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  • 1. Chapter 28 Management of Patients With Coronary Vascular Disorders
  • 2. Coronary Artery Disease <ul><li>Atherosclerosis is an abnormal accumulation of lipids and fibrous tissues in the vessel wall </li></ul><ul><li>The atheromas (plaque) protrude into the lumen of the vessel, narrowing it and obstructing blood flow </li></ul><ul><li>The thrombus may obstruct blood flow leading to myocardial infarction or sudden death </li></ul>
  • 3. Risk Factors <ul><li>Modifiable risk factors </li></ul><ul><ul><li>Cholesterol levels </li></ul></ul><ul><ul><li>Cigarette smoking </li></ul></ul><ul><ul><li>Hypertension </li></ul></ul><ul><ul><li>Diabetes mellitus </li></ul></ul><ul><li>Nonmodifiable risk factors </li></ul><ul><ul><li>Age </li></ul></ul><ul><ul><li>Gender </li></ul></ul><ul><ul><li>Family history </li></ul></ul><ul><ul><li>Race </li></ul></ul>
  • 4. &nbsp;
  • 5. Angina Pectoris <ul><li>Episodes or paroxysms of pain or pressure in anterior chest </li></ul><ul><li>Caused by insufficient coronary blood flow </li></ul><ul><li>Pharmacologic therapy </li></ul><ul><ul><li>Nitrates </li></ul></ul><ul><ul><li>Beta-adrenergic blocking agents </li></ul></ul><ul><ul><li>Calcium channel blocking agents </li></ul></ul><ul><ul><li>Antiplatelet and anticoagulant medications </li></ul></ul><ul><li>Revascularization procedures </li></ul>
  • 6. Myocardial Infarction <ul><li>Myocardial cells are permanently destroyed </li></ul><ul><li>Caused by reduced blood flow in coronary artery due to embolus or thrombus </li></ul><ul><li>Pharmacologic therapy </li></ul><ul><ul><li>Thrombolytics </li></ul></ul><ul><ul><li>Analgesics </li></ul></ul><ul><ul><li>ACE inhibitors </li></ul></ul><ul><li>Emergency percutaneous transluminal coronary angioplasty </li></ul><ul><li>Cardiac Rehabilitation </li></ul>
  • 7. Invasive Coronary Artery Procedures <ul><li>PTCA compresses atheroma and stretches coronary artery </li></ul><ul><li>Coronary artery stent is inserted after PTCA to keep vessel open </li></ul><ul><li>Atherectomy is removal of atheroma </li></ul><ul><li>Brachytherapy inhibits smooth muscle cell proliferation by placing radioisotope close to lesion </li></ul><ul><li>Transmyocardial laser revascularization burns a channel into but not through the muscle </li></ul>
  • 8. &nbsp;
  • 9. &nbsp;
  • 10. Surgical Procedures <ul><li>Coronary artery revascularization utilizes another vein to bypass diseased coronary artery </li></ul><ul><li>Complications include: MI, dysrhythmias, and hemorrhage </li></ul><ul><li>Post-op care focuses on wound care, progressive activity, and nutrition </li></ul>
  • 11. &nbsp;

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