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. Coronary Artery Disease • High Blood Pressure • High Cholesterol/Obesity • Smoking • Diabetes • Genetics has a role • Stress • Aging

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

11. 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. 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. 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.

16. Angiography/Cardiac Catheterization

17. Treatments • Rest • Heart Healthy Diet • Stress Reduction • Smoking Cessation • Exercise • Controlling Diabetes and Hypertension

18. Statins • Cholesterol-lowering drugs. They block the enzyme in the liver responsible for making cholesterol. • Simvastatin (Zocor) • Atorvastatin (Lipitor) • Rosuvastatin (Crestor)

19. Nitrates • Dilate (open) the arteries of the heart which increases blood flow. • Nitroglycerin • Isosorbide dinitrate (Isordil)

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

21. Aspirin and Plavix • 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.

22. Heparin • Heparin may be given IV to thin blood and prevent further clot formation. Close monitoring has to be done to watch for bleeding.

23. Lovenox • 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.

24. 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

25. 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. • Block beta-adrenergic receptors, preventing adrenaline (epinephrine) from stimulating these receptors. • Metoprolol • Propranolol • Carvedilol

27. 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.

28. Calcium Channel Blockers 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)

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

31. Stent: • Tube placed in an artery to keep it open.

32. 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.

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

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

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

36. Diagnosis • Blood pressure readings. Several visits. • Lab work (Lipid panels, Chemistry, CBC) • Urinalysis (most patients with kidney problems have hypertension). • Electrocardiogram • Echocardiogram

37. Treatment • 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.

38. Congestive Heart Failure • Progressive decrease in the ability of the heart to contract. • Blood backs up in the heart. Things get “congested.”

39. Causes • Diseases that damage the heart or cause “heart fatigue.” (Coronary artery disease, Myocardial infarction, infection, valve defects, hypertension, etc).

40. Signs and Symptoms • Peripheral Edema (swelling in feet or hands) • Weight gain • Neck vein distention • Enlargement of spleen • Fluid in the lungs (sounds “wet”)/pulmonary edema (frothy bloody sputum)/pleural effusions • Shortness of breath

41. Diagnosis • Assessment • Chest X-Ray • BNP – Lab test • Electrocardiogram • Echocardiogram

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

43. Pericardiocentsis

45. Thoracentsis

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

47. Causes • Myocardial Infarction • Electrolyte imbalance • Drugs • Electrical Shock • Congenital • Idiopathic

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

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

50. Greater than 100bpm= Tachycardia