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Unformatted text preview: NUR 360 Cardiovascular Diseases (CVD) • Introduction • Framingham Study • Framingham Scoring System: identifies patients whose short term risk (10 years) warrants intensive treatment for heart disease Age Total cholesterol Smoking status HDL cholesterol Systolic BP Pathogenesis concepts r/t CHD • Inflammation: chlamydia pneumonae; C-reactive protein (CRP) • Hemostasis: fibrinogen • Endothelial dysfunction (homocysteine) Normal Blood Lipid Profile Total Cholesterol (TC): 200 or less (not > 4 x HDL) HDL Cholesterol: Men 45; Women 55 TC/HDL Ratio: 4:1 or less Triglycerides (TFG): 200 or less LDL Cholesterol: 130 or less *Must be <100 for patients with CHD Atherogenic Non-HDL Cholesterol High Levels are important Risk Factors: VLDL Cholesterol Apolipoprotein A1 Extended Lipid Profile Apolioprotein B Lipoprotein (a) *genetically determined (should be < 30 mg/dl) Classification of Hypertension Women and Heart Disease Higher mortality after MI Higher false positive stress tests Higher mortality after CABG Women diabetics have > risk for CHD Metabolic Syndrome Characterized by : 1 Insulin Resistance High triglycerides, low HDL, possibly high LDL Central obesity Hypertension Hallmarks of Metabolic Syndrome BMI > 24.9 WHR > 0.8 in women and >0.95 in men Triglyceride level > 150 mg/dl HDL < 40 mg/dl B/P > 140/90 2 elevated FBG levels > 126 mg/dl or a random BG >200 mg/dl Sx of POS Hyperuricemia (> 5.8 mg/dl in women; >7.4 mg/dl in men) Acanthosis nigricans Treatment for Metabolic Syndrome Medications : 1) ACEIs and ARBs preserve renal function; 2) Beta-blockers prevent endothelial damage (but increase lipid levels and insulin resistance) 3) Thiazides are particularly effective in African Americans and elderly; prevent osteoporosis, but they increase LDL and triglycerides and increase uric acid 4) Calcium Channel blockers appropriate if patients don’t tolerate beta blockers 5) Oral hypoglycemics (Avandia, Actos, Metforin) Case Study : A 45 yo woman has been hospitalized for an emergency appendectomy. She is 6 hours post-operative and will be staying on your unit for the next 24 hours. You collect her VS: BP 148/90, HR 82, RR 16, BMI 38. Her labwork consists of the following values: CBC is WNL, cholesterol 282, HDL 38, LDL 170, triglycerides 280, FBG 170. labwork consists of the following values: CBC is WNL, cholesterol 282, HDL 38, LDL 170, triglycerides 280, FBG 170....
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- Spring '06
- chest pain, infarction, beta blockers