Coronary Artery.txt

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Coronary Artery.txt
2013-03-17 03:19:51
Coronary Artery

Coronary Artery
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  1. Angina pectoris
    Chest pain that occurs when the heart's supply of blood carrying oxygen and energy-rich nutrients is insufficient to meet the demands of the heart. (p. 368)
  2. Antilipemic
    A drug that reduces lipid levels. (p. 455)
  3. Apolipoproteins
    The protein components of lipoproteins. (p. 456)
  4. Atherosclerosis
    "A common form of arteriosclerosis involving deposits of fatty, cholesterol-containing material (plaques) within arterial walls. (p. 368)"
  5. Cholesterol
    "A fat-soluble crystalline steroid alcohol found in animal fats and oils and egg yolk and widely distributed in the body, especially in the bile, blood, brain tissue, liver, kidneys, adrenal glands, and myelin sheaths of nerve fibers. (p. 455)"
  6. Chylomicrons
    "Minute droplets of lipoproteins; the forms in which dietary fats are absorbed from the small intestine. Chylomicrons consist of about 90% triglycerides and small amounts of cholesterol, phospholipids, and proteins. (p. 456)"
  7. Coronary arteries
    Arteries that deliver oxygen to the heart muscle. (p. 368)
  8. Coronary artery disease (CAD)
    "Any one of the abnormal conditions that can affect the arteries of the heart and produce various pathologic effects, especially a reduced supply of oxygen and nutrients to the myocardium. (p. 368)"
  9. Exogenous lipids
    "Lipids originating outside the body or an organ (e.g., dietary fats) or produced as the result of external factors, such as a disease caused by a bacterial or viral agent foreign to the body. (p. 456)"
  10. Foam cells
    "The characteristic initial lesion of atherosclerosis, also known as a fatty streak. (p. 457)"
  11. Hydroxymethylglutaryl–coenzyme A (HMG–CoA) reductase inhibitors
    A class of cholesterol-lowering drugs that work by inhibiting the rate-limiting step in cholesterol synthesis; also commonly referred to as statins. (p. 459)
  12. Hypercholesterolemia
    A condition in which higher than normal amounts of cholesterol are present in the blood. High levels of cholesterol and other lipids may lead to the development of atherosclerosis and serious illnesses such as coronary heart disease. (p. 456)
  13. Ischemia
    Poor blood supply to an organ. (p. 368)
  14. Ischemic heart disease
    Poor blood supply to the heart via the coronary arteries. (p. 368)
  15. Lipoprotein
    "A conjugated protein in which lipids form an integral part of the molecule. Lipoproteins are synthesized primarily in the liver; contain varying amounts of triglycerides, cholesterol, phospholipids, and protein; and are classified according to their composition and density. (p. 456)"
  16. Myocardial infarction (MI)
    Gross necrosis of the myocardium following interruption of blood supply; it is almost always caused by atherosclerosis of the coronary arteries and is commonly called heart attack. (p. 368)
  17. Reflex tachycardia
    "A rapid heartbeat caused by a variety of autonomic nervous system effects, such as blood pressure changes, fever, or emotional stress. (p. 370)"
  18. Statins
    A class of cholesterol-lowering drugs that are more formally known as HMG–CoA reductase inhibitors. (p. 459)
  19. Triglycerides
    "Compounds consisting of fatty acids and a type of alcohol known as glycerol. Triglycerides make up most animal and vegetable fats and are the principal lipids in the blood, where they circulate bound to a protein, forming high-density and low-density lipoproteins (HDLs and LDLs). (al 455)"
  20. Vasospastic angina
    Ischemia-induced myocardial chest pain caused by spasms of the coronary arteries. (al 368)
  21. Acute coronary syndrome (ACS)
  22. Acute myocardial infarction (AMI)
  23. Pathophysiology of angina pectoris
    "A lack of blood, thus a lack of oxygen supply and waste removal, of the heart muscle. Coronary artery disease is generally the main cause of angina due to atherosclerosis of the coronary arteries.; More than 30 minutes of ischemia can cause irreversible damages to the myocardial tissue"
  24. Causes of angina pectoris
    "Coronary heart disease ; Hypermetabolic conditions; Anemia, heart failure, ventricular hypertrophy, pulmonary diseases"
  25. 3 types of angina
    "Stable, unstable, & variant (prinzmetal's)"
  26. Stable
    Most common & predictable; Occurs when work of heart increased; Relieved by rest and nitrates or both
  27. Unstable angina
    Occurs with ? frequency and severity and duration; Unpredictable pain; Often will increase in frequency duration and severity over time; At risk for myocardial infarction
  28. variant (prinzmetal's)
    Atypical & unpredictable; Caused by coronary spasm
  29. Tests for angina
    Electrocardiogram; Stress Electrocardiogram; Radionuclide testing; Echocardiography; Coronary angiography
  30. Electrocardiogram
    "Ischemia – ST depression, flattened or inverted T"
  31. Stress Electrocardiogram
    same as exercise EKG testing
  32. Radionuclide testing
    radioactive material injection then imaging (planar or single-photon emission computed tomography [SPECT]) and stress (exercise or pharmacologic)
  33. Echocardiography
    sound waves to produce images of your heart
  34. Coronary angiography
    gold standard
  35. Angina: Medication Treatment
    "Nitrates, Beta blockers, & Calcium channel blockers"
  36. Nitrates
    "Sublingual nitro, drug of choice for acute angina; acts in 1-2 minutes; Take NTG immediately; Tolerance can develop; IV Nitro – only glass bottle, non PVC tubing; Wear gloves when applying paste or ointment; Client should keep NTG in glass bottle, away from heat, light, moisture, replace every 6 months"
  37. Common side effects of nitrates
    " headache, nausea, dizziness, hypotension"
  38. Beta blockers
    "First line drugs for stable angina; Block cardiac stimulating effects; MONITOR BP AND APICAL, hold if HR < 50; CONTRAINDICATED in clients with asthma or severe COPD; They may make Prinzmetal angina worse; Do not abruptly discontinue; Client should report irregular pulse, swelling or weight gain, or difficulty breathing"
  39. types of beta blockers
    "propranolol, metoprolol, atenolol"
  40. types of Calcium channel blockers
    "nifedipine, diltiazem, verapamil"
  41. Calcium channel blockers
    "For angina, HTN and dysrhythmias; Reduce myocardial oxygen demand; Often prescribed for Prinzmetal’s angina; MONITOR BP AND APICAL, hold if HR < 50 or BP low; Signs of toxicity: nausea, generalized weakness, signs of decreased cardiac output, hypotension, bradycardia, AV block"
  42. subjective data for angina
    "When Did the Pain Start?; What Were You Doing When the Pain Started?; How Long Did the Pain Last?; Using a Scale of 0–10, How Would You Rate the Pain?"
  43. objective data for angina
    "Vital Signs (Blood Pressure & Altered heart and respiratory rates); Overall Appearance (Weight, Skin color and tone, Posture and level of functional ability)"
  44. Normal sinus rhythm
  45. CAD Risk Factors: non-modifiable
    Age – 50% of MI occur in >65 age group; Genetics – family history; Gender – men affected earlier than woman
  46. CAD Risk Factors: modifiable
    "Hypertension; Diabetes; Hyperlipidemia; Cigarette smoking; Obesity; Inactivity; Diet; Metabolic syndrome; Premature menopause, oral; contraceptive use and HRT"
  47. CAD Risk Factors: contributing
    Homocysteine level; Menopause; Inflammatory responses
  48. Metabolic Syndrome
    Group of metabolic risk factors that occur in individuals that are associated with an increased risk of heart disease
  49. underlying causes of Metabolic Syndrome
    Being overweight/Obesity; Physical inactivity; Genetics (insulin resistance)
  50. characteristics of Metabolic Syndrome
    "Abdominal obesity (Hip and waist should not be equal); Abnormal blood lipids (low HDL, high triglycerides); Hypertension; Elevated fasting blood glucose; Clotting tendency; Inflammatory factors"
  51. Labs for CAD
    Lipid Profile; C-reactive protein (Elevated levels predictive of CHD)
  52. Lipid Profile
    Triglyceride (<150); Total cholesterol (<200); HDL ( > 40); LDL (<100); VLDL
  53. HDL
    "(highly desirable)– move easily through blood and are beneficial to body, stable, do not stick to artery walls, help prevent heart disease by carrying cholesterol away from arteries and back to liver, should be ( > 40)"
  54. LDL
    "(less desirable)– contain more fat, less protein, unstable, stick to and can damage cells lining inside of artery – waxy accumulation of LDL & other fatty substances = plaque, should be (<100)"
  55. VLDL
    "very bad, mostly lipids, non-HDL lipoproteins increase risk of non-fatal heart attack and angina in those with heart disease (contains the highest amts of triglyceride which is associated with CAD)"
  56. C-reactive protein
    A protein found in the blood which measures presence and degree of inflammation within the arterial wall. You must remember that atherosclerosis is a chronic inflammatory condition.
  57. CAD: Diagnostic Testing
    EKG-tracing of heart activity; Exercise ECG testing or Chemical Stress Test; EBCT – electron beam computed tomography; Myocardial perfusion imaging
  58. EKG-tracing of heart activity
    EKG changes are present with cardiac ischemia
  59. Exercise ECG testing or Chemical Stress Test
    "Positive if myocardial ischemia is detected in the EKG tracing, chest pain with the increased HR, excess fatigue, and EKG abnormalities"
  60. EBCT – electron beam computed tomography
    "3-D image of heart and coronary arteries that detects the amt of calcium in the coronary arteries. Because calcification occurs with atherosclerotic plague formation, measurement of coronary calcium may reflect the extent of coronary atherosclerosis . High coronary calcium is associated with CAD"
  61. Myocardial perfusion imaging
    Looks at myocardial blood flow ; Costly tests; Thallium/ stress test; Scans during stress and at rest are compared
  62. CAD risk reduction treatment
    "smoking cessation; reduce saturated fat & cholesterol intake; alcohol for middle age & older adults (men 2 drinks & women 1); decrease weight (BMI 18.5 - 24.9); exercise (30 min 5 - 6 days/wk); control hypertension, diabetes management; relaxation & stress management"
  63. CAD cholesterol lowering treatment
    Statins; bile acid sequestrants; nicotinic acid (niacin); fibric acid derivatives
  64. Statins
    "Zocor, Mevacor, Lipitor, Lescol, Crestor"
  65. bile acid sequestrants
    "Questran, Colestid, Welchol"
  66. nicotinic acid (niacin)
    "Nicobid, Nicolar, Niaspan"
  67. fibric acid derivatives
    "Lopid, Tricor, Atromid-S"
  68. Actions of Statins
    Inhibits production of the enzyme HMG-CoA; First line treatment for hypercholesterolemia
  69. monitor Statins for…
    "Are lab values improving (decrease in total cholesterol LDL, VLDL,, triglycerides) and increasing HDL; Monitor liver enzymes (AST, alk phos, bilirubin); Monitoring for muscle tenderness (CPK); Monitor meds that may interact with statins (diltiazem verapamil, niacin) increase risk for myopathy (muscle pain); Administer with food (30% decrease absorption without food), large amts of grapefruit juice may increase risk of toxicity with most statins"
  70. Side effects of Statins
    "abd cramps, constipation, diarrhea, flatus, heartburn, rashes"
  71. Actions of bile acid sequestrants
    Lower LDL levels by binding with bile acids in intestine; Can be inconvenient and cause GI side effects
  72. monitor bile acid sequestrants for…
    Administered 1 – 2 times per day mixed in 4-6 oz of water or juice with meals; May decrease absorption and effects of other meds; Are lab values improving (decrease in total cholesterol LDL)
  73. Side effects of bile acid sequestrants
    "Constipation, abdominal discomfort, nausea."
  74. Actions of nicotinic acid
    "Lowers total cholesterol; Prescription, extended release tab can raise HDL also; Usually used with other meds "
  75. monitor nicotinic acid for…
    "Administer with meals and cold beverage to minimize GI effects; Use caution in those with liver disease, PUD, gout, type 2 DM; Assess for pellagra (Niacin deficiency): dermatitis, stomatitis, glossitis, anemia, N&V, confusion, memory loss, delirium prior to and throughout therapy; Monitor labs; Monitor side effects"
  76. Actions of fibric acid derivatives
    "Decreases triglycerides and possibly LDL; Used to treat very high triglyceride levels, may be used cautiously with statins; Up to 2 months may be needed to achieve therapeutic effect"
  77. monitor fibric acid derivatives for…
    "May take with meals if GI distress; May increase effects of warfarin or some hypoglycemic agents; Monitor side effects; Monitor liver function tests (AST, ALT LDH, CK, alk phos, bilirubin), cholesterol levels (LDL and VLDL) and triglyceride"
  78. Side effects of ASA (low dose)
    GI bleeding and upset
  79. CAD antiplatelet treatment
  80. Actions of ASA (low dose)
    Reduces coagulability of the blood so it can flow through narrowed vessels easier; Also ASA has anti-inflammatory properties so it can decrease the inflammation process in the arterial wall (remember that inflamed arterial walls can destabilize plaque and cause it to break off)