geron report (cardio)

7/31/2019 Geron Report (Cardio)

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Age-related changes of the systemHeart valves become thicker and more rigid sclerosisand fibrosisLess elasticity of vessels accumulation of calciumdepositsMore prominent arteries in head, neck, and extremities thinner skin, less subcutaneous fatDecreased cardiac output heart muscle losses efficiency and contractile strength (elevator than stairs, drive than walklong distance, receiving bad news, run to catch a bus)BP increases to compensate for increased peripheralresistanceLess efficient O2 utilization


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Primary level of Prevention-Health Promotion for the SystemDisorders

Encourage to engage in physical activity for aminimum of 60 minutes (total) every day or asrecommended by your primary health care provider.Have a physical examination before beginning a newprogram of exercise

not smoking or drinking excessively achieving and maintaining a healthy weighteating a heart-healthy well-balanced diet. Consume alow-saturated fat, low cholesterol diet can help fight

cardiovascular disease.Monitoring blood pressureFollow prescribed therapy for hypertension, elevatedserum lipids and diabetes.


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Secondary level of Prevention-Health Maintenance

(Diagnostic Procedures)


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Laboratory tests Lipid Profile- cholesterol, triglycerides, and lipoproteins are measured to

evaluate a persons risk of developing atherosclerotic disease especially if there is family history of premature heart diseaseor to diagnose a specific lipoprotein abnormality.

C-Reactive Protein- is a venous blood test that measures levels of CRP, a

protein produced by liver in response to systemicinflammation. Higher level of hs-CRP (3.0 mg/dl orgreater)may be greater at risk for CVD


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Fluoroscopy is an imaging technique commonly used by physicians to obtain real-time moving images of the

internal structures of a patient through the use of afluoroscope. In its simplest form, a fluoroscope consists of an X-ray source and fluorescent screen between which apatient is placed. However, modern f luoroscopes couplethe screen to an X-ray image intensifier and CCD videocamera allowing the images to be recorded and played ona monitor.


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Cardiac Stress Testing - evaluate the response of cardiovascular system to stress. Helps determine thepresence of CAD, cause of chest pain, functionalcapacity of heart after an MI or heart surgery.(example)


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Echocardiography - ultrasound test that is used tomeasure the ejection fraction and examine the size, shape,and motion of cardiac structures. It is particularly useful fordiagnosing pericardial effusions; determining chamber sizeand etiology of heart murmurs; evaluating the function of heart valves, including prosthetic heart valves: and evaluating ventricular wall motion.


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Magnetic Resonance Angiography (MRA) -examine both the physiologic and anatomicproperties of the heart such as diagnosing thediseases of the aorta, heart muscle, andpericardium, as well as congenital heart lesions.


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Phonocardiography recording of audible vibrationscoming from the heart and great vessels, phonogramsassist in diagnosing the timing and cardiac sounds andmurmurs.


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Holter monitoringuse of holter monitor

ECG can be recordcontinuously for over aperiod of a day or longeron an outpatient basis.

Done to determine whichdysrhythmias maybecausing clinicalmanifestations that may

not occur during a routineECG.


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InvasiveProcedures


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MRI - provides the best information on chamber size, wall motion, valvular function and great vessel bloodflow.


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Cardiac Catherization

- radiopaque arterial and venous cathetersare introduced into selected blood vessels of the right and left sides of the heart. Used to

diagnose CAD, assess coronary artery patency, and determine the extent of atherosclerosis.


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Angiography orarteriography is a medicalimaging technique used to visualize the inside, orlumen, of blood vessels andorgans of the body, withparticular interest in thearteries, veins and the heartchambers. This is

traditionally done by injecting a radio-opaquecontrast agent into theblood vessel and imaging

using X-ray basedtechniques such asfluoroscopy.


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Radionuclide imaging - thallium scanningtest using a special camera and small amount of radioactive substance injected into thebloodstream to make an image of the blood flowto the heart.


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Hypertension

intermittent or sustained elevation in thediastolic or systolic pressure. Presentwhen the arterial pressure is 140/90 or

higher and will result to arterioscleroticchanges in the arteries throughout thebody.


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Modifiable Risk Factors:High Na intake

ObesityExcess alcohol consumptionSmoking

DMImpaired Renal FailureStressDiet


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Non-modifiable Risk Factors:

Family HistoryAgeRace


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Manifestations:Diastolic pressure greater than 120 mmHg

Headache

DrowsinessConfusionTachycardia and tachypneaDyspnea

CyanosisSeizures


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Papilledema

Alterations in vision or speechDizzinessSudden fall

Transient or permanent paralysis onone side (Hemiplegia)


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Non-medical Intervention

Monitor vital signs especially BP

Provide safetyMaintain bed rest with head of the bed elevated at 45 degreesMonitor intake and outputMonitor urinary output, and if oliguria or anuria occurs notifythe physician

Maintain patent airwayMonitor neurological statusHave emergency medications and resuscitation equipmentreadily availableMonitor IV therapy, assessing fluid overload

Increase the knowledge of the patient about the disease, itsrestriction and recommendations.Encourage lifestyle modification


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DASH diet:

Approaches to stop hypertension (dietrich in fruits, vegetables, and low-fatdairy products with a reduced content of saturated and total fat)


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Medical intervention:

Administer antihypertensive oral medicationssuch as Diuretics, Beta-Blockers, ACE Inhibitors,Calcium channel blockers, Angiotensin II

receptor blockers and Alpha 1-BlockersPromoting appropriate nutrition (low sodium diet)Provide supplemental oxygen if needed


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Hypotension- a decrease inblood pressure toless than 100/60mmHG that

compromisessystemic perfusion-occurs when blood

pressure during andafter each heartbeatis much lower than

usual. This meansthe heart, brain, and

other parts of thebody do not getenough blood.


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Modifiable Risk Factors:Cardiovascular diseasesInadequate rest and sleepMedications

Insufficient fluid intakeStarvationAllergic Reactions


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Non- Modifiable Risk Factors

Age Family History Sex Race


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Manifestations:-lightheadedness or dizziness-shortness of breath-fatigue

-fainting-seizures-headache

-temporary blurring of vision


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Medical InterventionsVolume resuscitation (usually with crystalloid)Blood pressure support (with norepinephrine orequivalent)Ensure adequate tissue perfusionAddress the underlying problem (i.e. antibiotic forinfection, stent or CABG for infarction, steroids foradrenal insufficiency, etc...)

Medium-term (and less well-demonstrated) treatmentsof hypotension include:Blood sugar control (80-150 by one study)Early nutrition (by mouth or by tube to prevent ileus)Steroid support


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Non-medical Interventions:

Monitor vital signs Providing Safety Adding electrolytes to a diet

Positioning the client-lifting the legs Monitor neurologic status


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Action stat! If the patient's systolic pressure is less than 80 mm Hg, or 30

mm Hg below his baseline, suspect shock. Quickly evaluate the patient for a decreased LOC. Check his apical pulse for tachycardia and his respirations for tachypnea. Inspect the patient for cool, clammy skin. Elevate the patient's legs above the level of his heart, or place him in Trendelenburg's position if the bed can be adjusted. Then insert a large-bore I.V.catheter to replace fluids and blood or to administer drugs.Prepare to administer oxygen with mechanical ventilation if necessary. Monitor the patient's intake and output and insert an indwelling urinary catheter to accurately measure urine output. The patient may need a central venous catheter or a pulmonary artery catheter to facilitate monitoring of his fluid status. Prepare for cardiac monitoring to evaluate cardiac rhythm. Be ready to insert a nasogastric tube to prevent aspiration in the comatose patient. Throughout emergency interventions, keep the patient's spinal column immobile until spinal cord trauma is ruled out.


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TREATMENT


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Coronary artery bypass surgery , also coronary artery bypass graft (CABG pronounced cabbage) surgery , andcolloquially heart bypass or bypass surgery is a surgicalprocedure performed to relieve angina and reduce the riskof death from coronary artery disease . Arteries or veins

from elsewhere in the patient's body are grafted to thecoronary arteries to bypass atherosclerotic narrowing's andimprove the blood supply to the coronary circulationsupplying the myocardium (heart muscle). This surgery is

usually performed with the heart stopped, necessitatingthe usage of cardiopulmonary bypass; techniques areavailable to perform CABG on a beating heart, so-called"off-pump" surgery.


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Cardiac Rehabilitation

Cardiac rehabilitation is amedically supervised program tohelp heart patients recover

quickly and improve their overallphysical, mental and socialfunctioning. The goal is tostabilize, slow or even reverse theprogression of cardiovascular

disease, thereby reducing the riskof heart disease, another cardiacevent or death.


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Cardiac rehabilitation programs include:Counseling so the patient can understand andmanage the disease processBeginning an exercise programCounseling on nutritionHelping the patient modify risk factors such ashigh blood pressure, smoking, high blood

cholesterol, physical inactivity, obesity anddiabetes.Providing vocational guidance to enable thepatient to return to workSupplying information on physical limitationsLending emotional supportCounseling on appropriate use of prescribedmedications


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HEART

TRANSPLANT


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M- Instruct the patient to take drugs as prescribedby physician. Emphasize the importance of usingthe drugs at the right timing of intake and rightdosage. Drugs should not be stop abruptlywithout the consent of the physician because ofits rebound tendencies.

E- Instruct the folks to provide and maintain stressfree environment to lessen the discomfort of thepatient and not to aggravate the symptoms of thedisease.

T- Encourage the patient to perform diversionarytactics( e.g. relaxation technique, reading, musictherapy etc.) and promote ambulation and non-strenous activities.


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H- Inform patients on how to preventcomplications. Provide enough and

appropriate knowledge to the disease andadvise some lifestyle modifications.

O- Instruct the patient when to return for follow

up appointments with the health care giver.Reporting of any untoward signs andsymptoms to the health care givers is essential.

D- Advise the patients to eat healthy foods andavoid foods with high sodium and highcholesterol content.


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S- Encourage the family to support the patientphysically, financially, emotionally andspiritually. Give enough information to thefolks in order for them to understand thesituation of the patient.

S- Give spiritual support to the patient inaccordance to his/her religious affiliationand beliefs. Let the patient verbalize his/her

feelings and stay on his/her side if needed.


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geron report (cardio)

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