Zusammenfassung der Ressource
Coronary Artery
Disease & Peripheral
Vascular Disease
Anmerkungen:
- Risk
Factor/Cause
- athersclerosis
- Dyslipidemia
- Hypertension
- Diabetes
- Modifiable-
Changeable
&
Nonmodifiable-
nonchangeable
- Clinical
Manifestations (Coronary Artery Disease)
- Screening
Measures What
is Healthy?
- LDL <60mg/dL
- HDL > 130mg/dL
- Triglycerides
<150mg/dL
- Cholestrol <200mg/dL
- Troponin
- C-reactive Protein
- Stress Test
- Echocardiogram
- Agina Types
Anmerkungen:
- Ischemia/lack of O2 to cardiac cells. Ischemia secondary to athsclerosis. When artery is blocked more than 75%. Cardiac cells is only good for 20min damage occurs. Mycardium will become hypoxic in first 10sec. The heart looses ability to contract and uses anaerobic metabolism. Lactic buildsup which causes pain/agina. Referred pain can occur left arm, shoulder/jaw
- Chronic Stable
Anmerkungen:
- Longterm, intermittent [5-15min], characterized by squeezing, heavy, choking pressure sensation, complaint of indigestion or burning. EKG ST segment depression. Inverted T wave. Indicated of ischemia/lack of Oxygen
ACE inhibitor/Iogenic Blocker/Calcium channel blocker/Nitrates- pill form disolve under tongue or as paste. Nitrates Every 15min. Throw in the Sharps. Severe Headache gets on skin.
- Prinzmetal's Angina
Anmerkungen:
- Variable can happen at rest.
- Raynauds phenomenon
Anmerkungen:
- Spasm of the smooth muscle & increase intracellular calcium. More prone to prinzmetal's if migraine prone.
ACE inhibitors, nitrates & calcium channel blockers. dilatizem
- Spams
- Unstable
Agina
Anmerkungen:
- More woman than men. Sudden, Unpredictable, consider an emergency, fatigue, fever, anxiety, fear, indigestion.
- EMERGENCY
- EKG
- T wave
inverted
- NSTEMI
- ST depression
- Mycardial Deprived
of O2 becoems
hypoxic in 10sec
- STEMI
- ST elevation
- Pain Left arm,
shoulder or Jaw
- Interventions
- Drugs
- Adrenergic Blockers
- ACE inhibitors
- Calcium Channel Blockers
- Dilitiazeme
- Nitrates
- Headache
- Dark bottle
- Antiplatelet
therapy
Anmerkungen:
- Heparin, Coumadin, ASA, Pradexa
- Beta blocker
- Pain- Morphine
Anmerkungen:
- Flutter- Digoxin
Anmerkungen:
- Break up Clott!!!
Altikase, streptikinase
TPA 4hr window onset
pain
- Bradycardia-
Epinephrine,
Atropine
- Low BP:
Dopamine,
Butamine
- Rapid- Verapamil & Adenocard
Anmerkungen:
- PVC- Lidocaine
Anmerkungen:
- 1800 ADA, Low
sodium, Low fat
& Cholestrol diet
- Stents
- Femoral artery?
- 5-6hrs
- Lay in bed head
no higher than
30degrees
- Lift legs to
avoid rupture
- Wrist
- Chance for
bleed out is
less
- Thrombectomy
- Teach
- Excercise
- Quite
smoking/excessive
drinking
- Protocol for MI
- #1 Oxygen [Elevate
the Bed]/ [2-4L]
- #2 Start
IV /VS
- Reassure the Patient
- EKG/Cardiac Monitor
- Nitroglycerin [Still
pain? another nitro
after 5min]
Anmerkungen:
- #3 Nitro call Healthcare Provider!!!!
- Focused
Cardiac
Assessment
- Questions
- Pain? Long,
characterisitics
- History
- Medications
- ACLS
- as tolerated
- CABG
- 1.) Chronic endothelial
Damage 2.) Fatty
Streak [Can develope
fatty Streak at 15yr
old] 3.) Fibrous Plaque
4.) Complicated Lesion
- Compensation:
"Collateral
Circulation"
- Clinical Manifestations
(Peripheral Vascular
Disease)
Anmerkungen:
- Asymptomatic [Physical Examination], Symptomatic- complain of pain on exertion [Claudication], Critical Limb ischemia- Rest pain, tissue loss
- Pallor with elevation
- Decreased sesation/Numbness, Coolness
- Soreness on toes that do not heal
- Leg color changes
- Slower growth of toe nails, hair & Thicken of toenails
- Shiny skin, thin, Red
- Weak Pulse
- Erectile
dysfunction
- Rest pain- Burning sensation in legs
- Intermittant pain/
Cramping with activity
- Extremity dark Red
when dependent
- Skin Breakdown
Anmerkungen:
- The skin cannot heal. Needs extra Oxygen to heal.
- Skin
Discoloration
- hip, Thigh,
Buttocks
- ELEVATION pallor & Dependent Rubor
- Diagnositics
- Arteriogram
"Gold Standard"
- Complication of PVD
- Gangrene
- Limb Amputation
- Infection/Sepsis
- Complication
"Myocardial
Infarction"
Anmerkungen:
- Left Coronary Artery is consider widow maker because distribute blood to left ventricle. If block high chance of mortality.
- Interventions
- Smoking
Cessation
- Support Hose
- Foot Care
- Rest for Pain
- Drugs
- Anticoagulation
- Antiplatelet
- Antihypertensive
Anmerkungen:
- ACE inhibitors, Calcium channel Blockers, Beta blockers
- Invasive
- Percutaneous
Transluminal
Angioplasty (PTA)
- Antherectomy
- Surgical
- Revascularization
[Bypass
Grafts]
- Endartectomy
- Teach
- Activity
- Dangling Legs
improve pain teach
that this is bad sign
- Excercise