Aneurysms
Define Abdominal Aortic Aneurysm
An aneurysm is a permanent localized dilation of an artery that forms when the middle layer (media) of the artery is weakened, producing a stretching effect in the inner layer (intima) and outer layers of the artery. While the artery widens, tension in the wall increases, further widening occurs, and the aneurysm enlarges. Abdominal Aortic Aneurysms occur above the diaphragm.
What is CABG?
An invasive surgical treatment is coronary artery bypass grafting (CABG). With CABG, blockages in coronary arteries are bypassed using other arteries from the chest or arm or veins from the legs... Then arteries or veins being used as bypasses are surgically attached to the diseased coronary artery, creating an alternate path for blood to flow around the blockage.
What does an ideal lipid panel look like?
Cholesterol < 200mg/dl
LDL < 100 mg/dl
HDL > 40-60mg/dl
Triglycerides <150
IV Push 1mg of atropine
Atropine.
List some symptoms of aneurysms
Often Asymptomatic!
AAA= abdominal pain
TAA= back pain
Chest or flank pain
SUDDEN tearing pain
Systolic Bruit
Sometimes you can see their pulse in their back
Please list 3/12 possible complications of CABG:
Complications associated with CABG include bleeding, dysrhythmias, MI, stroke, nonunion of the sternum, sternal infection, renal failure because of decreased renal blood flow, or heart failure. Complications of bypass include induction of a systemic inflammatory response resulting in vasodilatory shock, heparin-induced thrombocytopenia, activation of platelets, and the complications associated with cross clamping the aorta during the procedure.
Synchronized cardioversion, reduce rate with Ca channel blockers & beta blockers, antiarrhythmics like Tikosyn, and an ANTICOAGULANT TO PREVENT STROKE!
What are some interventions for atrial fibrillation?
Medication to relieve angina
The book says Ca channel blockers lower blood pressure and improve circulation through the coronary arteries which helps prevent the pain of angina.
What does the healthcare team use to diagnose an aneurysm?
Gold Standard = CT Scan with IV Contrast
Abdominal US
Transthoracic Echo (TTE)
Cardiac MRI for AAA only
Difference between stable and unstable angina:
Stable gets better with rest and usually starts with physical activity.
Unstable doesn't get better with rest and may occur during rest. It is a major sign of impending MI.
What are the symptoms of a right-sided MI?
JVD, hypotension, bradycardia due to damage to the SA node, and N/V.
Vagal maneuvers, Oxygen, ADENOSINE, Ca channel blockers, beta-blockers, and synchronized cardioversion.
What does the surgical management of an aneurysm look like?
<5cm AND Asymptomatic AND no ruptured = no surgical intervention required at this time, but yearly CTs instead.
Aneurysmectomy: resected and a graft is placed
EVAR: Endovascular Aneurysm Repair. Graft is placed inside the aneurysm which causes it to shrink.
List 3 labs of heart damage
CK-MB > 3
Troponin Female >12
Troponin Male >20
BNP > 500
What are the symptoms of left-sided MI?
Dyspnea, tachycardia, and hypertension that turns into hypotension.
What is a medication that blocks the activity of certain signals in the heart causing Atrial Fib and Atrial Flutter?
Tikosyn (dofetilide)
What does the pharmacological management of a MI look like?
Goals = control pain, dilate coronary arteries, prevent clots, and decrease myocardial workload.
Nitroglycerin, given 3 times 5 minutes apart is the 1st choice for pain because it dilates the arteries, improving oxygen-rich blood flow to the heart.
Morphine, if the pain is not relieved by morphine, because it reduces the workload of the heart (may cause hypotension, N/V, respiratory depression).
Aspirin, because it makes platelets slippery so new clots won't form and old clots won't get bigger.
Beta blockers, because they decrease the cardiac workload.
Heparin, because it breaks up thrombus and prevents new ones from forming.
Fibrinolytic therapy, which is the breakdown of fibrin (the proteins that form a net). Part of the coagulation cascade. Should be administered within 30 minutes of the MI start. ex.s from class: t-PA, TNK. The FDA currently allows the following: Streptokinase, Anistreplase, t-PA, reteplase, and tenecteplase. R.A.T.S are listed in the textbook under Medications to Treat Clotting Disorders.
Reperfusion therapy should be administered within 90 minutes.
What does the pharmacological management of an aneurysm look like?
Aggressive management of the B/P with ACE inhibitors, ARB's, and Beta-Blockers (can you name a few?). Also, antibiotics so the body doesn't develop an infection that immediately turns septic: Macrolides, Tetracyclines, Statins.
Prinzmetal
What is pain caused by coronary artery spasm?
What are the typical and atypical symptoms of MI?
Typical: CHEST PAIN, SOB, N/V, Sweating, and generalized fatigue.
Atypical: jaw and tooth pain, shoulder blade pain, and upper back pain.
When should you reach for Digoxin and what are the therapeutic levels?
Chronic A-fib, A-flutter, or PSVT with heart failure. Therapeutic levels = 0.5-2.0 ng/dl. Hypokalemia increases the chances of toxicity.
What does the pharmacological management of CAD look like?
HINT: BANCS
Goal = stop aggregation of the blood to the epithelium, control factors that led to the damage of the coronary arteries, and relieve symptoms.
Beta Blockers, because they decrease cardiac load.
Antiplatelets, because they inhibit platelet aggregation to prevent clot development.
Nitrates, because they dilate the arteries.
Ca Channel Blockers, because they lower blood pressure.
Statins, because they reduce the total amount of cholesterol in the body.