14127708
| Question | Answer |
| Epidemiology | Cardiovascular disease (CVD) is the leading cause of death in Australia and was the underlying cause of death in 43,946 Australian deaths in 2012 (30% of all deaths) Where CVD was listed as underlying cause of death: •46% were due to coronary heart disease (CHD) |
| Risk factors (modifiable and non-modifiable) | -Non-Modifiable Age Gender Genetics -Modifiable HTN, DM,Hyperlipidaemia, Obesity, Diet, Lifestyle |
| Cause of coronary artery disease | Largely by the formation and possible proliferation of scleroses in blood vessels which are thought to occur due to blood vessel damage |
| Artherosclerosis | Lipids accumulate in the intimal layer of arteries, fibroblasts,in the area respond by producing collagen and smooth muscle proliferate together forming a complex lesion called plaque, plaque consists of mostly cholesterol, triglycerides, phospholipids, collagen of cholesterol and smooth muscle cells. Plaque reduces lumen size of the affected artery impairing blood flow. |
| Angina (stable & unstable) | Stable angina is chest pain caused by moderate to heavy exercise, while unstable angina doesn't have a predictable trigger- unpredictable, increasing in frequency, severity and duration, may occur at rest. |
| Pathophysiology behind angina | myocardial needs is greater than what is supplied by the partially occluded blood vessel. Myocardial cells become Ischemic and shift to anaerobic metabolism which produces lactic acid that stimulates nerve ending in the muscle causing pain. |
| Acute coronary syndrome & myocardial infarction | Occurs when the complete of coronary artery interrupts blood supply to an area of myocardium. Affected area becomes ischaemic and eventually dies (myocardial infarction) |
| Symptoms of artherosclerosis | Could be asymptomatic until an area of the heart no longer receives sufficient oxygen which may lead to angina |
| Three types of angina and differences | Stable- most predictable occurs after physical exertion exposure to cold or by stress. Relieved by rest and nitrates . Unstable- pain is unpredictable, increasing in frequency, severity and duration, may occur at rest. Prinzmetal's(Variant)- Unpredictable and appears often at night unknown cause but it is due to coronary artery spasm with or without artherosclerotic lesion. |
| Classic signs of myocardial infarction | Chest pain radiating to left arm Tachycardia, tachypnoea Dyspnoea, SOB N&V Anxiety sense of impending doom Diaphoresis Diminished peripheral pulse Arrhythmias Decreased LOC Signs of left heart failure |
| Relevant examinations | Total serum cholesterol C-reactive protein serum protein associated with inflammation process and elevated blood levels of these protein can be of CHD Ankle brachial blood pressure index (ABI) an ABI <0.9 in either leg indicates the presence of peripheral artery disease Exercise ECG testing Electron beam computed tomography Myocardial perfusion imaging ECG Stress electrocardiography Coronary angiography (gold standard) |
| Examinations specific for MI | Serum cardiac markers Creatinine kinase(CK)- CK level correlates the size of the infarction CK-MB CK specific to cardiac muscle CKMB greater than 5% is a positive indicator of MI Cardiac muscle troponin cardiac troponin are not detectable in the blood unless there is a cardiac necrosis Myoglobin first cardiac marker after an MI |
| Nursing assessments | Cardiac - various abnormalities may be heard on auscultation: third and fourth heart sound, systolic murmurs, paradoxical splitting of the second heart sound, a pericardial friction rub and rales over the lung. Other vitals, LOC Pain scale /PQRST |
| Relevant meds for artherosclerosis | - Statins (pravastatin) or other hypolipidaemics - Aspirin to prevent clotting - HTN medications if relevant |
| Relevant meds for angina | - GTN can be used for prophylaxis/treatment - Beta blockers can be used as a treatment |
| Relevant meds for MI | - GTN - Aspirin -Morphine |
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