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of the CV
System
CAD
Refers to the variety of pathologic
conditions that cause narrowing
of the coronary arteries
Atherosclerosis- Deposits of
cholesterol and lipids within the
walls of the artery
Risk Factors: Family history,
hyperlipidemia, smoking, DM, HPN,
obesity, sedentary/stressful
lifestyle
Family history,
Hyperlipidemia, DM,HPN
Hyperlipidemia, smoking,
obesity, stressful/sedentary lifestyle
Anti hyperlipidemics
Lifestyle mods
Endothelial Injury
Inflammation
Thromboxane
Permeability
Release of
Adhesion Molecules
Macrophage adhere to
Endothelium
ASA
Foam Cells
Fatty Streaks
Vasoconstriction
Platelet Aggregation
PTCA.
endartherectomy
Release of enzymes
and toxic O2 Radicals
Oxidation
Serotonin, Endothelin
Vessel obstruction
Necrosis of
vessel tissue
Smooth muscle
cells develop
Endothelial Dysfunction
Fibrous Plaque
Metabolism of Fats
Dietary Fats
Stomach
Small Intestines
Fibrates
Gemfibrozil, niacin
Hmg CoA blockers
Myocadial
Infarction
Death of myocardial cells from
inadequate oxygenation
Signs and symptoms: Pain, N&V,
dyspnea, cool and clammy skin,
elevated temperature,initial
increase, then drop in
BP,restlessness
Laboratory findings: Elevated WBC,
CPK, AST, LDH
ECG Changes: pathologic
Q wave, ST segment elevation,
inverted T wave
Types of MI
TYPE
Artery
Occluded
Anterior
Location of
ST/Q wave
changes
V1-V4
Inferior
RCA
Lateral
I, Avl, V5-V6
LCX
Posterior
V1-V2
RCA
LADA
Types of MI
TYPE
Layer affected
Subendocardial
Inner layer
Subepicardial
Transmural
All layers
PTCA,CABG,ASA Thrombolytocs
Myocardial Ischemia
CKMB, TROP I, T
O2, CBR,
Laxatives,
NTG,
Lifestyle
Mod
O2 Supply O2 Demand
Leukocytosis,ESR
Cellular Hypoxia
Cellular Necrosis
Anaerobic Metabolism
H Ions
Antiarrythmics
Morphine
Lactic Acid
LDH Flipping
Chest Pain
Glucose,
Fatty Acids
Diaphoresis
HR
After Load
Cool,
Clammy Skin
Contractility
Cardiotonics
BP
Disatolic Filling
CO
Rheumatic Heart
Disease
Inflammatory disorder that involves
the heart, joints, muscle and CNS
Assessment findings
Major (Jones Criteria)
Carditis
Aschoff nodules,
valvular insuffucienscy
Cardiomegaly
SOB, hepatomegaly, edema
Polyarthritis
Sunbcutaneus nodules
Chorea/ Sydenhams chorea/St.
Vitus dance
Erythema marginatum
Minor
History of GAS infection
Fever
Elevated ESR, WBC, ASO titer
GAS infection
(Beta hemolytic Streptococcus)
Fever, elevated
WBC,ESR
Inflammatory
response
Penicillin/
Erythromycin
Activation of T cells
by streptococcal antigens
Anti-inflammatory
ents ( steroids,NSAIDS)
CNS
Binds to receptors
within.
Heart
Positioning
ASA
Chorea
Swelling, heat, pain
arthralgia
Decrease stimulation
Safety precautions
Joints
Polyarthritis
Subcutaneus nodules
Heart
Pericarditis
Endocardial
Inflammation
Friction rub
Chest pain
Inflammation of
valve leaflets
Erosion of leaflet
contact
Valve replacement,
thrombolytics
Murmur
Clumping of vegetation
With platelets & fibrin
Penetrates
myocardium
Scarring/shortening
Fibrin deposits
Develop with area of
necrosis
Decreased elasticity
Mitral/ Tricuspid
regurgitation
Bed rest
CHF
Aschoff nodules
Arrythmias
Disruption in the normal events of
cardiac cycle which may/ may not
lead to decreased cardiac output
(to which the manifestations are
attributed).
Shock, anemia,
respiratory distress,
cellular hypoxia
Exercise, pain,
strong emotions, anxiety
O2, Bed rest
Carotid massage,
identify
effective
coping strategies
Decreased CO
Decreased
arterial pressure
Sympathetic
stimulation
Hyperthyroidism
Increased
Cathecolamines
Ca channel blockers
Increased HR >100BPM
Hyperkalemia, digoxin,
MI, hypothermia
Late hypoxia
Symphatomimetics
pacers
Decreased
automaticity
Decreased
ATP
Increased vagal
stimulation
HR <60BPM
Electrolyte
imbalance
Anterior MI
Hypoxia
Correct
imbalance
Shortening of
the phases of
cardiac cycle
Increased cell
permeability
Impulses not
conducted to
the ventricles
Digoxin, Ca channel
Blockers, class Ia, II
antiarrythmics, sychronized
cardiovertion
Atrial rate
200-400BPM
Pathophysiology of Atrial
Fibrillation/Flutter
Synchronized cardioversion
Irritability