Cardiac chapter
2. describe four general treatment measured for cardiac disorders
1. dietary modifications (reduce fat intake, or at least LDL and trans fats)
2. exercise regularly
3. cessation of cigarette or smoking
4. appropriate drug therapy
3. identify 10 risk factors for developing atherosclerosis. Indicate which ones are
modifiable and which ones are not. Note that these are the same risk factors for heart
disease. Cannot be changed: age, gender, genetic and familial factors,
Modifiable: diet and cholesterol level and intake, cigarette smoking, sedentary lifestyle, presence of
diabetes myelitis, poorly uncontrolled HBP, oral contraceptives.
4. describe the process of atheroma formation, from the initial fatty streaks in the arterial
wall intima to a complicated plaque.
• Endothelial injury in the artery, often at a very young age
• Endothelial injury causes inflammation in the area, leading to elevated C-creatinine (CRP)
protein level
• WBC (monocytes and macrophages) accumulate in the intima and muscle layer of artery
• Smooth muscle cells proliferate and multiply
• A plaque forms and inflammation persist
• Platelets adhere to the rough damaged arterial wall forming a thrombus and partial
obstruction of the artery
• Lipids continue to build up at the site of injury along with fibrous tissue. Platelets adhere and
release prostaglandins, which precipitate inflammation and vasospasm
• This draws more platelet to adhere at the site, enlarginf the thrombus and partial obstructing
the artery.. arterial flow become more turbulent increasing the thrombus formation.
•
5 describe the significance of plaque formation, including 5 potent complications of
atherosclerosis.
Development of atheromatous plaques narrows the lumen of arteries, restricting flow, causing
turbulence, thrombus formation, and potential embolism. The atheroma also damages the arterial wall,
weakening the structure and decreasing elasticity, and ultimately may calcify, causing further rigidity.
Complications include thrombus formation with partial angina or total occlusion, if total obstruction
-MI, stroke and peripheral vascular damage, aneurysm, or rupture and hemorrhage
6. which vessels are affected by atherosclerosis?
Primarily large arteries particularly at bifurcations--aorta, coronary, iliac, carotids
7. describe common therapeutic interventions, to include lifestyle changes, used in
the treatment of atherosclerosis.
1. Maintain weight at healthy levels to reduce the risk of metabolic syndrome,HBP, and atherosclerosis
2. lower serum cholesterol and LDL in diet by reducing the intake of saturated fats and using
,unsaturated veggie oils; high dietary fiber intake also decreases LDL
3. sodium intake minimized for control of hypertension
4. control of primary disorders such as diabetes and HBP
5. stop smoking
6. exercise appropriate for age and health status to promote collateral circulation and reduce
LDL levels
7. oral anticoagulant therapy in case of thrombus formation concern
8. surgical intervention
8. explain the rationale for prescribing the following drugs:
1. Antilipidemics or lipid-lowering drugs:- to lower cholesterol and lipids level
2. Platelet inhibitors- lower platelet aggregation leading to a lower chance of thrombosis, and
thus leading to a lower chance of heart attack and stroke
3. Anticoagulants- interfere with clotting factor synthesis (warfarin) or inhibit thrombin
formation(heparin), leading to a lower chance of thrombosis and a lower chance of heart
attacks and strokes
4. Antihypertensive- help decrease cardiac workload
9. what type of surgical intervention can be used in advanced atheroma.
Percutaneous transluminal coronary angioplasty (PTCA)
Coronary artery bypass grafting
Laser Angioplasty
Angina pectoralis
10. define angina pectoralis
Chest pain, occurs when there is a deficit of oxygen in the heart muscle. Occurs when the blood and
oxygen supply to the myocardium is impaired and heart is working harder to and the need of oxygen
increases.
11. what is the underlying pathology involved in angina pectoralis?
The reduced blood supply may be due to a partial obstruction, by atherosclerosis or spasm in the
coronary arteries
12. identify disorders that may cause or predispose an individual to angina
Atherosclerosis
Arteriosclerosis
Vasospasm
Myocardial hypertrophy
Severe anemias
Respiratory diseases
13. what is the most serious complication of angina pectoralis?
Myocardial infarction
, 14. the factors listed below often precipitate an attack in an individual with history
of angina. Explain the mechanism involved for each of them:
1. Smoking a cigarette or being exposed to secondhand smoke – smoke causes
vasoconstriction, leading to increased venous return and increased heart rate
2. Going from a warm environment to a cold – this causes vasoconstriction too,
3. Engaging in an argument or other stressful behavior—stimulates SNS and increases heart rate
4. Exercise such as climbing a flight of stairs or rushing to catch a bus—increase heart reate due
to an increase O2 demand
15. describe the classic manifestations of an angina attack. What is the usual duration of
an angina attack?
The classic manifestations are recurrent, intermittent brief episodes of substernal chest pain, described
as tightness or pressure that may radiate to the neck or left arm. An anginal attack usually lasts a few
seconds or minutes and can be quickly relieved by rest and coronary vasodilators.
16. what type of drug is used to treat an acute anginal attack? Explain how this
drugs relief chest pain.
Nitroglycerin, is a coronary vasodilator that relieve vasospasm in the coronary arteries but also
reduce systemic resistance which decreases systemic oxygen demand
17. in an emergency anginal attack, how will you administer nitroglycerin?
Admin sublingual because the medic enters directly into blood flow
18. outline the management of an anginal attack.
1. let pt rest, stop activity
2. seat pt in an UPRIGHT position
3. give nitroglycerine sublingually
4. check pulse and respiration
5. give oxygen if necessary
6. for a pt with known angina the AHA recommends a second dose of ntg if pain persists for more
than 5 minutes. After 3 doses w/in a 10 minute period and no relief it should be treated as MI. Call for
emergency medical intervention
7. For pt w/o history of angina emergency medical aid should be sought after 2 minutes w/o relief
19. when should emergency medical services be required?
after 3 doses of nytrogl within 10 minutes and no relief, may be a sign of MI
20.
Drug group Action and effects Adverse effects Example
b-adrenergic Block Beta They cause dizziness metoprolol
blockers adrenergic receptors, and fatigue.
, slowing the heart
rate, reducing the
workload of the
heart.
Calcium channel Vasodilator, blocks Dizziness, fainting, Nifedipine,
blockers calcium channel, headache amlodipine
reducing cardiac
contractility and
work
Nitrates(vasodilators Reduces cardiac Headache, Nitroglycerin
; transdermal or workload; decreases Dizziness. isosorbide
oral form) peripheral resistance Lightheadedn
by vasodilation ess.
Nausea.
Flushing.
Burning and
tingling under the
tongue.
Low blood
pressure.
21. list other types of medication that might be prescribed for an individual with
angina, and explain the rationale for each.
-antihypertensive to lower blood pressure and cardiac workload
-diuretic to help control blood pressure and prevent edema
-platelet inhibitor to lower platelet aggregation and the chance of thrombus formation
-antihyperlipidemic to lower blood cholesterol and LDL levels and hopefully slow or arrest
progression of atherosclerosis
22. identify surgical interventions that might be used in the treatm of angina
Angioplasty and stent insertion; coronary bypass graft
23. describe nonpharmacologic interventions that could help to control angina.
-avoid situations known to precipitate attack (stress)
-stop smoking
-consume diet low in saturated and trans-fats
-restrict sodium intake
-lose weight if overweight
-engage in a consistent exercise program
-reduce stress
2. describe four general treatment measured for cardiac disorders
1. dietary modifications (reduce fat intake, or at least LDL and trans fats)
2. exercise regularly
3. cessation of cigarette or smoking
4. appropriate drug therapy
3. identify 10 risk factors for developing atherosclerosis. Indicate which ones are
modifiable and which ones are not. Note that these are the same risk factors for heart
disease. Cannot be changed: age, gender, genetic and familial factors,
Modifiable: diet and cholesterol level and intake, cigarette smoking, sedentary lifestyle, presence of
diabetes myelitis, poorly uncontrolled HBP, oral contraceptives.
4. describe the process of atheroma formation, from the initial fatty streaks in the arterial
wall intima to a complicated plaque.
• Endothelial injury in the artery, often at a very young age
• Endothelial injury causes inflammation in the area, leading to elevated C-creatinine (CRP)
protein level
• WBC (monocytes and macrophages) accumulate in the intima and muscle layer of artery
• Smooth muscle cells proliferate and multiply
• A plaque forms and inflammation persist
• Platelets adhere to the rough damaged arterial wall forming a thrombus and partial
obstruction of the artery
• Lipids continue to build up at the site of injury along with fibrous tissue. Platelets adhere and
release prostaglandins, which precipitate inflammation and vasospasm
• This draws more platelet to adhere at the site, enlarginf the thrombus and partial obstructing
the artery.. arterial flow become more turbulent increasing the thrombus formation.
•
5 describe the significance of plaque formation, including 5 potent complications of
atherosclerosis.
Development of atheromatous plaques narrows the lumen of arteries, restricting flow, causing
turbulence, thrombus formation, and potential embolism. The atheroma also damages the arterial wall,
weakening the structure and decreasing elasticity, and ultimately may calcify, causing further rigidity.
Complications include thrombus formation with partial angina or total occlusion, if total obstruction
-MI, stroke and peripheral vascular damage, aneurysm, or rupture and hemorrhage
6. which vessels are affected by atherosclerosis?
Primarily large arteries particularly at bifurcations--aorta, coronary, iliac, carotids
7. describe common therapeutic interventions, to include lifestyle changes, used in
the treatment of atherosclerosis.
1. Maintain weight at healthy levels to reduce the risk of metabolic syndrome,HBP, and atherosclerosis
2. lower serum cholesterol and LDL in diet by reducing the intake of saturated fats and using
,unsaturated veggie oils; high dietary fiber intake also decreases LDL
3. sodium intake minimized for control of hypertension
4. control of primary disorders such as diabetes and HBP
5. stop smoking
6. exercise appropriate for age and health status to promote collateral circulation and reduce
LDL levels
7. oral anticoagulant therapy in case of thrombus formation concern
8. surgical intervention
8. explain the rationale for prescribing the following drugs:
1. Antilipidemics or lipid-lowering drugs:- to lower cholesterol and lipids level
2. Platelet inhibitors- lower platelet aggregation leading to a lower chance of thrombosis, and
thus leading to a lower chance of heart attack and stroke
3. Anticoagulants- interfere with clotting factor synthesis (warfarin) or inhibit thrombin
formation(heparin), leading to a lower chance of thrombosis and a lower chance of heart
attacks and strokes
4. Antihypertensive- help decrease cardiac workload
9. what type of surgical intervention can be used in advanced atheroma.
Percutaneous transluminal coronary angioplasty (PTCA)
Coronary artery bypass grafting
Laser Angioplasty
Angina pectoralis
10. define angina pectoralis
Chest pain, occurs when there is a deficit of oxygen in the heart muscle. Occurs when the blood and
oxygen supply to the myocardium is impaired and heart is working harder to and the need of oxygen
increases.
11. what is the underlying pathology involved in angina pectoralis?
The reduced blood supply may be due to a partial obstruction, by atherosclerosis or spasm in the
coronary arteries
12. identify disorders that may cause or predispose an individual to angina
Atherosclerosis
Arteriosclerosis
Vasospasm
Myocardial hypertrophy
Severe anemias
Respiratory diseases
13. what is the most serious complication of angina pectoralis?
Myocardial infarction
, 14. the factors listed below often precipitate an attack in an individual with history
of angina. Explain the mechanism involved for each of them:
1. Smoking a cigarette or being exposed to secondhand smoke – smoke causes
vasoconstriction, leading to increased venous return and increased heart rate
2. Going from a warm environment to a cold – this causes vasoconstriction too,
3. Engaging in an argument or other stressful behavior—stimulates SNS and increases heart rate
4. Exercise such as climbing a flight of stairs or rushing to catch a bus—increase heart reate due
to an increase O2 demand
15. describe the classic manifestations of an angina attack. What is the usual duration of
an angina attack?
The classic manifestations are recurrent, intermittent brief episodes of substernal chest pain, described
as tightness or pressure that may radiate to the neck or left arm. An anginal attack usually lasts a few
seconds or minutes and can be quickly relieved by rest and coronary vasodilators.
16. what type of drug is used to treat an acute anginal attack? Explain how this
drugs relief chest pain.
Nitroglycerin, is a coronary vasodilator that relieve vasospasm in the coronary arteries but also
reduce systemic resistance which decreases systemic oxygen demand
17. in an emergency anginal attack, how will you administer nitroglycerin?
Admin sublingual because the medic enters directly into blood flow
18. outline the management of an anginal attack.
1. let pt rest, stop activity
2. seat pt in an UPRIGHT position
3. give nitroglycerine sublingually
4. check pulse and respiration
5. give oxygen if necessary
6. for a pt with known angina the AHA recommends a second dose of ntg if pain persists for more
than 5 minutes. After 3 doses w/in a 10 minute period and no relief it should be treated as MI. Call for
emergency medical intervention
7. For pt w/o history of angina emergency medical aid should be sought after 2 minutes w/o relief
19. when should emergency medical services be required?
after 3 doses of nytrogl within 10 minutes and no relief, may be a sign of MI
20.
Drug group Action and effects Adverse effects Example
b-adrenergic Block Beta They cause dizziness metoprolol
blockers adrenergic receptors, and fatigue.
, slowing the heart
rate, reducing the
workload of the
heart.
Calcium channel Vasodilator, blocks Dizziness, fainting, Nifedipine,
blockers calcium channel, headache amlodipine
reducing cardiac
contractility and
work
Nitrates(vasodilators Reduces cardiac Headache, Nitroglycerin
; transdermal or workload; decreases Dizziness. isosorbide
oral form) peripheral resistance Lightheadedn
by vasodilation ess.
Nausea.
Flushing.
Burning and
tingling under the
tongue.
Low blood
pressure.
21. list other types of medication that might be prescribed for an individual with
angina, and explain the rationale for each.
-antihypertensive to lower blood pressure and cardiac workload
-diuretic to help control blood pressure and prevent edema
-platelet inhibitor to lower platelet aggregation and the chance of thrombus formation
-antihyperlipidemic to lower blood cholesterol and LDL levels and hopefully slow or arrest
progression of atherosclerosis
22. identify surgical interventions that might be used in the treatm of angina
Angioplasty and stent insertion; coronary bypass graft
23. describe nonpharmacologic interventions that could help to control angina.
-avoid situations known to precipitate attack (stress)
-stop smoking
-consume diet low in saturated and trans-fats
-restrict sodium intake
-lose weight if overweight
-engage in a consistent exercise program
-reduce stress
