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    Coronary Artery Disease:: Pathology & Treatment

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    John Fisher
    The correct order is: C. NTG 0.4 mg, ASA 324 mg, 12 lead, morphine 2-5 mg

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    Coronary Artery Disease:: Pathology & Treatment

    Uploaded by

    John Fisher
    65 views17 pages
    The correct order is: C. NTG 0.4 mg, ASA 324 mg, 12 lead, morphine 2-5 mg

    Original Description:

    Coronary Artery Disease PPT presentation

    Original Title

    CAD PPT

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    The correct order is: C. NTG 0.4 mg, ASA 324 mg, 12 lead, morphine 2-5 mg

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    65 views17 pages

    Coronary Artery Disease:: Pathology & Treatment

    Uploaded by

    John Fisher
    The correct order is: C. NTG 0.4 mg, ASA 324 mg, 12 lead, morphine 2-5 mg

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 17

    Coronary Artery Disease:

    Pathology & Treatment


    Coronary Artery Disease (CAD)
    • Narrowing of coronary arteries from atherosclerosis
    • Forms of CAD:
    1. AMI
    2. Angina
    3. Stroke
    Coronary Pathology

    Atherosclerosis causes:
    • Acute intraluminal thrombus
    • Progresses for decades before symptoms (affecting tunica
    intima)
    • Risk factors: HTN, high cholesterol, smoking, DM, genetics
    • Elevated total cholesterol, elevated LDL
    PROGRESSION OF ATHEROSCLEROSIS
    Plaque Disruption
    • Atherosclerotic plaque composed of
    cholesterol
    • Plaque tears, leads to form thrombus
    • Thrombus absorbs into arterial wall,
    narrowing the lumen
    • Progresses until fully occluded
    Atherosclerosis effects the _____.
    A. tunica adventitia
    B. tunica intima
    C. tunica media
    D. tunica externa
    Angina (stable)

    • Increased myocardial 02 demand


    • Increased 02 demand occurs with
    exertion
    • Ischemic chest pain ensues
    • Classified as stable or unstable
    Angina (unstable)
    • Symptoms occur at rest
    • Methods to relieve pain don’t work
    • Requires prompt management
    • Impending MI
    Acute Myocardial Infarction (AMI)

    • Muscle necrosis caused by reduced


    blood supply to myocardium
    • Results from acute thrombus
    • Note symptoms and observe EKG
    findings
    Clinical Presentations of Acute MI (AMI)
    • Chest “pressure” rather than “tightness” or “heaviness”
    • Most often mid-retrosternal, may radiate
    • Diaphoresis, SOB, N/V also common
    • ST segment elevations, T wave inversions
    IDENTIFY. And don’t say anything about “bundle branches” or “peaked T waves”
    Treatment of Ischemic CAD
    Aspirin (ASA)
    • 324 mg PO (chewed)
    • Reduces chances of clot formation which reduces chance of
    AMI
    Beta-blockers
    • Metoprolol (Lopressor) 5 mg slow IVP
    • Reduces heart rate and contractility to decrease 02 demand
    Nitrates
    • Nitroglycerine tablet (or spray), 0.4 mg SL, q 3-5 mins
    • Nitroglycerine paste, 1 inch, transdermal
    • Tridal (nitro) drip
    • Vasodilates coronary arteries, increasing coronary perfusion
    Calcium Channel Blockers
    • Debatable – discuss with contact medical control
    • Not to be given if left ventricular dysfunction suspected/involved
    • 12 leads (serial)
    • Analgesia
    • Most important:
    • Thrombolytic therapy
    • Cardiac catherization
    47 y/o female c/o progressive weakness and bilateral elbow pain.
    Denies SOB, denies N/V. She does not smoke or drink. Hx of DM II
    which is somewhat managed.

    B/P: 150/70
    RR: 22
    P: 52 regular
    SPO2: 99%
    BGL: 315
    12 Lead: (next slide)
    Which set is in the correct order to trear unstable angina?
    A. 15 lpm 02, ASA 324 mg, 0.4 mg SL NTG, morphine 2 mg
    B. ASA 320 mg, NTG 0.4 mcg,12 lead, fentanyl 1 mcg/kg
    C. NTG 0.4 mg, ASA 324 mg, 12 lead, morphine 2-5 mg
    D. 02 4 lpm, NTG 0.4 mg, ASA 324 mg, morphine 2 mg, 12 lead

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