Chapter 28 management of cardiovascular disease 2.pdf

Chapter 28 Management of Patients With Coronary Vascular Disorders Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement True or False? Individuals at highest risk for a cardiac event within 10 years are those with ex...

Chapter 28 Management of Patients With Coronary Vascular Disorders Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement True or False? Individuals at highest risk for a cardiac event within 10 years are those with existing coronary artery disease. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True Loading… Individuals at highest risk for a cardiac event within 10 years are those with existing coronary artery disease and those with diabetes, peripheral arterial disease, abdominal aortic aneurysm, and carotid artery disease. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins  d Coronary Atherosclerosis Atherosclerosis is the abnormal accumulation of lipid deposits and fibrous tissue within arterial walls and lumen. In coronary atherosclerosis, blockages and narrowing of the coronary vessels reduce blood flow to the myocardium. Cardiovascular disease is the leading cause of death in the United States for men and women of all racial and ethnic groups. CAD, coronary artery disease, is the most prevalent cardiovascular disease in adults. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins  Causes; Nonmodifiable Risk Factors Family history of CAD (first-degree relative with cardiovascular disease at 55 years of age or younger for men and at 65 years of age or younger for women) Increasing age (more than 45 years for men; more than 55 years for women) Loading… Gender (men develop CAD at an earlier age than women) Race (higher incidence of heart disease in African Americans than in Caucasians) Modifiable Risk Factors Hyperlipidemia, Cigarette smoking, tobacco use. Hypertension Diabetes, Metabolic syndrome Obesity , Physical inactivity Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Pathophysiology of Atherosclerosis Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Coronary Arteries Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins  Clinical Manifestations Symptoms are due to myocardial ischemia Symptoms and complications are related to the location and degree of vessel obstruction A Angina pectoris & , mp & Myocardial infarction what the Symptoms of Coronary Atherosclerosis ↑ Heart failure & Sudden cardiac death Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins  Question Which is considered a modifiable risk factor for coronary artery disease? A. Race B. Gender C. Family history D. Cigarette smoking Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer D A modifiable risk factor for coronary artery disease is cigarette smoking. Race, gender, and family history are nonmodifiable risk factors. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins  The most common symptom of myocardial ischemia is chest pain; however, some individuals may be asymptomatic or have atypical symptoms such as Loading… weakness, dyspnea, and nausea. Atypical symptoms are more common in women and in persons who are older, or who have a history of heart failure or diabetes. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins  Prevention Controlling Cholesterol Abnormalities; Normal LDL cholesterol less than 100 mg/dL (less than 70 mg/dL for very high-risk patients) Total cholesterol less than 200 mg/dL HDL cholesterol greater than 40 mg/dL for males and greater than 50 mg/dL for females Triglyceride less than 150 mg/dL Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins  Dietary Measures Nutrient Recommended Intake Total calories Balance intake & expenditure Total fat 25-35% of total calories Saturated fat