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Coronary Artery/Heart Disease - HPA
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- 1EpidemiologyCardiovascular disease (CVD) is the leading cause of death in Australia and was the underlying cause of death in 43,946 Australian deaths in 2012 (30% of all deaths)
Where CVD was listed as underlying cause of death:
•46% were due to coronary heart disease (CHD) - 2Risk factors (modifiable and non-modifiable)-Non-Modifiable
Age
Gender
Genetics
-Modifiable
HTN, DM,Hyperlipidaemia, Obesity, Diet, Lifestyle - 3Cause of coronary artery diseaseLargely by the formation and possible proliferation of scleroses in blood vessels which are thought to occur due to blood vessel damage
- 4ArtherosclerosisLipids accumulate in the intimal layer of arteries, fibroblasts,in the area respond by producing collagen and smooth muscle proliferate together forming a complex lesion called plaque, plaque consists of mostly cholesterol, triglycerides, phospholipids, collagen of cholesterol and smooth muscle cells. Plaque reduces lumen size of the affected artery impairing blood flow.
- 5Angina (stable & unstable)Stable angina is chest pain caused by moderate to heavy exercise, while unstable angina doesn't have a predictable trigger- unpredictable, increasing in frequency, severity and duration, may occur at rest.
- 6Pathophysiology behind anginamyocardial needs is greater than what is supplied by the partially occluded blood vessel. Myocardial cells become Ischemic and shift to anaerobic metabolism which produces lactic acid that stimulates nerve ending in the muscle causing pain.
- 7Acute coronary syndrome & myocardial infarctionOccurs when the complete of coronary artery interrupts blood supply to an area of myocardium. Affected area becomes ischaemic and eventually dies (myocardial infarction)
- 8Symptoms of artherosclerosisCould be asymptomatic until an area of the heart no longer receives sufficient oxygen which may lead to angina
- 9Three types of angina and differencesStable- most predictable occurs after physical exertion exposure to cold or by stress. Relieved by rest and nitrates .
Unstable- pain is unpredictable, increasing in frequency, severity and duration, may occur at rest.
Prinzmetal's(Variant)- Unpredictable and appears often at night unknown cause but it is due to coronary artery spasm with or without artherosclerotic lesion. - 10Classic signs of myocardial infarctionChest pain radiating to left arm
Tachycardia, tachypnoea
Dyspnoea, SOB
N&V
Anxiety sense of impending doom
Diaphoresis
Diminished peripheral pulse
Arrhythmias
Decreased LOC
Signs of left heart failure - 11Relevant examinationsTotal serum cholesterol
C-reactive protein serum protein associated with inflammation process and elevated blood levels of these protein can be of CHD
Ankle brachial blood pressure index (ABI) an ABI <0.9 in either leg indicates the presence of peripheral artery disease
Exercise ECG testing
Electron beam computed tomography
Myocardial perfusion imaging
ECG
Stress electrocardiography
Coronary angiography (gold standard) - 12Examinations specific for MISerum cardiac markers
Creatinine kinase(CK)- CK level correlates the size of the infarction
CK-MB CK specific to cardiac muscle CKMB greater than 5% is a positive indicator of MI
Cardiac muscle troponin cardiac troponin are not detectable in the blood unless there is a cardiac necrosis
Myoglobin first cardiac marker after an MI - 13Nursing assessmentsCardiac - various abnormalities may be heard on auscultation: third and fourth heart sound, systolic murmurs, paradoxical splitting of the second heart sound, a pericardial friction rub and rales over the lung.
Other vitals, LOC
Pain scale /PQRST - 14Relevant meds for artherosclerosis- Statins (pravastatin) or other hypolipidaemics
- Aspirin to prevent clotting
- HTN medications if relevant - 15Relevant meds for angina- GTN can be used for prophylaxis/treatment
- Beta blockers can be used as a treatment - 16Relevant meds for MI- GTN
- Aspirin
-Morphine
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- El usuario ha eliminado su información de asignaturas Fichas sobre Coronary Artery/Heart Disease - HPA, creado por Usuario eliminado el 11/06/2018.
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- Creado por Em J · 11 jun 2018
- Copiado por Em J · 11 jun 2018
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