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nbcot Coronary Artery Disease
Review of Heart Disease
Terms in this set (79)
Define Coronary artery disease
Coronary atherosclerosis leading to coronary arterial narrowing and ischemia to myocardium
Thickening of the intimal layer of the blood vessel wall from accumulation of lipids
*depends on presence or absence of risk factors
Increases with age and presence of risk factors
Good with early detection and treatment
CAD non-modifiable risk factors
*significant family history
CAD modifiable risk factors
*high blood pressure
*elevated cholesterol levels
CAD Contributing risk factors
3 Main Clinical Syndromes of CAD
*Congestive Heart Failure
Angina Pectoris is clinical manifestation of:
Angina Pectoris is characterized by:
mild to moderate substernal chest pain/discomfort felt as:
*pressure or dull ache in the chest and left arm
* may also be felt anywhere in the upper body including neck, jaw, arm, epigastric area.
How long does angina pectoris pain last?
Usually less than 20 minutes due to transient ischemia.
Angina pectoris represents an imbalance in myocardial oxygen supply and demand brought on by:
*-increased demands on heart (exertion/exercise, emotional upsets,smoking, extremes of temperature, overeating, tachyarrhythmias)
*-vasospasm: symptoms may be present at rest.
2 types of angina
Classic exertional Angina...relieved with rest and/or sublingual nitroglycerin.
*coronary insufficiency with risk of myocardial infarction or sudden death
*Pain is difficult to control
*Presents with low level activity or rest
*-Prolonged Ischemia, injury, and death of an area of the myocardium caused by occlusion of one or more of the coronary arteries.
*-Results in necrosis of heart tissue.
Precipitating factors of Myocardial Infarction (MI)
*-Atherosclerotic Heart Disease with thrombus formation
*-coronary vasospasm or embolism
Sings and symptoms of MI
*-Severe substernal pain longer than 20 minutes which may radiate to neck, jaw, arm, epigastric area
*-Dyspnea, rapid respiration, shortness of breath
*-Indigestion, nausea, and vomitting
*-Pain may be misinterpreted as indigestion
*-Pain unrelieved by rest and/or sublingual nitroglycerin
*-Q wave infarction
*-Full thickness of myocardium
*-Non Q wave infarction
*-subendocardial, subepicardial, intramural infarctions
Right Coronary Artery Occlusion
*-Right Ventricle infarction
*-Disturbances of upper conduction system
Circumflex Artery Occlusion
Left Anterior Descending Artery Occlusion
*-Disturbances of Lower conduction system
Results of impaired ventricular function
*-Decreased stroke volume, cardiac output and ejection fracture
*-Increased end diastolic ventricular pressure.
(MI) injured and ischemia ares present with:
Congestive heart failure (CHF) also known as
Congestive Heart Failure
Condition when the heart is unable to maintain adequate circulation of the blood to meet the metabolic needs of the body.
Etiology of Congestive Heart Failure
may be caused by:
*-Coronary Artery Disease
*-Congenital Heart Disease
Physiological Abnormalities of Congestive Heart Failure
*-Decreased cardiac output
*-Elevated end diastolic pressures (preload)
*-increased heart rate
*-impaired ventricular contractility
Left Heart Failure
*-Blood is not adequately pumped into systemic circulation
*--due to inability of left ventricle to pump blood out of lungs, increases in ventricular end-diastolic pressure and left pressures .
Clinical symptoms of L Heart Failure
*-Dyspnea:exertional, orthopnea, and oxysmal nocturnal
*-Cough, rales, wheezing
*-Tachycardia, change in heart sounds
Clinical symptoms of R Heart Failure
*-Peripheral edema: weight gain, dependent edema, venous stasis
*-Change in heart sounds
Right Heart Failure
*-Blood is not adequately returned from systemic circulation to the heart
*-due to failure of right ventricle, increased pulmonary artery pressures.
Heart Disease Class 1
*-heart disease; no limits to activity, no complaints.
*- Max MET 6.5
Heart Disease Class 2
*-slight activity limit, comfort at rest, ordinary activity results in fatigue, pain, dyspnea, palpitations.
*-Max MET 4.5
Heart Disease Class 3
*-marked limitations; comfort at rest, less than ordinary activity, fatigue, palpitations, dyspnea, angina pain.
*-Max MET 3.0
Heart Disease Class 4
*-inability to carry out physical activity without discomfort, cardiac insufficiency present at rest, increased discomfort with an activity.
*-Max MET 1.5
CAD Diagnostic procedures
*-Cardiac stress test
*-Pulmonary function test
Purpose of chest x-ray (CAD)
Evaluate evidence of :
*-Congestion in lungs
*-Heart chamber hypertrophy
Purpose of Electrocardiogram (CAD)
*-ID Cardiac Arrhythmias
*-Assess amount and location of damage to myocardium
*-Determine adequacy of oxygenation of myocardium
Purpose of Holter Monitor (CAD)
*-Records ECG signals over a 24 hour period while person engages in normal daily routine to determine heart function during various activities.
Purpose of Echocardiogram (CAD)
*-Ultrasound used to record size, structure, and motion of the heart and vessels.
*- Reveals valvular defects and structural abnormalities
Purpose of Cardiac stress test (CAD)
*-Records cardiac activity during graded exercise.
*-Used to determine the extent to which cardiac disease affects functional capacity.
*-Provides guidelines related to the type and amount of physical activity that a person can engage in safely.
Purpose of Cardiac Catheterization (CAD)
*-Invasive procedure used to visualize coronary circulation to determine the degree of CAD, congenital heart defect, valvular disease, myocardial damage
Purpose of Pulmonary function Test (CAD)
*-Used to determine cause of dyspnea, degree of lung disease
*-Provides information related to endurance potential for functional activities.
Dietary interventions for CAD
5 Surgical interventions for CAD
*-Ventricular assistive devices (VADs)
*-Under fluoroscopy, surgical dilation of a blood vessel using balloon tipped catheter inflated inside lumen
*-Inserted into femoral artery and guided through the arterial system into coronary arteries
Results of angioplasty
*-Relieves obstructed blood flow in acute angina or acute MI
*-Improved coronary blood flow
*-Improved left ventricular function
Pliable wire mesh implanted post angioplasty to prevent restenosis and occlusion in coronary or peripheral arteries
Coronary Artery Bypass Grafting (CABG)
CABG results in:
*-Improved coronary blood flow and left ventricular function
Used in end-stage myocardial disease:
*-Ischemic Heart Disease
*-Valvular Heart Disease
Leaving the natural heart and piggy-backing the donor heart
Removing the diseased heart and replacing with a donor heart
Heart and lung transplant
remove both organs and replace with donor organs
Major problems post-transplant
*-complications on immunosuppressive therapy
Ventricular Assistive devices (VADs)
Implanted accessory pump that improves tissue perfusion and maintains cardiogenic circulation.
Ventricular Assistive devices are used with severely involved patients
*-Unresponsive to medication
*-severe ventricular dysfunction
*-awaiting heart transplant
VADs are often called
"bridge to transplantation"
Thrombolytic Therapy for acute MI
*-Medications administered to activate body's fibrinolytic system.
*-Restores coronary blood flow
2 types of Peripheral vascular disease (PVD)
3 types of Arterial disease
*-Thromboangiitis obliterans (Buerger's disease)
Chronic, occlusive arterial disease of medium and large sized vessels
Arteriosclerosis obliterans is associated with
Arteriosclerosis obliterans affects
primarily lower extremities
Chronic inflammatory vascular occlusive disease.
How does Thromboangiitis obliterans progress?
Begins distally and progresses proximally in both lower and upper extremities.
Symptoms of Thrombangiitis obliterans
*-diminished temperature sensation
*-risk of ulceration and gangrene
Thromboangiitis obliterans is most common with this population
young males who smoke
5 types of venous disease
*-Deep vein thrombosis
*-Chronic venous insufficiency
*-lymphatic disease (lymph-edema)
Distended, swollen superficial veins
Deep Vein Thrombosis (DVT)
*-Inflammation of a vein associated with formation of thrombus
*-usually occurs in lower extremities
Signs and symptoms of DVT
*-change in lower extremity temperature
DVT may be contributing factor to or complication of
DVT may be result of
Prolonged bed rest during serious illness
Lymphatic Disease (lymph-edema)
*-Excessive accumulation of fluid due to obstruction of lymphatics
*-Causes swelling of soft tissues in arms and legs
*-Abnormal vasoconstriction reflex exacerbated by exposure to cold or emotional stress
*-affects largely females
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