This document discusses coronary artery disease and myocardial infarction. Coronary artery disease occurs when the coronary arteries become narrowed or blocked, limiting blood flow to the heart and potentially causing chest pain or a heart attack. Risk factors include family history, age, gender, hypertension, smoking, obesity, diabetes, and physical inactivity. A heart attack occurs when an area of the heart muscle dies due to lack of oxygen from a blockage of blood flow. Symptoms include chest pain and potential complications are addressed through medications, surgery, monitoring, and lifestyle changes to manage risk factors and prevent future events.
This document discusses coronary artery disease and myocardial infarction. Coronary artery disease occurs when the coronary arteries become narrowed or blocked, limiting blood flow to the heart and potentially causing chest pain or a heart attack. Risk factors include family history, age, gender, hypertension, smoking, obesity, diabetes, and physical inactivity. A heart attack occurs when an area of the heart muscle dies due to lack of oxygen from a blockage of blood flow. Symptoms include chest pain and potential complications are addressed through medications, surgery, monitoring, and lifestyle changes to manage risk factors and prevent future events.
This document discusses coronary artery disease and myocardial infarction. Coronary artery disease occurs when the coronary arteries become narrowed or blocked, limiting blood flow to the heart and potentially causing chest pain or a heart attack. Risk factors include family history, age, gender, hypertension, smoking, obesity, diabetes, and physical inactivity. A heart attack occurs when an area of the heart muscle dies due to lack of oxygen from a blockage of blood flow. Symptoms include chest pain and potential complications are addressed through medications, surgery, monitoring, and lifestyle changes to manage risk factors and prevent future events.
This document discusses coronary artery disease and myocardial infarction. Coronary artery disease occurs when the coronary arteries become narrowed or blocked, limiting blood flow to the heart and potentially causing chest pain or a heart attack. Risk factors include family history, age, gender, hypertension, smoking, obesity, diabetes, and physical inactivity. A heart attack occurs when an area of the heart muscle dies due to lack of oxygen from a blockage of blood flow. Symptoms include chest pain and potential complications are addressed through medications, surgery, monitoring, and lifestyle changes to manage risk factors and prevent future events.
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CORONARY ARTERY DISEASE
The disorder of the coronary arteries that
disrupts bld supply to the myocardium. Permanent disruption of bld flow causes myocardial dysfxn, including sudden death.
CARDIOVASCULAR RISK FACTOR PROFILE family hx of heart dse sex Males: 35-55yrs - Females: > 50 yrs or p menopause hpn smoking overwt or obesity elevated serum level of lipids & fats DM physical inactivity; sedentary lifestyle stress for women < 50 yrs: use of estrogen & smoking ATHEROSCLEROSIS the basic underlying dse affecting coronary lumen size, is marked by changes in the intimal lining of the arteries. - obstructions of more than 75% of the lumen of one or more of the three coronary arteries inc. the risk of death.
ANGINA PECTORIS chest pain - used to describe pain as a symptom of myocardial ischemia w/c is the result of an imbalance bet myocardial O2 supply & demand.
MYOCARDIAL INFARCTION development of ischemia & necrosis of myocardial tissue. It results from the sudden decrease in coronary perfusion or an increase in myocardial O2 demand w/o adequate coronary perfusion
PATHOPHYSIOLOGY Waxy cholesterol plaque - Pearly grey mounds of tissue Deposit in the inner lining of the arteries Rough surface Attract platelet & fibrin Narrowing & less vessel wall surface Prevent absorption of nutrients by vessel wall Vessel wall weakens Distension of the vessel wall aneurysm Depress adjacent tissues rupture hemorrhage Blocking of vessel amt of bld the different parts of the heart Myocardial ischemia Angina pectoris Sudden cardiac death Myocardial infarction Area of concern Stable angina pectoris Variant (Prinzmetals) angina Unstable angina pectoris Myocardial infarction Chest Pain quality Aching, sharp, tingling or burning Similar to stable angina Similar to stable angina Crushing, squeezing,sta bbing, oppressive or as if a heavy obj sitting on the chest location & radiation Substernal w/ radiation to L shoulder, down the inner aspect of L or both arms; neck, jaw, & scapula Similar to stable angina Similar to stable angina Retrosternal & L precordial radiating down L arm & to the neck, jaws, teeth, epigastric area, & back Area of concern Stable angina pectoris Variant (Prinzmetals) angina Unstable angina pectoris Myocardial infarction Precipitating factors Exercise or activity that myocardial O2 demand Onset at rest; pain is cyclic, often occuring during sleep Pain may be brought on w/ less than usual exertion; may occur at rest May occur at reat or during exercise Duration & alleviating factors 3-15 mins; relieved by rest, stopping pain-inducing activies, nitroglycerine SL Pain intensifies quickly, tends to last longer than angina & subsides w/ exercise Prolonged & not ususally as quickly relieved by rest or taking nitroglycerine Continuous, lasting more than 30 mins, unrelieved by rest, position change or taking nitroglycerine Diagnosis ECG Cardiac enzymes CBC, ESR lipid levels Exercise Stress Test Cardiac catherterization & angiography Cardiac profile Cardiac enzyme Normal value with Acute Myocardial Infarction onset peak Duration Troponin I 0 ng/ml (> 1.5 ng/ml is dx for MI) 3.5 7 hrs 4 6 days CPK 96 140 IU/L (F) 38 174 IU/L (M) 4 6 hrs 12 - 24 hrs 3 -4 days CPK MB 0 24 48 hrs 12 24 hrs 2 3 days SGOT 6 18 IU/L (F) 7 21 IU/L (M) 12 18 hrs 24 48 hrs 3 -4 days LDH 70 180 mg/dl 24 48 hrs 3 6 days 7 10 days Other associated manifestations anxiety dyspnea nausea & vomiting cold clammy skin epifastric pain low grade fever leucocytosis ECG changes - injury: elevated ST - ischemia: inverted T wave - infarction: significant or deep Q wave Management medications - vasodilators - antihyperlipidemic agents - streptokinase - antiplatelet agent (aspirin) - diperidamole surgery - CABG (Coronary Artery Bypass Grafting)
- PTCA (Percutaneous Transluminal Coronary Angioplasty) general mgt - CV monitoring: arrhythmias, heart failure, extension of MI, cardiogenic shock, ventricular muscle rupture - ECG - IABP (Intra-Aortic Balloon Pump) - admission to CCU - Diet: Acute phase NPO or clear liquids progressing to 1500 cal, soft, low salt; no caffeine; small frequent feedings Discharge diet reduced saturated fats, cholesterol, Na restriction, limit total caloric consumption to maintain IBW - oxygenation Angina Pectoris 1. Stop activity. Rest 2. Nitroglycerine SL 3. Pearls of Amyl nitrate 4. Whiskey or brandy 5. Beta-blockers 6. Ca channel blockers Myocardial infarction 1. Reduce pain & promote comfort Morphine SO4; O2; semifowlers 2. Maintain adequate bld circulation 3. CBR 4. Diet 5. Facilitate fecal elimination 6. Promote adequate sexual expression 7. Encourage gradual return to usual activities NSG MGT
