Cardio part 3 Adult Health

• Coronary Artery Disease (CAD) is a cardiovascular disorder and the leading cause of death in the United States.
• CAD involves the narrowing or blockage of coronary arteries, affecting blood supply to the heart muscle.
• Key aspects of CAD include mechanisms, risk factors, symptoms, and management strategies.

Arteriosclerosis

• Arteriosclerosis is the thickening or hardening of the arteries, restricting blood flow.
• Arteriosclerosis reduces the ability of arteries to expand, leading to decreased blood flow.

Atherosclerosis

• Atherosclerosis is a type of arteriosclerosis.
• It involves plaque buildup inside the arteries, composed of fatty substances, cholesterol, cellular waste, calcium, etc.
• Atherosclerosis is the more prevalent condition compared to arteriosclerosis.

Coronary Heart Disease

• Coronary Heart Disease is the presence of coronary artery disease with symptoms like chest pain (angina).

Ischemic Heart Disease

• Ischemic Heart Disease results from insufficient blood supply (ischemia) to the heart muscle.
• Ischemic Heart Disease is often due to plaque buildup or blood clot obstruction in coronary arteries.
• The heart requires a constant supply of oxygen-rich blood to function properly.

Prevention

• Adopting and maintaining healthy habits is crucial for preventing CAD.
• Diet should avoid high-fat foods that contribute to CAD.
• Abstaining from smoking is essential.
• Plaque buildup is cumulative, with existing plaque remaining despite healthier habits.
• Regular physical activity helps maintain cardiovascular health
• Managing high cholesterol (hyperlipidemia) is important.

Asymptomatic CAD

• Plaque buildup can occur without noticeable symptoms

Angina Pectoris

• Angina Pectoris is chest pain/discomfort due to myocardial ischemia.
• Angina Pectoris occurs when myocardial oxygen demand exceeds supply.
• Angina Pectoris is often used interchangeably with chest pain.
• Angina is traditionally a chronic condition but can become acute.
• Stable Angina is pain that stops after activity ceases, while Unstable Angina has increased frequency/severity, not relieved by rest/nitroglycerin.

Precipitating Factors of Angina

• Atherosclerosis (plaque buildup)
• Coronary artery spasm
• Exertion or exercise
• Emotional stress
• Eating a large meal
• Cold weather
• Circadian rhythms (early morning)

Assessment of Angina

• Pain Level ranges from mild to excruciating.
• Location is typically substernal.
• Description includes pressure, burning, squeezing, or fullness.
• Radiation may extend to the neck, jaw, and left arm
• Associated Symptoms: mild indigestion, shortness of breath, nausea, vomiting, diaphoresis, dizziness

Angina Gender Differences

• Women present with different symptoms like nausea, vomiting, fatigue, indigestion, upper back pain, or abdominal discomfort.

Myocardial Infarction

• Myocardial Infarction is a heart attack resulting from prolonged ischemia.
• Myocardial Infarction leads to irreversible damage to the heart muscle.

Sudden Cardiac Death

• Sudden Cardiac Death is an abrupt loss of heart function, breathing, and consciousness.

Electrocardiogram (EKG)

• EKGs detect abnormalities in the heart's electrical activity.
• ST Elevation is a significant diagnostic indicator
• Normal EKG shows typical P, QRS, and T waves, with the ST segment returning to baseline.
• ST Elevation EKG occurs when the ST segment remains elevated instead of returning to baseline before the T wave.

Cardiac Biomarkers

• Cardiac Biomarkers are blood tests that measure cardiac enzymes and proteins released when the heart muscle is damaged.
• Elevated levels of cardiac biomarkers indicate myocardial infarction.

Echocardiogram

• Echocardiograms involve ultrasound to assess the heart's structure and function.
• Echocardiograms can reveal abnormalities like cardiomyopathy.

Heart Catheterization (Cardiac Cath)

• Heart Catheterization visualizes the coronary arteries and identify blockages.
• Heart Catheterization involves inserting a catheter into a blood vessel to inject contrast dye and take X-rays.

Exercise Stress Test

• Exercise Stress Tests evaluate heart function during physical activity.
• Exercise Stress Test involves monitoring EKG and blood pressure while the patient walks on a treadmill or cycles.

Clinical Signs of CAD

• Patients may appear cold and clammy, ashen in color.
• There may be shortness of breath and weakness.
• Vital signs (blood pressure and pulse) may be elevated due to pain
• Nature: Symptoms may come and go,
• Relief: may be relieved by changes in activity or nitroglycerin.

Complete Workup for Angina

• This includes vital signs monitoring, EKG, stress test, and cardiac biomarkers.

Medications for Angina

• Nitroglycerin is a vasodilator that increases blood flow to the heart and decreases its workload.
• Nitroglycerin is administered sublingually for rapid absorption.
• Monitor blood pressure before administering subsequent doses of Nitroglycerin, and wait five minutes between doses, as it can cause a hypotensive effect..
• Heparin may be administered if a blood clot is suspected.
• Aspirin is commonly administered to prevent further clot formation.

Aspirin Administration

• Patients arriving at the ER may be given either an 81 mg or a 325 mg aspirin.

Medication Review

• Be aware that the patient might already be on medications such as Plavix, calcium channel blockers, or beta blockers.
• Caution should be exercised, as calcium channel blockers and beta blockers can decrease heart rate and blood pressure.
• It is crucial to check these parameters before administering any additional medications.

Morphine for Pain

• Morphine, an opioid, may be administered for pain relief and can decrease respiratory rate.
• Ensure the patient's respiratory rate is within normal limits before administering morphine.

Invasive Interventions

• Consent forms are required for all invasive procedures.

Percutaneous Transluminal Coronary Angioplasty or Percutaneous Coronary Intervention (PTCA/PCI)

• Percutaneous Transluminal Coronary Angioplasty involves inserting a catheter into the narrowed part of the artery.

• A balloon is inflated to compress the plaque against the artery walls, increasing blood flow.

• A stent may be placed to maintain vessel patency.

• Patients with stents require anti-coagulants for at least three months, possibly longer.

• The patient is typically sedated but awake during the procedure, which lasts about one to two hours.

Coronary Artery Bypass Graft (CABG)

• Coronary Artery Bypass Graft involves bypassing blocked sections of the coronary artery.
• Grafts are placed above and below the obstruction to restore blood flow to the heart.

Nursing Interventions for Acute Angina

• Prioritize Airway, Breathing, and Circulation (ABCs).
• Comfort: Ensure patient comfort and promote rest in a calm environment.
• Pain Management: Treat pain and anxiety with appropriate medications (including nitroglycerin).
• Diet: Provide small, frequent meals to avoid triggering chest pain
• Activity: Balance rest periods with activity.
• Prophylactic Nitroglycerin: May be prescribed for patients with chronic angina before activities like exercise and sexual activity.
• Education: Explain all procedures/medications, addressing patient questions/concerns about angina
• Monitoring: Administer medications, monitor vital signs, and assess respiratory and cardiac systems
• Psychosocial Support: Allow patients to verbalize their concerns/feelings to decrease anxiety.
• Timing of Education: Educate the client when they are ready and stable; avoid during acute chest pain.
• Action During Symptoms: Teach patients to immediately stop activity if chest pain, dyspnea, syncope, or vertigo occurs.

Patient Teaching: Lifestyle Modifications

• Dietary Advice: Avoid heavy, large meals.
• Rest: Rest for one to two hours after meals.
• Environmental Factors: Avoid extremes in temperature.
• Substance Use: no caffeine or tobacco.
• Nitroglycerin Use: Take nitroglycerin prior to activities that may trigger angina. Keep nitroglycerin with the patient at all times. Replace nitroglycerin ever 3-6 months.

Additional Patient Education Points

• Nitroglycerin Sensations: A burning sensation indicates that the nitroglycerin is working.
• Nitroglycerin Side Effects: Nitroglycerin can cause headaches and flushing.
• Drug Interactions: Nitroglycerin should not be taken with erectile dysfunction medications due to the risk of severe hypotension.

Myocardial Infarction

• Definition: Commonly known as a heart attack, caused by blockage of a coronary artery branch.
• Process: Blockage can cause ishemia and chest pain, and can lead to tissue death.
• Severity Factors: Location and size of blockage, and presence of collateral circulation.

Collateral Circulation

• Definition: New blood vessels that bypass a blockage.
• Impact: Can mean fewer signs and symptoms for patients.
• Time Sensitivity: Time to emergency room is critical.
• MI Symptoms: More sever and long lasting than angina.

Unstable Angina

• Angina that changes in frequency, severity, or duration, indicates an increased risk of MI.
• Location of Mi: The location of the heart attack effects the severity and type of complications.

Anterior MI

• Affects the front of the heart and can cause severe issues due to its impact on the left ventricle.

Left Ventricle

• The primary pumping chamber of the heart, crucial for systemic circulation.

Rapid assessment

• Rapid assessment is essential for a timely intervention

Peak time

• Peak time for a heart attack is between 6:00am and 12:00pm noon due to circadian rhythm

Seasonal influence

• There is a seasonal influence, heart attacks are more common in winter months

Classic symptoms

• Severe, sudden, pressure-like chest pain that increases over time and radiation
• Sensation of squeezing or heavy weight on the chest
• Pain Radiating to the left arm, jaw, neck or teeth

Atypical symptoms

• Gastrointestinal (GI) symptoms instead of chest pain

Objective signs

• Pallor, erratic behavior, hypotension, shock
• Cardiac rhythm changes, vomiting, fever, diaphoresis

Pain Characteristics

• Location: Retrosternal or substernal chest pain
• Radiation: Radiates down the left arm, to the neck, jaw, and teeth

Women differences

• Women may experience different symptoms than men
• Common symptoms include unusual fatigue, sleep disturbances, and shortness of breath

Rapid Pulse & Weak Pulse

• Indicates compromised cardiac function

Blood Pressure Changes

• Blood pressure changes are initially elevated due to catecholamine release
• Can drop as cardiac output decreases

Nausea and Vomiting

• Common in inferior MI

Diagnostic studies

• Diagnostic studies include a 12-lead EKG, cardiac biomarkers, electrolyte levels, and cardiac catheterization.
• 12 Lead ECG should be performed within 10 minutes of arrival to the emergency room

Cardiac Biomarkers

• CK-MB: Specific for heart muscle damage.
• LDH: Indicates tissue damage.
• Troponin 1: The best indicator of myocardial infarction, cardiac-specific.

STEMI & NON-STEMI

• Understanding the difference between STEMI and NSTEMI is crucial for appropriate treatment
• Initial Treatment focuses on relieving pain, providing oxygen, and preventing further clot formation

Oxygen administration

• Administer Oxygen is at saturation is less than 91%
• Administer medication as soon as a patient starts to complaint about pain

Beta Blockers and Calcium Channel Blockers

• Can be administered to reduce heart rate and blood pressue

Reperfusion Strategies

• Reperfusion Strategies aim to restore blood flow to the heart muscle
• Percutaneous conronary intervention (PCI) is preferred but thrombolytics are used if PCI is not available

PCI

• PCI also know as PTCA (Percutaneous Transluminal Coronary Angioplasty)

Thrambolytics

• Thrombolytics are clot busting drugs for reperusion
• Thrombolytics must be infused within 6 hours of chest pain onset

Nursing interventions

• Nurses interventions inlcude monitoring vital signs and ensuring bed rest

Initial Recovery Phase

• Description: Administering prescribe medication
• Continuous cardiac monotoring and long periods of undisturbed rest

Dietary managemnet

• Description: Dietary perogression and support healing and prevent further cadiac event
• Initially patients are NPO (nothing by mouth) in case of procedures

Medication Management

• Lipid-lowing medications are often prescribed for the rest of the patients life
• Asses respiratory and cardiac intervention and strict intake and output ( I&O) monitoring

Nursing interventions and Health promotion

• Description: Key nursing actions and health promotion strategies for MI patients
• Review nursing interventions

Heart Failure

• Heart failure is a chronic condition resulting from structural and functional cardiac issue
• Can be caused by atrial fibrilation and a Complication by underlying heart disease
• Cardiac output is insufficient to meet the bodies needs due to the hearts inability to pump blood effectively

Preload and afterload

• Preload: The stretch or filling of the heart
• Afterload: The resistance the heart must overcome to eject blood

Right-Sided Heart Failure

• Right-sided heart failure occurs when the right ventricle cannot effectively pump blood into the pulmonary circulation and leading to systemic congestion

Left-Sided Heart Failure

• Left-sided heart failure occurs when the left ventricle cannot effectively pump blood into the systemic circulation and leading to pulmonary congestion.
• Assess symptoms: Shortness of breath and edema
• Prevent progression and compilations: early detection and intervention is key
• Positioning: high fowlers postition to breath

Dietary Management in Heart Failure

• Mild heart failure 2- gram sodium diet
• Severe heart failure: as low as 500 mg sodium diet
• Fluid Restriction: May be necessary to control edema and lund congestion

Patient Education

• Educating patients about self-management is essential for improving outcomes and preventing hospital reanimissions
• Daily Weight Monitoring: Same time and clothes