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B) Risk factors: unmodifiable age, gender, heredity, and family hx Modifiable: a) Elevated serum level lipids Cholesterol diet and liver ~ Normal 140-200 HDL normal Male >45 Females >50 ~ carries lipids AWAY from vessel LDL Should be < 130 ~ Have more cholesterol and attach to arterial walls. VLDL contains triglycerides should be < 200. ~ ETOH and simple sugars Inc. Triglycerides Homocysteniene levels Amino acids contains sulfure ~ alters endothelial lining ~ Inc. changes of clotting ~ to decrease levels take Vit B12, B6 and folic acid# 0/ =!"#$%|HH(EF(HH(d'` s Amino acid contains sulfurnc. chancSMOKING: increases BP and Decreases O2 Inc. Workload of heart and Inc. HR. II. Prevention and Treatment health promotion lifestyle changes ~ Diet step 1 decrease sat. fat decrease cholesterol by 10-15% Step 2 go Zeo,/6hnqy Bryan FalchukQMarias G3:Maria:school notes:Adult Nursing/Med Surg:Coronary Artery Disease ch 33 Bryan FalchukQMarias G3:Maria:school notes:Adult Nursing/Med Surg:Coronary Artery Disease ch 33 Bryan Falchuk,Marias G3:Temporary Items:Word Work File A_1 Bryan Falchuk,Marias G3:Temporary Items:Word Work File A_1 Bryan FalchukQMarias G3:Maria:school notes:Adult Nursing/Med Surg:Coronary Artery Disease ch 33 Bryan Falchuk,Marias G3:Temporary Items:Word Work File A_2 Bryan Falchuk,Marias G3:Temporary Items:Word Work File A_3 Bryan FalchukQMarias G3:Maria:school notes:Adult Nursing/Med Surg:Coronary Artery Disease ch 33 Bryan Falchuk,Marias G3:Temporary It1`1N51515150515050"60n6061606161606171 71707170717171718081f81l818181808181808091>1>1>1>1>0`91>190>0@14@1D@1F@1R@1X@1p@0r@1@1@1@1A1A1A1A1 A14A06A18A1NA1PA1ZA1A1A1A0A1A1A1A0B1"B1(B0LB1NB0bB1dB0jB0lB1`1B0B0C14C1dC1fC0tC1LD1ND1XD1^D1`D0jD1E1E1E0\E1^E1dE1fE1pE1E1E0E1HF1tF1vF1F1F1F1 G1G1G1RG1G1G1G1G1G1G1G1G1Go(oh J J ^J `OJQJo(h ^`OJQJo(h ^`OJQJo(oh ^`OJQJo(h ^`OJQJo(h ZZ^Z`OJQJo(oh **^*`OJQJo(h 88^8`OJQJo(h ^`OJQJo(oh   ^ `OJQJo(h   ^ `OJQJo(h xx^x`OJQJo(oh HH^H`OJQJo(h ^`OJQJo(h ^`OJQJo(oh ^`OJQJo(h 88^8`OJQJo(h^`. 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Restricts lipoprotien production Niacin (B Vit.) 3. Statins-- Locar SE: Rash and gas # 0/ =!"#$%|HH(EF(HH(d'` III. Manifestations of CAD Angina MI Suddent Death 1. Angina Pectoris transient (comes and goes) chest pain lasts 3-5 minutes Coronary arteries are chronically dilated Factors that affect O2 demand: Low BP Vasoconstriction HTN Aortic stenosis Precipitating factors: Excertion Increase HR and Increase O2 demand, Heart can t meet. Strong emotions Consumption of heavy meal blood transported to GI to digest food. Change of temp. Heat vasodilation, Cold vasoconstriction Cigarettes Sex Stimulates drugs cocaine Circadian rythms happens in AM stimulation of SNS. 2. 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Courier New"qh/F7f gh )!xx>4d|@Coronary Artery Disease: Bryan Falchuk Bryan FalchukII. Myocardial infarction Ischemia leads to irreversible damage to the heart Inferior MI Rt coronary artery ~ Rt atrium and ventricle SA node conduction Anterior MI left anterior descending artery Left sided failure bigger muscle mass Posterior MI circumflex occlusion A) Signs and Symptoms Chest pain N/V Ashen and cold Sweaty 80% with symptoms have arrythmias PVC s, V-tach and V-fib B) Complications: Left ventricular failure causes pulmonary edema S/S restlessness, dyspnea, crackles, wheezing and TOTAL CHF. Cardiogenic shock Pericarditis hear rub have pt hold breath so you can hear if it is the heart and not lungs. C) diagnostics: H and P and how the pt presents himself EKG done serially immediately 30 min. and 1 hr. 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Courier New"qh/F,Lfsgh )!xx>4d|@Coronary Artery Disease: Bryan Falchuk Bryan Falchuk FMicrosoft Word DocumentNB6WWord.Document.8 ՜.+,0 hp  ' PlexComOLSA)  Coronary Artery Disease: Title Oh+'0# 0/ =!"#$%|HH(EF(HH(d'` 3. Manifestations Signs and Symptoms Most common pain describe pain (squeezy, ache and heaviness) Feelings of doom SOB Cold sweat diaphoretic 4. Complications arrhythmias PVA s ventricular fibrillation 5. Diagnositics H and P EKG 12 lead Nuclear techniteum scan identifies areas of inadequate circulation in heart  hot spots . 6. Medications 1st line of treatment a) Platelet aggregate inhibitors ASA Plavix Ticlid b) Nitroglycerin decreases preload and afterload ~ coronary vasodilators==increase flow in coronary arteries decreases workload of heart ~ Routes SL, PO IV(titrate for effect) Transdermal (remove x 8 hr) ~ SE headache and hypotension. c) Beta Blockers ~ decreases HR, BP and O2 consumption Lopressor Zobeta Inderal Corgard ~ Can cause bronchoconstriction ~ Obtain a baseline HR and BP, hold if pulse < 60 and Systolic <100 d) Ca Channel Blockers ~ decreases systemic vascular resistance and decreases BP ~ Cause vasodilation ~ decreases myocardial contractility and decreases power ~ Decreases HR ~ Ultimately decreases workload of heart calan/verapamil Procardia Diltazem/cardizem 2F2h2z22D3b3334*4n4456j666677788f888N9r9$ & F a$ $`a$ r999999>4@@8AA"BNBdBlBBBC4CD4DDDE^EHF $ & Fa$ $ & F a$$ & F a$ $`a$ # 0/ =!"#$%|HH(EF(HH(d'`Calan / V Diltazem/C nverted T-wave, and abnormal Q-wave Cardiac markers-- ~ CK creatinekinase increases with a MI. Normal male 15-100 fem. 10-80 ~ MB band norm 0-9 increases with acute MI will rise after 4-6 hrs after MI but returns to normal within 3-4 days. ~ Troponin Normal T= 0-0.2 and I < 0.6 Will rise within 4-6 hours after the MI and stays elevated for up to 2 weeks. D) Collaboarative Care M orphine O O2 N nitro A ASA ICU EKG O2 2-4 L Morphin or demoral decreases pain, fear and anxiey, decreases contractility, O2 consumption, HR BP and workload Antirrythmia Rs lidocaine for PVCs Nitro SL or IV helps perfusion a little Thrmbolytic therapy within 6 hours * Biggest complication of thrombolytic therapy is hemorrhage. Stop therapy immediately if there is a change in pt s mental status. Possible bleed in the brain? HFHII I0IIFINI`I@JJJ`LbLPPPPQQ $ & Fa$ $^`a$  $ & Fa$ $^`a$  $ & Fa$    < H T `lt|'Coronary Artery Disease: 0oroBryan Falchuky ryaNormalaBryan Falchuky 14aMicrosoft Word 9.0e@r\@ss@jnN@8gh / =!"#$%|HH(EF(HH(d'`3 jbjb^^^^^^^^^^^dh<h<<l<<<<<< 8 L nfRRRRRRR,>p ^r)S<)S<<P2$<<RPTT<<<<R$Nl<<RD \!x P*RnnIPrrR1P0P0P0Z0Q 0Q 0`Q1R1R0R0S1S 1S 1S 1T 0"T1$T 0BT1DT 1FT 0XT1ZT 0hT0jT0lT1Z1zT1T1T0T1Z0T1Z1U1&U1(U14U1XU1ZU1hU0jU1Z1lU0zU0|U1U1U0U1Z1U1U1U1U1U1U0V1Z1V18V1:V1HV1bV1tV1V1V1V1V0`L1bL0919190909090*0v@0x@0z@1\1\1\1\1\\1^\1`\1h\1j\1`1n\1p\0r\0t\0v\0z@GTimes New Roman5Symbol3 Arial3Times;Wingdings? Courier New"qh/F;f gh )!xx>4d|@Coronary Artery Disease: Bryan Falchuk Bryan Falchuk FMicrosoft Word DocumentNB6WWord.Document.8 ՜.+,0 hp  ' PlexComOLSA)  Coronary Artery Disease: Title Oh+'0x  4 @ LX`hp'Coronary Artery Disease: 0oroBryan Falchuky ryaNormalaBryan Falchuky 13aMicrosoft Word 9.0e@c@jnN@RqghArteriosclerosispresence. SuddenExertionrhythmsArrhythmiasDiagnostics. Decreasesafter loadCoronary arrhythmiasanxiety7 / =!"#$%|HH(EF(HH(d'`3 jbjb^^^^^^^^^^^bh<h<<l<<<<<< 8 L nfSSSSSSS,^p ~rIS<IS<<P2$<<SPTT<<<<S$Nl<<SD Cv ?P*SnniPssS Coronary Artery Disease: AtherosclerosisFat deposits, intima of vessel walls. Ateriosclerosiselasticity and hardening I. CADdevelopment of CAD A) Stages fatty streaklipids in intima of vessel walls Starts at age 15. Raised fibrous plaque --Appears by age 30 --Initiated by endothelial injury Increased BPshearing of endothelium lining called denuding injury. Increased Cholesterol Cigarettes ? inflammation? complicated lesion plaque has lipid core surrounded by dead tissue. collateral circulation over months or years develop collateral circulation around hallowing. A youngperson having a MI is worse than an older person because havent developed collateral circulation. H  !J!r!!"&"0"Z"%%&@&*d3h334n669999>GGdLVZZZZZ\\^\j\l\n\p\r\t\z\```0J6CJmH 0J6CJj0J6CJU6CJ56H*55>*>*2R{|3xL $ & Fa$  $ & Fa$ $ & Fp^pa$ 8$^`a$  $ & Fa$  $`a$  Coronary Artery Disease: AtherosclerosisFat deposits, intima of vessel walls. Ateriosclerosiselasticity and hardening I. CADdevelopment of CAD A) Stages fatty streaklipids in intima of vessel walls Starts at age 15. Raised fibrous plaque --Appears by age 30 --Initiated by endothelial injury Increased BPshearing of endothelium lining called denuding injury. Increased Cholesterol Cigarettes ? inflammation? complicated lesion plaque has lipid core surrounded by dead tissue. collateral circulation over months or years develop collateral circulation around hallowing. A youngperson having a MI is worse than an older person because havent developed collateral circulation. H  !J!r!!"&"0"Z"%%&@&*d3h334n669999>GGdLVZZZZZ\\^\j\l\n\p\r\t\z\```bb0J6CJmH 0J6CJj0J6CJU6CJ56H*55>*>*4R{|3xL $ & Fa$  $ & Fa$ $ & Fp^pa$ 8$^`a$  $ & Fa$  $`a$ # 0/ =!"#$%|HH(EF(HH(d'` Thrombolytic Drugs: tPA Streptokinas Urokinase Retavase Criteria for thrmbolytic therapy : Chest pain with MI less than 6 hrs ago EKG supports/confirms MI No condition that will predispose to hemorrhage, surgery, car accident or pregnancy. Effective of thrombolytics: Decreases chest pain Return of S-T to baseline on EKG Reperfusion To prevent reocclusion Rx heparin IV with thrombolytic. Monitor PTT Treatment of CAD CABG open heart surgery Stent placement Athrectomy Balloon Drugs: Inotropic drugs increase contractility increase O2 demand too Digoxin/Lanoxin Dubutrex given IV acute lf vent. Failure. Inocor ACE inhibitors watch for hyperkaliemia Vasotec prevents vent. Remodeling Give stool softener vasgus nerve causes decreases HR and BP.  COLASE. Q`QQQRRR0SHSSSS$TDTZTjTlTzTTUlU|U~UUVZZ$a$  $ & Fa$ # 0/ =!"#$%|HH(EF(HH(d'`eThrombolytic Drugs: ~ ~ ~Maria Vogel s Med-Surg notes Ch. 33 CAD Page  PAGE 8~ Zt\v\x\z\`b $`a$ $a$# 0/ =!"#$%|HH(EF(HH(d'` Thrombolytic Drugs: tPA Streptokinas Urokinase Retavase Criteria for thrmbolytic therapy : Chest pain with MI less than 6 hrs ago EKG supports/confirms MI No condition that will predispose to hemorrhage, surgery, car accident or pregnancy. Effective of thrombolytics: Decreases chest pain Return of S-T to baseline on EKG Reperfusion To prevent reocclusion Rx heparin IV with thrombolytic. Monitor PTT Treatment of CAD CABG open heart surgery Stent placement Athrectomy Balloon Drugs: Inotropic drugs increase contractility increase O2 demand too Digoxin/Lanoxin Dubutrex given IV acute lf vent. Failure. Inocor ACE inhibitors watch for hyperkaliemia Vasotec prevents vent. Remodeling Give stool softener vasgus nerve causes decreases HR and BP.  COLASE. Q`QQQRRR0SHSSSS$TDTZTjTlTzTTUlU|U~UUVZZ$a$  $ & Fa$ # 0/ =!"#$%|HH(EF(HH(d'`eThrombolytic Drugs: ~ ~ ~Maria Vogel s Med-Surg notes Ch. 33 CAD Page  PAGE 8~ Zt\v\x\z\` $`a$ $a$Arteriosclerosispresence. SuddenExertionrhythmsArrhythmiasDiagnostics. Decreasesafter loadCoronary arrhythmiasanxiety7 / =!"#$%|HH(EF(HH(d'`7