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Caring for CHD and D
PN 102-Chp. 26
| Question | Answer |
|---|---|
| Name five lifestyle risk factors for heart disease. | smoking, obesity, physical inactivity, diet high in saturated fat, oral contraceptives. |
| Name four physiologic factors in CHD. | high blood pressure, DM, high blood lipids, metabolic syndrome |
| What is metabolic syndrome? | It is combination of medical disorders that increase the risk of developing HD cardiovascular disease |
| Name the eight disorders that make up metabolic syndrome. | abdominal obesity, hyperlipidemia, hyperetension, insulin resistance,clotting and inflammation tendencies, high homocystene levels, premature menopause. |
| What are homocystines? | They are an amino acid found in the blood from the breakdown of certain food and can cause heart damage |
| At what numbers is blood pressure considered to be too high? | 140/90 and over |
| What is LDL? | Low density lipoproteins (bad cholesterol) |
| What is VLDL? | Very Low Density Lipoproteins (really bad cholesterol) |
| What is HDL ? | High Density Lipoproteins. (Good cholesterol) |
| How does LDL and VLDL cause damage to the circulatory system? | The cause the formation on plaque in arteries. (artherosclerosis) |
| Why is HDL considered healthy? | They help clear LDL and VLDL cholesterol from the arteries and transport it to the liver for excretion. |
| What is artherosclerosis? | Plaque in medium and large arteries |
| How does it how does artherosclerosis cause damage? | Plaques builds up on artery walls and causes them to narrow thus lessening blood flow |
| What does ischemic mean? | A condition in which blood flow (and thus O2) is restricted to a part of the body. |
| What blood work is used to predict CHD? | Lipid panel and Serum C-reactive protein levels. |
| What does Serum C-reactive protein measure? | It is an indication of the level of inflammation in the circulatory system. |
| How much fat is recommended in the diet for heart health? | 25-35% of total daily calories. |
| What sort of fat is the best for heart health? | Monounsaturated |
| Name 3 sources of monounsaturated fats? | Olive oil, peanut oil, omega 3 fatty acids found in cold water fish. |
| Name the 4 classes of cholesterol lowering drugs | Statins, fiber acid derivatives, Bile acid sequestrants, nicotinic acids |
| How do statins drugs lower cholesterol? | They inhibit the formation of cholesterol in the liver or promotes its breakdown. |
| How do Bile acid sequestrants (aka resins) work to lower total cholesterol? | It binds cholesterol with a bile acid resin making it insoluble. It is then excreted. |
| What four ways do fiber active derivatives work to lower cholesterol? | 1)they stimulate the liver to breakdown VLDL to LDL. 2) they inhibit lipid formation 3) they stimulate catabolism of triglycerides 4)the increase the excretion of cholesterol in feces |
| What two ways do nicotinic acids lower cholesterol? | They inhibit the formation of VLDL, triglycerides and LDL. They raise HDL levels |
| What two ways are toxic effects of cholesterol drugs monitored? | Liver function testing and muscle enzymes are measured via blood tests |
| What are two common side effects of Nicotinic acids? | Niacin flush and pruitus |
| What can be a serious side effect of statin drugs? | muscle toxicity (myopathy/rhabdomyolysis) |
| How much aerobic exercise is recommended for heart health? | 30-45 minutes 4 to 6 times per week. |
| What is angina pectoris? | Chest pain that develops when there is temporary imbalance between myocardial blood supply and demand. |
| What usually increases angina pain? | Exercise, because it increases O2 demand |
| What are the 3 types of angina? | stable, unstable and Prinzmetal's |
| Which is the most common angina? | Stable |
| What 2 things cause stable angina pain? | Activity and stress |
| What two thing relieve stable angina pain? | rest and nitrates |
| Which form of angina is a sign of a possible MI? | Unstable |
| Name five symptoms of unstable angina. | It is unpredictable, it occurs at rest, it occurs with increasing duration, severity and frequency |
| What is Prinzmetal's angina? | An atypical angina caused by coronary artery spasm. |
| What are three of the signs of Prinzmetal's angina? | It occurs at the same time everyday, it occurs during sleep, it occurs without an identifiable cause. |
| How is it determined that angina is progressing toward an MI? | When it changes from stable to unstable |
| How long does the pain of angina usually last? | 15 minutes or less. |
| What are two risk factors for angina? | high blood lipids and DM |
| Name four tests used to dx angina. | electrocardiography, stress test, nuclear medicine studies and coronary angiography. |
| On a ECG what changes would one expect to see in wave formations? | During ischemia the ST segment is depressed and the T wave is flat or inverted. |
| What is the drug of choice for tx of acute angina? | sublingual nitroglycerin (NTG) |
| How soon does NTG act? | 1-2 minutes |
| How else can NTG be given besides sublingual? | Longer acting forms such as oral tablets, ointments and transdermal patch |
| Why are long acting forms of NTG given? | To pevent attacks not to tx acute phases |
| What other medications are often given to prevent angina? | Beta blockers |
| How do Beta blockers work? | They significantly slow heart rate |
| What two groups of people should never be given Beta blockers? | Pts with asthma and COPD-can cause bronchospasm |
| What other medication is often given for angina? | Daily low dose aspirin (81 mg) |
| What is percutaneous coronary revascularization (PCR)? | A surgical procedure to restore blood flow to the myocardium |
| How is percutaneous transluminal coronary angioplasty performed (PTCH)? | Under local anesthesia a balloon tipped cath is passed through the femoral artery. The balloon is inflated in the obstructed area, flattening the plaque on the artery wall. |
| What is usually inserted and left in the artery during PTCA? | An intracoronary stent |
| Name 3 possible complications of PTCA? | MI, bleeding, formation of a hematoma at the site of cath insertion |
| What sort of bandage is applied after after PTCA? | A pressure dressing |
| What is a coronary artery bypass graft (CABG)? | An artery or vein from another part of the body is sutured to the obstructed coronary artery thus restoring blood flow to the heart. |
| What are the two most common arteries used as grafts during a CABG? | The internal mammary artery (IMA) and the saphenous vein |
| How is the saphenous vein attached to the artery? | It is reversed so that the valves will not affect blood flow. |
| How is blood flow maintained during a CABG surgery? | The heart is stopped and a cardiopulmonary bypass pump is used. (aka-heart-lung machine) |
| How is transmyocardial laser revascularization performed? p.616 | A laser is used to drill tiny holes in the heart muscle for a CABG instead of open the chest |
| How is minimally invasive coronary artery surgery performed? p.616 | Several small surgical incisions |
| How often should NTG be replaced? | It sould be kept no longer than 6 months |
| How does NTG work? | It relaxes the smooth muscle layer of blood vessels, increasing the lumen size. |
| Name 3 side effects of NTG. | Hypotension, dizziness, headache |
| What happens during an acute myocardial infarction (AMI or MI)? | Cells in an area of cardiac muscle die due to lack of O2. |
| When do most pts with an MI die? | Within the first hour following onset. |
| What is the usual cause of coronary occlusion in an MI? | a thrombus in an area of atherosclerotic narrowing. |
| what is an infarction? | An area of necrotic tissue due to lack of O2. |
| How long can cardiac tissue be deprived of O2 before there is irreversible damage? | 20-45 minutes. |
| What are collateral blood vessels ? | Small arterioles that develop when a larger artery is occluded to maintain cardiac blood flow. |
| Where are most MI located in the heart? | The left ventricle because of its greater O2 demands and muscle mass. |
| How are MI described? | According to the area of the heart that is damaged |
| What is a transmural infarction? | An AMI where all layers of the heart are damaged. Endocardium, myocardium, and epicardium |
| What is a subendocardial infarction? | An AMI that affects only the inner layers the heart, the endocardium |
| Name 9 symptoms of an MI. | 1)crushing chest pain that radiates to the neck, shoulder or arm. 2) tachycardia 3) SOB 4)cool, clammy skin 5)diaphoresis 6)anxiety 7)feeling of impending doom 8) N/V 9)possible dysrhythmias |
| What two groups may not experience chest pain during an MI? | Women and older adults |
| Aside from the usual MI symptoms, what are 5 others that might be seen in women? | epigastric pain and nausea, chest pain when stressed or at rest, SOB, fatigue, weakness in the shoulders and upper arms |
| Aside from the usual MI symptoms, what are 5 more that might be seen in older adults? | vague complaints of SOB, confusion,fainting, dizziness, abdominal pain, cough |
| How does cocaine cause an MI? | Cocaine intoxication causes increased heart contractility, vasoconstriction, and hypertension. |
| Why is pump failure (or heart failure) a complication of an MI? | AMI reduces heart contractility and ventricle filling. HF develops when a large part of the heart cannot contract fully. |
| What percentage of the heart needs to be effected for pump failure to develope? | 20-30% |
| What sort of heart failure is the most common following an MI? | Left sided HF. |
| What is cardiogenic shock? | When more than 40% of the left ventricle is damaged pump failure develops due to the fact the heart it is unable to supply enough blood to the organs of the body. |
| What are signs of cardiogenic shock? | hypotension, impaired tissue perfusion,low urinary output, decreased consciousness, cool clammy skin. (As David said in class-"No BP, no pee, pee") |
| What is pericarditis? | inflammation of the pericardium |
| What are signs of cardiogenic shock? | hypotension, impaired tissue perfusion,low urinary output, decreased consciousness, cool clammy skin. (As David said in class-"No BP, no pee, pee") |
| What is pericarditis? | inflammation of the pericardium |
| When would pericarditis be expected to develops after an MI? | within 2-3 days |
| What are 3 s/s of pericarditis? | sharp stabbing pain in the area of the heart, pain that is aggravated by movement or deep breathing, frictional rub on auscultation |
| what is extension or expansion of an MI? | Continued chest pain, unstable vital signs and worsening heart failure following within 10-14 days after an MI. |
Created by:
3perfectcats
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