Circulatory Diseases and Treatments

1. Circulatory Diseases and Treatments Practicum I 2011-2012

2. Coronary Artery Disease

3. Coronary ArteriesSupply the heart muscle (myocardium) with oxygenated blood.

4. Coronary Artery Disease • These small vessels can become occluded. This happens when a blood clot forms on the inner wall of a coronary artery or the narrowing of the lumen.

5. Coronary Artery Disease • Result of atherosclerosis. • The fatty plaque first causes plugging of the artery. • Next, the roughened lining may rupture or cause abnormal clotting of the blood leading to a thrombotic occlusion.

7. Coronary Artery Disease • Blood flow is then decreased (ischemia) or stopped completely. • Lack of oxygen leads to tissue death (necrosis) of the myocardium. The area of necrosis is called an infarct. (MI=mycardial infarction=heart attack)

8. Coronary Artery Disease • Arteriosclerosis is hardening of the arteries. Artery walls become thick and loose their elasticity. • Can be a result of aging and chronic hypertension.

9. CAD Causes • High Blood Pressure • High Cholesterol/Obesity • Smoking • Diabetes • Genetics has a role • Stress • Aging

10. CAD Signs and Symptoms • Angina • SOB (shortness of breath) • Heart attack (crushing pain, diaphoresis, nausea, pallor, light headedness. • Fatigue • Lack of energy

11. CAD Diagnosis • History (medical past, symptoms, risk factors). Also current medications, vital sign recordings, and previous surgeries. • Physical exam (listen for murmurs, abnormal pulse, skin color and temp, swelling.) • Vital signs (BP, HR, RR, Temp)

12. CAD Diagnosis • EKG/ECG • Chest x-ray • Angiography/Cath lab • Stress test • Echo (EF%) • Normal EF is 50-70% • Average is 58% • Labs: Cardiac Enzymes, Lipid panels, BNP.

13. Acute Coronary Syndromes (ACSs) • Conditions caused by myocardial ischemia. (Temporary oxygen insufficiency). MI is when the myocardium is suddenly completely deprived of oxygen. • Some heart muscle cells die and are replaced by scar tissue. • Symptoms include angina (chest pain) which may radiate to the neck, jaw, and left arm.

14. Angiography/Cardiac Catheterization

15. CAD Treatment Medical Rest Heart Healthy Diet Stress Reduction Smoking Cessation Exercise Controlling Diabetes and Hypertension

16. CAD Treatments Medications • Statin drugs: Cholesterol-lowering drugs. They block the enzyme in the liver responsible for making cholesterol. • Simvastatin (Zocor) • Atorvastatin (Lipitor) • Rosuvastatin (Crestor)

17. CAD Treatments (Medication) Nitrates • Dilate (open) the arteries of the heart which increases blood flow. • Nitroglycerin • Isosorbide dinitrate (Isordil)

18. CAD • Thrombolytics are clot busting drugs. • tPA (alteplase) • Urokinase • Streptokinase • These must be used in first few hours of an MI.

19. Other medications • Aspirin is given to help prevent clot formation. It doesn’t break up clots. • If a patient is intolerant of aspirin (ASA) clopidogrel (Plavix) is prescribed. • Heparin may be given IV to thin blood and prevent further clot formation. Close monitoring has to be done to watch for bleeding. • Lovenox (low molecular weight heparin) is widely used now since no blood levels have to be monitored and there is less risk of bleeding. It is given in an injection in the abdomen.

20. Lovenox

21. ACE inhibitors (angiotension-converting enzyme) • Angiotension in a hormone produced by the liver. It causes vasoconstriction which increases blood pressure. • These medications decrease production of angiotension converting enzyme. • Captopril • Lisinopril

23. Beta blockers • Beta-blockers improve the heart's ability to relax, decrease the production of harmful substances produced by the body in response to heart failure, and slow the heart rate. Over time, beta-blockers improve the heart's pumping ability. • Beta blockers block beta-adrenergic receptors, preventing adrenaline (epinephrine) from stimulating these receptors. • Metoprolol • Propranolol • Carvedilol

25. Calcium Channel Blockers • Blocks the entry of calcium into the muscle cells of the heart and the arteries. It is the entry of calcium into these cells that causes the heart to contract and arteries to narrow. By blocking the entry of calcium, calcium channel blocker decrease the contraction of the heart and dilate (widen) the arteries. By dilating the arteries, CCBs reduce the pressure in the arteries. This makes it easier for the heart to pump blood, and, as a result, the heart needs less oxygen. By reducing the heart's need for oxygen, CCBs prevent or relieve angina • Nicardipine (Cardene) • Amlodipine (Norvasc) • Nifedipine (Procardia) • Diltiazem (Cardizem)

27. CAD Treatments • Percutaneous Coronary Intervention (PCI). • Types of (Balloon Angioplasty, Stents)

28. CAD Treatments • Stent: tube placed in an artery to keep it open.

29. CAD Treatments • Coronary Artery Bypass Graft • Surgical procedure in which one or more blocked coronary arteries are bypassed by a blood vessel graft to restore normal blood flow to the heart. These grafts usually come from the patient’s own arteries and veins located in the chest (thoracic), leg (saphenous) or arm (radial). The graft goes around the blocked artery (or arteries) to create new pathways for blood to flow to the heart.

30. Hypertension • Abnormally high blood pressure. • Often called the “silent killer” because it often goes unrecognized until complications arise.

31. Causes of Hypertension • High Sodium Intake • Age • Race • Obesity • Genetics • Kidney Failure • Lack of Exercise • Diabetes • Smoking

32. Signs and Symptoms of Hypertension • Headache • Dizziness • Nausea • Blurred vision • Chest pain • Shortness of breath • Flushing • Nose bleeds

33. Diagnosis of Hypertension • Blood pressure readings. Several visits (to avoid “white coat” syndrome. Home journaling. Size does matter (in blood pressure cuffs). • Lab work (Lipid panels, Chemistry, CBC) • Urinalysis (most patients with kidney problems have hypertension). • ECG • Echo

34. Treatment of Hypertension • Lifestyle changes: low sodium, low fat diet; smoking cessation, exercise, stress reduction, weight loss. • Medications: Diuretics (water pills), Beta blockers, ACE inhibitors, Calcium channel blockers. • Treat underlying problem.

35. Congestive Heart Failure • Progressive decrease in the ability of the heart to contract. • Things get “congested.”

36. Causes of CHF • Diseases that damage the heart or cause “heart fatigue.” (CAD, MI, infection, valve defects, hypertension, etc).

37. Signs and Symptoms of CHF • Edema (ankle) • Weight gain • Neck vein distention • Enlargement of spleen • Fluid in the lungs (sounds “wet”)/pulmonary edema (frothy bloody sputum)/pleural effusions • Shortness of breath

38. Diagnosis of CHF • Assessment • CXR • BNP • ECG • Echo

39. Treatment of CHF • Lifestyle changes (smoking cessation, heart healthy diet, exercise) • LOWER SALT INTAKE • Fluid restriction • ACE inhibitors • Beta blockers • Diuretics • Oxygen (for SOB) • Thoracentsis • Pericardiocentsis

40. Pericardiocentsis

41. Thoracentsis

42. Arrhythmias • An abnormal heart rhythm. • Causes an abnormal heart beat.

43. Too Fast = Tachycardia

44. Too Slow = Bradycardia

45. Fibrillation = quivering

46. Heart Block (Junctional) Impulse from AV junction is blocked

47. Causes of Arrhythmias • MI • Electrolyte imbalance • Drugs • Electrical Shock • Congenital • Idiopathic

48. Signs and Symptoms of Arrhythmias • Palpitations • Dizziness • Irregular Pulse • Shortness of breath • Weakness • Fatigue • Chest pain

49. Diagnosis of Arrhythmias • ECG • Lab work (chemistry sets) • Stress Tests • Holter monitor

50. Treatment of arrthymias