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Circulatory Diseases and Treatments

Circulatory Diseases and Treatments. Coronary Artery Disease. Coronary Arteries Supply the heart muscle (myocardium) with oxygenated blood. Coronary Artery Disease.

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Circulatory Diseases and Treatments

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  1. Circulatory Diseases and Treatments

  2. Coronary Artery Disease

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

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

  5. CAD • Usually the result of atherosclerosis (deposits of fatty compounds on the inner lining of an artery). • 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.

  6. CAD • 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)

  7. MI

  8. 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.

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

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

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

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

  13. 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.

  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-lower drugs. The 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

  22. 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

  23. 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)

  24. CAD Treatments • Percutaneous Coronary Intervention (PCI). • Types of (Ballon Angioplasty, Stents)

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

  26. 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.

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

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

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

  30. 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

  31. 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.

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

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

  34. 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

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

  36. 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 • Pericardi0centsis

  37. Pericardiocentsis

  38. Thoracentsis

  39. Arrthymias • An abnormal heart rhythm. • Causes an abnormal heart beat.

  40. Too Fast = Tachycardia

  41. Too Slow = Bradycardia

  42. Fibrillation = quivering

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

  44. Causes of Arrthymias • MI • Electrolyte imbalance • Drugs • Electrical Shock • Congenital • Idiopathic

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

  46. Diagnosis of Arrthymias • ECG • Lab work (chemistry sets) • Stress Tests • Holter monitor

  47. Treatment of arrthymias

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