Coronary Artery Disease & Peripheral Vascular Disease

Nota:

• Lewis pg. 714

1. Risk Factor/Cause
   1. athersclerosis
   2. Dyslipidemia
   3. Hypertension
   4. Diabetes
   5. Modifiable- Changeable & Nonmodifiable- nonchangeable
2. Clinical Manifestations (Coronary Artery Disease)
   1. Screening Measures What is Healthy?
      1. LDL <60mg/dL
      2. HDL > 130mg/dL
      3. Triglycerides <150mg/dL
      4. Cholestrol <200mg/dL
      5. Troponin
      6. C-reactive Protein
      7. Stress Test
      8. Echocardiogram
   2. Agina Types

      Nota:

      • 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
      1. Chronic Stable

         Nota:

         • 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. 
      2. Prinzmetal's Angina

         Nota:

         • Variable can happen at rest. 
         1. Raynauds phenomenon

            Nota:

            • Spasm of the smooth muscle &amp; increase intracellular calcium. More prone to prinzmetal's if migraine prone.  ACE inhibitors, nitrates &amp; calcium channel blockers. dilatizem 
         2. Spams
      3. Unstable Agina

         Nota:

         • More woman than men. Sudden, Unpredictable, consider an emergency, fatigue, fever, anxiety, fear, indigestion. 
         1. EMERGENCY
   3. EKG
      1. T wave inverted
   4. NSTEMI
      1. ST depression
   5. Mycardial Deprived of O2 becoems hypoxic in 10sec
   6. STEMI
      1. ST elevation
   7. Pain Left arm, shoulder or Jaw
3. Interventions
   1. Drugs
      1. Adrenergic Blockers
      2. ACE inhibitors
      3. Calcium Channel Blockers
         1. Dilitiazeme
      4. Nitrates
         1. Headache
         2. Dark bottle
      5. Antiplatelet therapy

         Nota:

         • Heparin, Coumadin, ASA,  Pradexa
      6. Beta blocker
      7. Pain- Morphine

         Nota:

         • After Nitro!
      8. Flutter- Digoxin

         Nota:

         • Digoxin
      9. Break up Clott!!! Altikase, streptikinase TPA 4hr window onset pain
      10. Bradycardia- Epinephrine, Atropine
      11. Low BP: Dopamine, Butamine
      12. Rapid- Verapamil & Adenocard

          Nota:

          • Verapamil or adenocard
      13. PVC- Lidocaine

          Nota:

          • Lidocaine
   2. 1800 ADA, Low sodium, Low fat & Cholestrol diet
   3. Stents
      1. Femoral artery?
         1. 5-6hrs
         2. Lay in bed head no higher than 30degrees
         3. Lift legs to avoid rupture
      2. Wrist
         1. Chance for bleed out is less
   4. Thrombectomy
   5. Teach
      1. Excercise
      2. Quite smoking/excessive drinking
   6. Protocol for MI
      1. #1 Oxygen [Elevate the Bed]/ [2-4L]
      2. #2 Start IV /VS
      3. Reassure the Patient
      4. EKG/Cardiac Monitor
      5. Nitroglycerin [Still pain? another nitro after 5min]

         Nota:

         • #3 Nitro call Healthcare Provider!!!!
      6. Focused Cardiac Assessment
   7. Questions
      1. Pain? Long, characterisitics
      2. History
      3. Medications
   8. ACLS
   9. as tolerated
   10. CABG
4. 1.) Chronic endothelial Damage 2.) Fatty Streak [Can develope fatty Streak at 15yr old] 3.) Fibrous Plaque 4.) Complicated Lesion
   1. Compensation: "Collateral Circulation"
5. Clinical Manifestations (Peripheral Vascular Disease)

   Nota:

   • Asymptomatic [Physical Examination], Symptomatic- complain of pain on exertion [Claudication], Critical Limb ischemia- Rest pain, tissue loss
   1. Pallor with elevation
   2. Decreased sesation/Numbness, Coolness
   3. Soreness on toes that do not heal
   4. Leg color changes
   5. Slower growth of toe nails, hair & Thicken of toenails
   6. Shiny skin, thin, Red
   7. Weak Pulse
   8. Erectile dysfunction
   9. Rest pain- Burning sensation in legs
   10. Intermittant pain/ Cramping with activity
   11. Extremity dark Red when dependent
   12. Skin Breakdown

       Nota:

       • The skin cannot heal. Needs extra Oxygen to heal. 
   13. Skin Discoloration
   14. hip, Thigh, Buttocks
   15. ELEVATION pallor & Dependent Rubor
   16. Diagnositics
       1. Arteriogram "Gold Standard"
6. Complication of PVD
   1. Gangrene
   2. Limb Amputation
   3. Infection/Sepsis
7. Complication "Myocardial Infarction"

   Nota:

   • Left Coronary Artery is consider widow maker because distribute blood to left ventricle. If block high chance of mortality.
8. Interventions
   1. Smoking Cessation
   2. Support Hose
   3. Foot Care
   4. Rest for Pain
   5. Drugs
      1. Anticoagulation
      2. Antiplatelet
      3. Antihypertensive

         Nota:

         • ACE inhibitors, Calcium channel Blockers, Beta blockers
   6. Invasive
      1. Percutaneous Transluminal Angioplasty (PTA)
      2. Antherectomy
   7. Surgical
      1. Revascularization [Bypass Grafts]
      2. Endartectomy
   8. Teach
      1. Activity
      2. Dangling Legs improve pain teach that this is bad sign
   9. Excercise