Post on 04-Jun-2018
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8/13/2019 Cardiovascular Disorders Angina
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Cardiovascular Disorders
Atherosclerosis
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Atherosclerosis
Risk factors
Non-modifiable
Gender
Genetics
Age
Culture/Ethnic
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Atherosclerosis
Modifiable Risk Factors
Smoking
Hyperlipidemia
Hypertension
Diabetes
Obesity
Sedentary lifestyle Stress
Psychosocial
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Notes
Psychosocial-type A personality aggressive, compulsive,perfectionism,
Diabetes encourages plaque formation. Changes to microvascular(collateral circulation) makes wall sticky and encourages clotformation platelet aggregation
Smoking is proportional to amount of cigarettes smoked.Catecholomine release causes tachycardia, increase in bloodpressure. Vasoconstriction of coronary arteries. Platelet adhesion
Smoking also decreases oxygen and increases carbon monoxide.
Diabetics tend to have higher ldl and vldl levels.
Sedentary lifestyle increases lipids, helps to lower blood sugar.
Reduces stress and lowers blood pressure. Stress increases catecholomines, increase heart rate,.
Catecholomines are epinephrine, norepinephrine and dopamine
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Atherosclerosis
Coronary arteries arise from the coronary sinus
from the base of the Aorta
Provide nutrients to cardiac muscle
CAD
Obstruct blood flow to the heart muscle
Lumen is obstructed
Causes ischemia
Supply of nutrients does not meet demand
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Notes
Ischemia- decreased blood supply to an
organ
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Atherosclerosis
Symptoms are related to the amount of
obstruction
Death may occur if left untreated
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Angina Pectoris
Angina-spasmodic, cramp like, choking feeling
Pectoris-chest/ Breast area
Decreased blood supply when moreoxygenated blood is needed
Cold
Stress
Exertion
Anxiety
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Notes
Cold causes vasoconstriction
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Angina Pectoris
Unstable
Occurs at rest
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Angina Pectoris
Signs and Symptoms Pain
Chest, back, jaw, throat, left arm, shoulder, neck
Dyspnea
Anxiety
Apprehension
Diaphoresis
nausea
Symptoms in women may appear differently than inmen
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Notes
Heaviness or tightness to chest, feels like
indigestion, denial, squeezing,
Women-palpitations, chest discomfort
during rest, pain in abdomen,
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Angina Pectoris
Treatment
Usually can be relieved by rest since pain iscaused by temporary lack of oxygen supply tothe heart
Assess vital signs
Administer oxygen Check ECG monitor
Nitroglycerin SL X 3, 5 minutes apart PRN Vasodilator
Angina Pectoris can be a precursor to an MI
Notify MD if Nitroglycerin is not effective, thiscould be a sign of MI
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Notes
Always check blood pressure prior to
administering nitroglycerin since it is a
vasodilator
Causes headache due to vasodilation of
cerebral vessels/ warn patient
Tell story of pt in room 259
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Angina Pectoris
Assessment
Subjective
Pain- assess location, intensity, radiation, duration,
precipitating factors
What reliefs the pain?
Have the episodes of pain increased?
Is the pain becoming more severe
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Angina Pectoris
Objective Data
Look for signs the patient may be in pain such as
rubbing elbows or chest
Note any changes in vital signs such as
tachycardia, increase in blood pressure
Diaphoresis
Anxiety Pale
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Angina Pectoris
Diagnostic Tests
ECG
Rhythm changes or elevation
Holter Monitor
Exercise Stress Test
Thallium Scanning
PET
Coronary Angiography
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Notes
Make sure students know that a patient
maintains a journal during a holter monitor
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Angina Pectoris
Medical Management
Control Symptoms
Daily Aspirin
Vasodilators
Beta-adrenergic blocking agents
Calcium channel blocking agents
Nitroglycerin SL
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Angina Pectoris
Surgical Interventions
Angioplasty (PTCA)
Stent Placement
CABG
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Angina Pectoris
Surgical Interventions PTCA (Percutaneous Transluminal Coronary
Angioplasty Invasive Sterile technique Performed by Cardiologist Sign consent for CABG due to potential for complications Done under Fluoroscopy Need sedation Assess for allergy to iodine, shellfish, contrast
Femoral or Brachial artery is used to cannulate the coronaryarteries
Complications include hemorrhage, vessel closure, need forsurgery, MI,
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Angina Pectoris
Treatment
Coronary Stent Placement
Expandable, meshlike structure
Designed to help hold the arterial wall open
Need to have anticoagulant therapy
Sedation usually given
Assess for allergy to shellfish, iodine, contrast
Complications include hemorrhage at insertion site,
injury to arterial wall, dysrhythmias, emergencysurgery, stent thrombosis, acute MI
Hospital stay for 1-3 days
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Angina Pectoris
Treatment
CABG (Coronary Artery Bypass Graft)
Surgical management
Veins from legs or internal mammary artery is
used
Patient requires at least one night stay in ICU and
about 5 days in the hospital Cardiac rehabilitation is usually ordered afterward
Patient should not use a trapeze bar
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Notes
Internal mammary is preferred since this is
more like an artery. Veins need to be
turned inside out due to valves
Internal mammary artery lasts longer (15
years)
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