart
  • Elevated C-reactive protein- c-reactive protein tells us there is inflammation somewhere in the body

Risk factor cluster: obesity, diabetes, low HDL- cleans up vessels, high LDL- distrupts the body’s ability to dissolve clots

Complicaitons: 
Angina
- Elderly may not recognize this
- Ischemia somewhere in the heart- low oxygenation
- Teach patient to sit down! 

Myocardial Infarction: tissue died

Heart Failure- the pump isn’t pumping like it should

Arrhythmias- heart is not beating the way it should

Management:
Health Promotion:
- Identification/ Management of high risk people: Physically inactive, obese, high cholesterol, HTN, DM

Procedures
Cardiac caths
Angioplasty- balloon with stent placement- wire cage goes over the balloon and the ballon is taken out while the cage stays
Coronary artery bypass surgery- take a vessels from somewhere and bypass the plug
***PCTA- percutaneous transluminal coronary angioplasty- go into the vessel itself and look for

Prevention:
Lifestyle changes:

exercise more (2x a week)

Nutrition therapy

  • High fiber (TLC diet), food groups with vitamins C&E (help with inflammation), folic acid, B6, B12, soy products (no soy if you have a thyroid problem) and limiting fats except the omegas 3/6- limit 6 more than 3)
  • Low saturated fat
  • Low red meat
  • No whole milk, no cheese, slow down on eggs and butter
  • Slow down on alcohol and carbs

Early diagnosis can stop the progression

Management - Drugs:
Cholesterol lowering drug therapy
- Drugs that restrict lipoprotein production
- Drugs that increase lipoprotein removal
- Drugs that decrease cholesterol absorption
- Pravastatin

Alternatives:
Fish and fish oils
Flax and flaxseed oil- Omega 3 with fiber
Other dietary sources of Omega 3s- walnuts, canola, soy, olives
Supplements to reduce BP/Cholesterol
ALA, Artichoke, barley, beta-sitosterol, psyllium- metamusal, cocoa, Co Q10, garlic, oat bran

VLDL- LDL inhibitors

  • Niacin , fibric acid derivatives
  • Our ability to dissolve clots will go away if our LDL is high

Antiplatelet therapy

  • Low dose aspirin, Plavix
  • Natural agents- Niacin- can buy at health food store and it will open up the blood vessels DO NOT TAKE WITHOUT PERMISSION FROM DOCTOR
  • Beta Blockers
  • Nitroglycerin- vasodilator – relieves chest pain because it opens the vessel to give oxygen to that particular area – comes in cream- WEAR GLOVES, sublingual, patch, tabs
  • Angiotensin-converting enzyme inhibiters & angiotensin II receptor blockers
  • Want to manage the plaque which is lipoproteins and cholesterol

Lifestyle changes:
Stop smoking- constricts blood vessels and causes more workload on heart
Control the BP- keep around 120 systolic
Cholesterol control- LDL: lower than 100 HDL: above 40 for men about 50 for women
Keep diabetes under control
Keep moving
Eat healthy- low fat, low cholesterol
Maintain a healthy weight
Manage stress- breathing exercises
Regular check-ups- some people at risk don’t have any s/s so it’s important to get regular check ups.

5
Q

Athersclerotic 
Progression

A
  • Begins with damaged epithelium
  • Next: fatty streak with lipid core formation- around age 15- can reverse at age 15 with healthy diet
  • Next: Fibrous plaque- wall begins to thicken, occurs around age 30
  • Lastly: Complicated lesion- Clots, leakage
  • As atherosclorosis advances, the thrombus enlarges, O2 rich blood becomes inadequate so collateral circulation starts to form
6
Q

Diagnostics for CAD

A

Electrocardiogram (ECG)

  • Holter monitoring- walk around with it for 24 hours to a month, detects your heart
  • ***you may not see a heart attack happening in the moment. Cannot count on ECG for MI until damage has been done
  • Echocardiogram- shows weakened areas of heart
  • Stress test- treadmill or drug, will have ECG during this time so that it shows what it is doing. The goal is to stress the heart and its blood supply enough that if there is underlying disease ischemia EKG changes will develop
  • Cardiac cath or angiogram- see vessels of the heart and can blow it up to widen the part that is plugged off and smash the cholesterol into the vessel and place stent. If less than 70% occluded, they won’t place stent. Data obtained includes:
  • hemodynamic pressures: arterial and left ventricle
  • ventricular gram (dye injected into the left ventricle)
  • multiple views of the right coronary artery
  • multiple views of the left coronary artery
  • Gives many views of the artery/ventricle
    Limitations
  • Can only measure lumen size
  • ***Not predictive of plaque state (ie rupture)
  • Invasive: need consent form
  • Heart scans (CT)
  • Magnetic Resonance Angiography (MRA)- Goes into arteries with dyes
7
Q

Cardiac Catheterization

A

Invasive procedure used to measure cardiac chamber pressures and assess patency of the coronary arteries- need consent form

Requires ECG and hemodynamic monitoring; emergency equipment must be available

Assessment prior to test; allergies (especially to dyes), blood work (routine, CBC, Electrolytes)

Assessment of patient after procedure: circulation, potential for bleeding, potential for dysrhythmias

Activity restrictions- if go through the femorals

Patient education before & after procedure

Watch for bleeding or hematomas building up

8
Q

Invasive Coronary Artery Procedures

A

PTCA compresses atheroma and stretches coronary artery
Coronary artery stent is inserted after PTCA to keep vessel open

Atherectomy is removal of atheroma

Brachytherapy inhibits smooth muscle cell proliferation by placing radioisotope close to lesion

Transmyocardial laser revascularization: burns a channel into but not through the muscle

Angiogenesis- new blood vessels begin to grow around the blockage as a bypass (collateral circulation)

Coronary artery revascularization- utilizes another vein to bypass (building artificial collateral circulation around the area) diseased coronary artery

  • Complications include: MI, dysrhythmias, and hemorrhage
  • Post-op care focuses on wound care, progressive activity- will not let them lay in the bed because they will get weaker , and nutrition
9
Q

Post op teaching

A

Signs and symptoms of infection ( temp >100.4)
Pain management
Activities to avoid ( driving, lifting >5 lbs)
Lifestyle modification
Symptoms to report to the surgeon( weight gain, SOB, swelling, drainage…)
Home med actions dosages and side effects