Coronary Artery Disease &Acute Coronary Syndromes Most Common cause of cardiovascular disability and death. It refers to a spectrum of illnessesthat range from the least lifethreatening to the most lifethreatening acute coronarysyndrome(AMI/ Heart attack). Incomplete occlusion of the coronary arterieslead to Angina (ischemia) Complete occlusion of the coronary arterieslead to Myocardial Infarction The heart will pump harder to meet the O2demand leading to Congestive Heart Failure.
Non Modifiable Risk Factors of CAD/ ACS Age Gender Race Heredity
Modifiable Risk Factors of CAD/ACS Stress Diet Exercise Cigarette Smoking Alcohol Hypertension Hyperlipidimia Diabetes Mellitus Obesity Personality Type or BehavioralFactors Contraceptive Pills
Cardiovascular Assessment Chest Pain Most common Due to Ischemia or MI Precipitated by stress or can be relieved by Nitroglycerin (NTG) In MI, it is more intense, unrelated to activities andcant be relieved by NTG If it occurs during breathing, suspect respiratory problems
Cardiovascular Assessment Dyspnea subjective feeling (inability to get enough air). Dyspnea on exertion is due to increased O2myocardial demand. Orthopnea is related to blood pooling in the pulmonary bed; suspect Pulmonary Edema Any sudden or acute dyspnea may be a sign of Pulmonary Embolism
Cardiovascular Assessment Cough/sputum Mucoid and foamy sputum can be a sign of CHF Pink-tinged frothy appearance may signal PulmonaryEdema. Whitish, viral infection Change in color other than the above mentioned maysignify bacterial infection.
Cyanosis Bluish discoloration of the skin and mucousmembrane Sat O2 is below 90% Fatigue May be due to Anemias or related to decreasedCardiac Output
Palpitations Awareness of rapid or irregular heart beat Autonomic Nervous System and Adrenal Glandsresponse (stress) Syncope Transient loss of consciousness Due to decreased cerebral tissue perfusion Edema Due to: Increased Hydrostatic Pressure (HP) Decreased Colloidal OncoticPressure (COP) Obstructed Lymphatic or Vascular System Related to Inflammatory reaction Types of Edema Bilateral edema =CHF or Renal Failure Unilateral edema =Vascular or Lymphatic obstruction Non-pitting edema =Inflammatory Pitting edema =HP and COP derangement
Skin Color, temperature, hair growth, nails,capillary refill spooning of fingers /clubbing of fingers
Heart rate 60-100 Rhythm regular or irregular Bruits and Thrills murmurlike; vascular inorigin- palpate a thrill, auscultate a bruit Blood Pressure Jugular venous pressure
Laboratory & Diagnostic Test Complete Blood Count- RBC suggest tissueoxygenation.Elevated WBC may indicate infectious heartdisease and MI. Erythrocyte Sedimentation Rate (ESR )- Itsis elevated in infectious heart disorder or MI. Normal range: Males: 15-20mm/hr Females: 20-30 mm/hr