Student Nurse Laura

Orem – "creative effort of one human being to help another human being."

CVD Notes:

Posted by Laura on March 28, 2011

Atheroma: abnormal accumulation of lipid & fibrous tissue in intima of coronary artery walls that changes their structure and function

Major manifestation : CP due to impaired blood flow > 70% blockage

What are the various Metabolic Syndromes which will increase risk of Coronary Artery Disease?

Elevated C-Reactive Protein          > 3mg

Central Obesity                               > 35” W, 40” M

Fasting BS                                       > 100

Elevated BP                                      > 140/90

Triglycerides                                    > 150

Angina Pectoris – not completely occluded

♥     Stable Angina – Reversible, relieved by rest

♥     Unstable Angina –  Progressive, plaque ruptures, occurs at rest (Pre-infarction, Crescendo)

♣ Prinzmetal (variant or resting) Angina – Coronary Artery ‘Spasm’, occurs only at rest.

♥     Intractable (refractory) Angina – severe incapacitating chest pain

♥     Silent Ischemia – objective evidence, but asymptomatic. DM

Myocardial Infarction (MI) – Occlusion

♥     Non ‘Q’ Wave MI (nontransmural) – only myocardium

♣   T Wave Inversion Ischemia

♣   Elevated ST segment Injury

♥     Q Wave Infarct (transmural) – involves all 3 layers

 

Ischemia & Tx Differences

Unstable Angina: thrombus partially or intermittently occludes the coronary artery; CP, s/s occurs at rest with exception: limits activity > 10 min.; Bio-markers are NOT elevated. Tx: MONA, ABCS-Ph,

Non-ST Segment Elevation: thrombus partially or intermittently occludes the coronary artery; CP, s/s occurs at rest with exception: limits activity – longer in duration and more severe than in unstable angina; Bio-markers ARE elevated. Tx: MONA, ABCS-Ph, include cardiac catherization and possible PTCA

Non-ST Segment Elevation: thrombus FULLY occludes the coronary artery; CP, s/s occurs at rest with exception: limits activity – longer in duration and more severe than in unstable angina; ST segment elevation or new left bundle branch block on EKG, Bio-markers ARE elevated. Tx: MONA, ABCS-Ph,  – PTCA within 90 minutes of medical evaluation to keep vessel open; Fibrinolytic therapy within 30 minutes of medical evaluation.


TPA

Tissue plasminogen activator (alteplase) activates plasminogen to break clot.

IV bolus → infusion → IV heparin or LMWH and ASA

*relief of pain, early peak enzymes, reverses EKG changes, saves cardiac muscle.

*complications: hemorrhage, reperfusion arrhythmis – Tx: with amiodarone!

Reperfusion injury: damaged tissue from reperfusion leads to dysrhythmias.

 

Cardiogenic Shock (end stage of LV dysfunction due to extensive damage. Loss of contractility, marked reduction in CO, inadequate perfusion to vital organs) : Too much fluid volume – leads to inadequate tissue perfusion / shock syndrome: Tx: If hypervolemic=diuretics, if hypovolemia=albumin,

Norepinephrine

S/S: Weak rapid pulse

 

Pulmonary Effusion: fluid is normally only 50mL. Tx: Pericardiocentesis, pericardiotomy

Pulmonary Edema: when head is above heart (HOB ele.) you have Jugular vein distention, and blood – tinges frothy sputum. (RV is supplying more blood than LV can handle and accumulates into pulmonary beds leaking from capillaries into airways.) = Hypoxemia!

Cardiac Tamponade: falling systolic BO, narrowing Pulse Pressure, Rising venous pressure (increased JVD) muffled heart sounds.

 

 

Hypothermia

What is hypothermia good for: Neuroprotection.  Unconscious adults  w/spontaneous circulation (<1 hr) , out of hospital cardiac arrest for 12-24hrs at 32-34C when initial rhythm was V Fib. MAP > 60, Systolic BP > 90

Contraindicated: bleeding, infection, head trauma, unstable arrhythmia, downtime > 10min w/o BLS, < 18 not an adult, Pregnancy

Works if <10 to BLS  a witnessed Arrest!

 

CCP for R ventricular function and systemic fluid status.  Normal 2-6

http://www.rnceus.com/hemo/cvp.htm

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