crit exam2 more heart stuff

Coronary Artery Disease caused by

atherosclerosis

CAD risk factors modifiable

smoking, inactivity, overweight, diabetes, HTN, cholesterol (high LDL, low HDL)

nonmodifiable risk factors of CAD

age (more than 65 yrs old)

african, mexican, native & asian american descent

males

women after menopause (death rate higher)

CAD includes 3 dx categorized as acute coronary syndrome which are

1) unstable angina

2) NSTEMI

3) STEMI 

angina pectoris (stable angina) is caused by

physical exertion & emotional stress

symptoms of angina pectoris

pressure, fullness, squeezing, heaviness and pain in chest

how is angina pectoris alleviated

rest or nitroglycerin

myocardial infarction

blood flow to myocardium is blocked causing prolonged ischemia resulting in tissue death from lack of oxygen

MI assessment

midsternal chest pain: “my chest is being squeezed & crushed”

• severe, crushing pressure, can radiate to arms, unrelieved with nitroglycerin

pale & diaphoretic

dyspnea, tachypnea, hypotension, dysrhythmia

syncope, n/v

feeling of impending doom

MI physical exam

restless, agitated & in distress

skin is cool and moist

vitals show low grade fever, hyper/hypotension, tachy/bradycardia

irregular faint pulse

diminished S1, S2 & S3 pericardial friction rub

JVD, HF, PE

labored breathing, crackles, rhonchi

MI management: Percutaneos Coronary Intervention

catheter inserted into artery

artery is opened y balloon tip & stent is placed

reestablishes blood flow

used for pts who present within 12 hrs

MI management: Fibrinolytic/thrombolytic Therapy

tenecteplase(TNK), tissue plasminogen activator (TPA)

clot busting drugs used to dissolve blood clots that are blocking coronary artery during STEMI

in stemi—> give within 30 mins of hospital admin

MI also managed with

CABG

cardiogenic shock

hemodynamic complication of acute MI

*most serious complication

cardiogenic shock sx

rapid thready pulse

cool moist skin

chest pain

dyspnea, tachypnea

inspiratory crackles

SBP less than 85

ventricular septal rupture

mechanical complication of acute MI

*greatest risk within first 24 hrs & lasts up to 5 days

symptom of ventricular septal rupture

new loud systolic murmur

CABG

surgical procedure that improves blood flow to myocardium, done to revascularize ischemic areas of heart

• surgeon creates bypass for blood to flow around the blocked arteries

• blood vessels taken from other part of body & grafted so oxygenated blood reaches myocardium

CABG procedure provides additional conduits for blood flow in..

1) saphenous vein (leg)

2) internal mammary artery

3) radial artery