229 Ch 23 Lecture

Cardiovascular Risk Reduction in Adults

Guidelines for Assessments and Panels

• Screening Frequency:

  • Adults aged 20 and older should receive a fasting lipid panel every 5 years.

  • More frequent testing is required for patients with abnormal results, previous myocardial infarction (MI), or open-heart surgery.

Dietary Recommendations

• Dietary Focus:

  • Emphasize plant-based foods: fruits, vegetables, and whole grains.

  • Minimize intake of red meat and processed foods.

Smoking Cessation

• Impact of Smoking:

  • Smoking is a significant risk factor, leading to hypertension, which is defined as blood pressure ≥ 130/80.

Understanding Acute Coronary Syndrome (ACS)

Definition and Types

• Acute Coronary Syndrome:

  • An emergency condition characterized by acute onset of myocardial ischemia leading to myocardial death without prompt intervention.

  • Types:

    • Unstable Angina

    • Non-ST Elevation Myocardial Infarction (NSTEMI)

    • ST Elevation Myocardial Infarction (STEMI)

Symptoms and Diagnosis

• Symptoms:

  • Chest pain that may be severe or present with shortness of breath, nausea, and anxiety.

• Diagnostic Tests:

  • Electrocardiogram (EKG): Should be performed within 10 minutes of arrival at the emergency room to rule out MI.

  • Cardiac Enzymes: Troponins, myoglobin, and creatinine kinase (CK) help in diagnosing ACS based on the levels of these proteins in circulation after myocardial injury.

Initial Management of ACS

Emergency Interventions

• Immediate Actions:

  • Administer supplemental oxygen, nitroglycerin, and morphine for pain relief and to reduce cardiac workload.

  • Prepare for transport to the catheterization lab for percutaneous coronary intervention (PCI) within 60 minutes.

Medications for Treatment

• Thrombolytics:

  • Alteplase is used to dissolve thrombus which can be administered under strict time constraints for maximum efficacy.

Cardiac Rehabilitation Post-Procedure

Phases of Cardiac Rehabilitation

• Phase 1:

  • Education on diagnosis, signs and symptoms, and management post-discharge.

• Phase 2:

  • Supervised physical conditioning with gradual increase in activity levels.

• Phase 3:

  • Long-term outpatient rehabilitation directed by the patient and their family.

Surgical Procedures

• Coronary Artery Bypass Grafting (CABG):

  • Performed when arteries are >70% blocked, or >50% blocked in the left main artery.

  • Saphenous vein is often harvested to create a bypass.

  • Post-operative monitoring needed for complications like bleeding and decreased cardiac output.

Intraoperative Considerations

Role of Perfusionist

• Monitoring and Responsibilities:

  • Operate the cardiopulmonary bypass machine, maintaining blood flow and organ perfusion during surgery.

Postoperative Care

Recovery Monitoring

• Initial Care:

  • Monitor vital signs, hemodynamics, and ensure stable recovery from anesthesia.

  • Assess for cardiovascular complications and manage pain effectively.

• Educate Patients:

  • About self-care, recognizing complications, and medication adherence.