List at least 4 cardiovascular conditions.
- CHD
- angina
- ACS(acute coronary syndrome)
- AMI (acute myocardial infarction)
- heart failure
- cardiomyopathy
- endocardtitis
- aneurysm
What is CAD and what is the most common cause?
Coronary Artery Disease
-atherosclerosis is the most common cause of CAD
list some non-modifiable risk factors for CAD
- age
- gender
- ethnicity
- genetic predisposition
- low birth weight
- diabetes mellitus
- hormonal/biochemical factors
list some modifiable risk factors for CAD
- blood cholesterol
- tobacco smoking
- high blood pressure
- overwieght/obesity
- diet
- alcohol consumption
- social class
- geographical distribution.
Differentiate what stable angina would present as in a CAD pt?
- pain occurs with increasing workload (exercise)
- pain is stable abd predicatable (occurs with emotion or exertion)
- stable atherosclerotic plaque
- radiates to the neck/shoulders/arm (only lasting 2-5minutes)
- relieved by rest
- cardiac markers normal
- ECG- T wave inversion during angina
Differentiate what Acute Coronary Syndrome (ACS) would present as in a CAD pt?
- pain increasing with coronary spasm or unstable plaque/thrombus blockage
- pain occurs at rest and is increasing in severity/frequency
- pain last 10 mins or longer and radiate to neck/Lshoulder/arm
- ECG- ST segment depression with T wave inversion
- cardiac markers may start off normal but have a late elevation.
What is the management for angina/ACS?
- A to E assessment
- medicate as prescribed
How do we assess chest pain?
PQRST assessment
p-precipitating factors = what brought it on? presenting complain? was it induced?
q-quality= Is this normal? whats different? use pain scale. how severe is the pain?
r-radiation= does it go anywhere? Is it dull, ache, throbbing?
s-severity= any associated symptoms?
t-time of onset= when did it start?
What observations/monitoring would we be performing on a pt with suspected cardiac issues?
- reassure the pt
- baseline obs
- 12 lead ECG (9/10 can be diagnosed through this)
- Iv access
- bloods need to be taken = assess for troponin and cardiac enzymes (creatine kinase)
- is there a need for cardiac monitoring
- contact dr
what ongoing management would we performing on the pt?
- repeat ECG
- observe for associated symptoms
- evaluate effectiveness of interventions
- provide O2 if hypoxic (under 94%)
- pain management if pain continues = morphine ( be aware of side effect of respiratory depression)
Why is it important that we look for cardiac enzymes in the blood work?
- allows for early detection after heart damage: 4-6 hrs
- raised levels of CK (creatine kinase) indicate muscle damage
why would an echocardiogram be performed on a pt with suspected cardiovascular problems?
An echocardiogram allows examination of valves and myocardial wall movements.
What is Glycerl trinitrate (GTN) and list the side effects and effects it has on the body.
- it is a vasodilator / coronary artery drug.
Effects: reduce pain, reduces myocardial oxygen demand and causes peripheral and coronary vasodilation.
-it increases blood flow
Side effects: dilates blood vessels
-we need to be monitoring BP and HR
what type of medication would we be giving a pt with cardiovascular problems for pain management?
Morphine as it reduces:
- anxiety
- resp rate
- myocardial oxygen demand
- BP
- venous return
Why take an ECG?
- to detect and monitor changes in HR and rhythm
- make clinical diagnosis
- assess treatment
What does Atenolol (Anselol) used for and what are the reactions that could occur from taking this drug?
-it is a beta-blocker drug
-used to treat hypertension, angina, MI, cardiac arrythmias
Reactions:
-constipation
-nausea
-dry mouth
-bradycardia
-postural hypotension
-raynauds
What mnemonic should we remember for treating cardiovascular problems?
M.O.N.A M=morphine O=oxygen (below 94%) N= nitrates A= asprin
On an ECG what does P wave represent?
Atrial depolarisation
On an ECG what does PR segment represent?
Delay at AV Node
On an ECG what does QRS complex represent?
Ventricular muscle depolarisation
On an ECG what does T wave represent?
Ventricular repolarization.
When the cells regain a negative charge)
On an ECG what does Isoelectric line represent?
No electrical activity
On an ECG what does PP interval represent?
measures the beginning of 1 P wave to the next Pwave
On an ECG what does RR interval represent and used for?
used to determine ventricular rate and rhythm;
Measures from 1 QRS complex to the next QRS complex
