Cardio Midterms-OFI PDF

Angina Pectoris ACUTE MYOCARDIAL - a chest pain caused by insufficient oxygen and INFARCTION nutrients to the myocardial tissue because of - The death of myocardial cells from inadequate inadequate coronary blood fl...

Angina Pectoris ACUTE MYOCARDIAL - a chest pain caused by insufficient oxygen and INFARCTION nutrients to the myocardial tissue because of - The death of myocardial cells from inadequate inadequate coronary blood flow. oxygenation - often caused by a sudden complete - results when Myocardial oxygen demand exceeds blockage of a coronary artery Myocardial oxygen supply ACS and MI Spectrum includes: Causes: a. Unstable Angina 1. Atherosclerosis b. NSTEMI - partial occlusion of coronary artery, or 2. Hypertension conditions like; 3. DM 1. increased metabolic demand ( extreme physical 4. Polycythemia Vera exertion, hypertension) 5. Aortic Regurgitation 2. severe aortic valve stenosis 3. low cardiac output Patterns of angina c. STEMI - total occlusion of coronary artery - carries a great 1. Stable angina risk of death and disability - also called exertional angina. - occurs with activities that involve exertion or Causes: emotional stress - atherosclerosis - relieved with rest or nitroglycerin - Coronary artery spasm - usually has a stable pattern of onset, duration, - Coronary thrombosis severity, and relieving factors - Decreased oxygen supply ( acute blood loss, anemia, low blood pressure) 2. Unstable angina - Increased demand for oxygen ( rapid HR, ingestion of - also called preinfarction angina, intermittent coronary cocaine) syndrome. - occurs with an unpredictable degree of exertion or Risk Factors emotion 1. Cigarette smoking - increases in occurrence, duration, and severity over 2. Hyperlipidemia time 3. Diabetes - Pain may not be relieved with nitroglycerin. 4. Obesity 5. Sedentary lifestyle 3. Variant angina 6. Stress - also called Prinzmetal’s or vasospastic angina. 7. Sex : men – older than 50 yrs. Old women – - results from coronary artery spasm. postmenopausal - may occur at rest 8. Family history - prolonged and severe, and occurs at the same time of the day, most often in the morning Assessment findings: 4. Intractable angina 1. Pain - accumulation of metabolites within the ischemic - is a chronic incapacitating angina that is unresponsive part to interventions - same as in angina - crushing with sudden onset 5. Angina decubitus - UNRELIEVED by rest or nitrates - a paroxysmal chest pain that occurs when the client 2. nausea/vomiting, dyspnea reclines and lessens when the client 3. skin: cool, clammy, ashen 4. elevated temperature 6. Postinfarction angina 5. initial increase in BP and pulse, with gradual drop in BP - occurs after an MI, when residual ischemia may cause 6. Restlessness episodes of angina. 7. Occasional findings: rales or crackles 7. Nocturnal Angina - possibly associated with rapid eye movement sleep during dreaming Acute myocardial infarction care Diagnostic and Lab tests for cardio management vascular diseases 1. Salvage myocardium/limit infarction size DIAGNOSTIC TESTS a. thrombolytic therapy - dissolve/break up blood Purpose: clots - Assist in iden fying the causes of cardiac related signs b. intra-aortic balloon pump - ↑ myocardial O2 and symptoms perfusion - Identify abnormalities that affect the prognosis of the c. PTCA – percutaneous transluminal coronary patient angiography - Screen for risk factors associated with CAD o angioplasty - opens the narrowed arteries - To determine baseline values before initiating o Stenting - stops the vessel from collapsing interventions. 2. Improve myocardial oxygen supply Cardiac biomarkers a. supplemental oxygen  CK-MB - Creatine- Kinase Myocardial Bound ( most b. aspirin - prevent platelet adherence on coronary specific) artery  LDH - Lactic Dehydrogenase c. heparin - dissolves blood clot  Myoglobin - released from myocardium within 2 hours of coronary occlusion 3. Decrease myocardial oxygen demand  Trop I or Trop T - proteins involved in muscle a. mechanical assist devices contraction b. bedrest c. NPO, liquid or soft diet Blood chemistry d. beta-adrenergic blocking agents - interferes w/ the  Lipid profile - Cholesterol, triglycerides & lipoproteins binding to the receptors of epinephrine and other  Na - helps send electrical signals between cells and stress hormones controlling the amount of fluid in the body  Potassium - Has major role in cardiac electrophysiology 4. Decrease preload (except RV infarction) function a. morphine sulfate – relief of moderate to severe pain  Calcium - necessary for blood coagulability, b. Nitroglycerin – widens or dilates the arteries neuromuscular activity and automaticity of the nodal c. diuretic agents – leaves less water to be reabsorbed cells (sinus and atrioventricular node) into the blood  Magnesium - plays a major role in muscular contraction 5. decrease afterload a. morphine sulfate (B-type) natriuretic peptide (BNP) b. NTG ( nitroglycerine) - widens or dilates the arteries - a neurohormone that helps regulate BP and Fluid c. Calcium channel blocking agent (CCB) - reduce volume coronary vasospasm - ↓ BP by relaxing the smooth - secreted from the ventricles in response to increased muscle preload with resulting elevated ventricular pressure d. ACE inhibitors - reduce tension of blood vessels and - useful for prompt diagnosis of HF reduce blood volume C-reactive protein (CRP) 6. increase contractility - a protein produced by the liver in response to systemic a. positive inotropics (dobutamine, dopamine) - inflammation. increases contractility and CO - Inflammation is thought to play a role in the development and progression of atherosclerosis 7. maintain electrophysiologic stability 1. lidocaine - antiarrythmic - Na channel blocker Homocysteine 2. amiodarone - slows intracardiac conduction - K+ - an amino acid, is linked to the development of channel blocker atherosclerosis because it can damage the endothelial 3. beta-adrenergic blocking agents lining of arteries and promote thrombus formation. 4. calcium channel blocking agents 5. magnesium sulfate / potassium chloride 8. maintain hemodynamic stability a. volume loading to provide adequate pressure loading e.g. IVF b. vaso-active medications (dopamine, norepinephrine) Hematologic studies Left-Sided Heart Failure 1. CBC - Decreased cardiac output, pulmonary congestion. 2. WBC - Symptoms include shortness of breath and fatigue 3. Hemoglobin and hematocrit 4. Platelets Right-Sided Heart Failure 5. BUN, Creatinine - Impaired blood flow to the lungs, systemic congestion. 6. Glucose - Symptoms include edema and ascites. 7. Glycosylated hemoglobin (HbA1C) - hemoglobin which is bound to glucose Common Signs and Symptoms of CHF 8. Coagulation studies  Dyspnea (shortness of breath)  Fatigue Coagulation studies  Edema 1. PTT - partial thromboplastin time  Coughing or wheezing 2. PT - protime  Increased urination at night 3. INR - international normalized ratio Risk Factors Other exams  Hypertension (high blood pressure) 1. ECG - Most important initial diagnostic procedure  Diabetes 2. Chest x- ray  Obesity 3. Continous cardiac monitoring  Coronary artery disease (CAD) 4. Cardiac stress testing  Family history of heart disease 5. Echocardiography  Lifestyle factors such as smoking or sedentary behavior 6. Cardiac catheterization Management Hemodynamic Monitoring  Dietary changes (e.g., heart-healthy diet) - Critically ill patients require continuous assessment of  Regular physical activity their cardiovascular system to diagnose and manage  Medications to control blood pressure and diabetes if their complex medical conditions necessary Central Venous Pressure Monitoring Diagnostic Tools - is a measurement of the pressure in the vena cava or  history and physical examination. right atrium - 2 to 6 mm Hg or 5-10cmH2O  Imaging (e.g., echocardiogram).  Blood tests (e.g., BNP levels) Pulmonary Artery Pressure Monitoring - used in critical care for assessing left ventricular Medications function, diagnosing the etiology of shock, and  Diuretics evaluating the patient’s response to medical  ACE inhibitors interventions (e.g., fluid administration, vasoactive  beta-blockers medications  aldosterone antagonists.  Importance of adherence to medication regimen Lifestyle Modifications Congestive Heart Failure  Dietary changes (e.g., low sodium). - A chronic condition where the heart is unable to pump  Regular exercise as tolerated. sufficient blood to meet the body's needs.  Monitoring weight and symptoms. Major Risk Factors Advanced Therapies  Hypertension  Device therapy (e.g., ICD, CRT)  Coronary artery disease  Heart transplantation for eligible patients  Diabetes  Obesity  Smoking  Age  Family history