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the body compensate for atherosclerosis
- family predisposation for plaque development
- b vitamin help reduce
A1c should be below what?
Ultrasound, looks at valves and blood flow
Beta Blockers should be contridicted in patients with what?
Cardiac Catheterization diagnostic
- Allergic to shellfish?
- Informed consent
- check creatine level
- Check BP, HR, bleeding
- Legs straight for 46 hours
Carry's Lipids away from vessels (GOOD)
More Cholesterol and carry to vessels (Bad)
Carry both bad and triglycerides (very bad)
What do statins do?
- Block the sythesis of cholesterol and increase LDL receptors in the liver
- Decreases LDL
- Decreases Triglycerids
- Increases HDL
Rash, GI disturbances, elevated liver enzymes
Monitor liver enzymes and creatine kinase 3-6 months LFT if increased liver enzymes.
What does it do?
- Water soluable B vitiams inhibits synthesis and secretion of VLDL and LDL
- Decreases LDL and Triglycerides
- Increases HDL
Flushing and pruitius in upper torso and face, GI disturbances, N&V, Can elevate homocysteine levels
- Take NSaid or aspirin 30-60 min before given to reduce redness and take with food
- Treat elevated homocysteine levels with folic acid
What type is it?
What does it do?
- Bile-Acid Sequstrants
- eliminates cholesterial via bile, decreases ldl and cholesterol
Unpleasant taste, gi disturbances
- interferes with absorption of digoxin, tthiazide diuretics, warfarin, some antibodics
- Don't take with Coumadin!
Primary reason for stable angina
insufficient blood flow is narrowing of coronary arteries by atherosclerosis
For ischemia to occur in the heart, how much stenosis is in the coronary artery disease?
What factors would determine a MI instead of stable angina?
- accompanied by N&V
- If more than 3-5 min
- EKG change
Medical Management of Stable angina
- A- Aspirin and Anti-anginals
- B- Beta blocker and blood pressure
- C-Cholesterol and Cigerettes
- D- Diet and Diabetes
- E-Education and Exersice
Adenosine Diphosphate Receptor antagonists
- Clopidogrel (Plavix)
- Agrivates platelet formation
- Alternative to Aspirin
- Decreases preload and afterload
- Watch for othostatic hypotension
What are they?
- Inhibits sympathetic nervous stimulation of the heart, reduce both HR and Contractility, Decreases afterload
- Watch for hypotension because masks signs, bradycardia, hypotension, wheezing, GI, ED
- Don't give to a patient with asthma
- Calcium channel blockers
- Prevnts calcium entry into vascular smooth muscles cells
- Conronary and peripheral vasodilation
- Decreases HR and Contractility
- Monitor digoxin levels because it could lead to toxticity
- Ace inhibitor
- Decreases endothelial dsyfunction
Hypotension, dizziness, hyperkalemia, acute renal failure, angioedema
Aspirin and NSAIDs may reduce drug effectivness. Dont use with k+ sparing diuretics
- Unfractionated heparin
- Prevent converision of fibrinogen to fibrin and prothrombin to thrombin
- Low-molecular-weight heparin
- enhances effect of antithrombin III
- Inactivates activated factor x ant thrombin
- prevents fibrinogen conversion into fibrin
Tissue plasminogen activator (tPA; alterplase (Activase))
- Fibrinolytic therapy
- breaks up fibrin meshwork in clots
- used only in st-segment-elevation MI
- bedrest anywhere 6-24 hours
- Will be on anticoagulants or rheomacrodex
- Monitor vitials including cardiac monitoring
- assess for kidney function because dye
- avoid showering for 24 hours and bath for a few days
Guidelines for nitrates
Take one then in 5 min take 2nd in 5 min take 3rd if no relief call 911.