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1

CAD non-modifiable and modifiable risk factors

Non-modifiable

  • Age:
  • Increased age-disease process begins early and develops gradually.
  • Gender:
  • Highest for middle-aged white caucasian
  • Race:
  • Caucasian males highest risk
  • Genetic:
  • Inherited tendencies for atherosclerosis

Modifiable

  • Tobacco
  • Hypertension
  • Physical Activity
  • Obesity
  • Dyslipidemia
  • Diabetes
  • Stress
  • ETOH abuse
  • HRT

2

Where do we want out patients with CAD for BP?

less than 120/less than 80

3

prehypertension

120-139/80-89

4

high blood pressure stage 1

140-159/90-99

5

high blood pressure stage 2

160 or higher/100 or higher

6

hypertensive crisis

higher than 180/higher than 110

7

what does exercise really help with regards to HDL, LDL, TG?

eally helps HDL and TG

8

How does diet affect LDL, HDL, TG

LDL: lowers it

HDL: little effect

TG: lowers it

9

what do omega fatty acids help with?

triglycerides

10

most used to treat lipid levels

Statins: effects LDL, HDL, and triglycerides

 

11

optimal total cholesterol and ldl, HDL,TC/HDL

total: less than 160

LDL: less than 100

HDL: above 45

TC/HDL: less than 3

12

Type of angina?

Pain w/exertion-relief w/rest

stable Angina

13

Type of Angina?

Pain onset w/ rest
Caused by vasospams 

Prinzmetal's

14

type of angina?

Pain onset w/rest
Precursor to AMI

unstable angina

15

type of angina?

Unrecognized symptoms

Silent agina

16

causative factors of Angina

  • Physical exertion
  • Temperature extremes
  • Strong emotions
  • Heavy meal
  • Tobacco use
  • Sexual activity
  • Stimulants
  • Circadian rhythm patterns

17

Treatment of stable angina?

  • etiology: Myocardial ischemia
  • Symptoms: episodic, aggravated with exercise, relieved w/NTG
  • Treatment: NTG, beta blockers, ca+ channel blockers, ACE inhibitors

18

Unstable angina treatment

  • etiology: ruptured or thickened plaque with platelet and fibrin thrombus
  • symptoms: increasing episodes, occurs with rest and exercise, not relieved with NTG
  • treatment: NTG, tPA, morphine (dilates vessels), ASA

19

Prinzmetals angina treatment

  • etiology: Coronary vasospasams
  • symptoms: Occurs at rest, Triggered with smoking, May have ST elevation,
  • AV Block or Ventricular arrhythmias
  • Treatment: Ca+ Channel Blockers

20

progressive inflammatory disorder of arterial wall that is characterized by focal lipid rich deposits of atheroma that remain clinically silent until they become large enough to impair tissue perfusion

atherosclerosis

21

Stemi vs NonStemi

ST elevation= stemi.  Elevation in the t "firemans cap"
ST depression= non-stemi.

22

APQRST evaluation of chest pain

  • A= Associated Symptoms Dyspnea, nausea, diaphoresis, palpitations, feeling of impending doom
  • P= Precipitating Factors  Exertion, Cold Exposure, meals, movement. Relieved by: rest, NTG, or position?
  • Q= Quality Heaviness, tightness, sharp, stabbing, burning
  • R= Region, Radiation, Risk Factors Radiates to: arm, jaw, back, below diaphram. Region: substernal, left lateral, right chest. Risk factors: HTN, DM, Obesity, Dyslipidemia, Smoking
  • S= Severity Rate pain on scale 0-10
  • T= Timing Onset and duration of pain, nocturnal?, constant? Intermittent?

 

 

23

CPK and Troponin

  • CPK MB: rises 4-8 hours, peaks 12-24, remains elevated for a day
  • Troponin: (breakdown in cardiac muscle) rises in 3 hours, peaks 12-18 hours, stays elevated for 14 days

  • Troponin t: 0.1 or less micrograms per liter
  • Troponin  I: less than 10 micrograms

24

C-Reactive protein

  • Produced by liver w/ inflammation
  • Rules out stable angina
  • Good o get pt. baseline
  • Reference range
  • Low- < 1.0 mg/dL
  • Average- 1.0-3.0 mg/dL
  • High- > 3.0 mg/dL

25

normal BUN

10-20

 

26

normal creatinine

0.5-1.1

27

normal creatinine clearance

130-170 ml/min

28

myoglobin

  • Peak levels occur 1-4 hours
  • Doubling in 2 hours ++ MI
  • Reference range: < 90 mcg/L

29

nursing immediate action for MI

Pt. placed in semi-fowlers position
-ECG  and Cardiac Enzyme Assessment
-IV line started (at least 18 guage)
-ASA 325 mg given: Four baby ASA, Clopidogrel (Plavix) 300 mg (becomes an issue if they need to go to surgery)
-Oxygen
-Beta Blockers
-ACE inhibitors (if CHF present): watch out for asthma patients

 

-NTG titrate to releive chest pain but keep SBP above 90 mm/Hg

             -start drip 5 mics per min, can titrate as high as         400
             -Works as a vasodilator
             -Decreases peripheral resistance
             -Increased coronary blood flow

 

Heparin vs Lovenox

-Neither lyse the clot only prevents new clots
-Heparin increased risk of HTP
-Lovenox longer more predictable action
-Not preferred if Surgery anticipated  

30

cardiac catheterization

  • Procedure which involves placement of a catheter into RT or LT side of heart.
  • Invasive
  • Coronary angiography is often included together with cardiac catheterization
  • Diagnostic procedure and/or
  • a therapeutic procedure
  • Adults & Children