IHD Patho 2012_Student Version (2)

Total cholesterol ldl c and tg hdl 40 mgdl diabetes

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total cholesterol, LDL-C, and TG HDL ( < 40 mg/dl) Diabetes mellitus Related to glycemic control Obesity ( 20% over ideal body weight) Contributes to BP, insulin resistance, HDL, TG Sedentary lifestyle Contributes to BP, lipids, insulin resistance
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Modifiable Risk Factors 2200 C-reactive protein (CRP) Serum marker for systemic inflammation 2200 lipoprotein (a) Genetically determined 2200 homocysteine – Associated with vitamin B 6 , B 12 , and folate Chronic kidney disease
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Spectrum of CHD
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What is Angina?? Symptomatic paroxysmal chest pain or pressure sensation caused by transient myocardial ischemia Photo adopted from: http://nursingcrib.com/nursing-notes-reviewer/coronary-artery-disease/
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Characteristics of  Angina Pectoris Quality of pain Heavy pressure, squeezing, tightness, crushing, burning May be mistaken for indigestion Chest “pressure” or “discomfort” NOT sharp or stabbing Does not change with position No relationship between severity of pain and extent of CAD Photo adopted from: http://medical-surgical-nursing.blogspot.com/
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Characteristics of  Angina Pectoris Location of pain Usually substernal or retrosternal Can also occur in: Epigastrium Neck Shoulders Back Arms Jaw http://nursing-trivia.blogspot.com/2010/09/nursing-care-plan-tuberculosis-tb-plus.html
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Characteristics of  Angina Pectoris Radiation of chest pain Arms Shoulders Jaw Neck Duration Stable angina usually brief (3-5 minutes) Unstable angina longer in duration, usually > 20 minutes Both can range ½ minute to 30 minutes
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Characteristics of  Angina Pectoris Precipitating factors Physical activity, sexual intercourse Emotional distress, fright, anger Cold weather Smoking Large meals, walking after meals
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Characteristics of  Angina Pectoris Relieving factors Rest Sublingual nitroglycerin (SL NTG) Relief within 30 seconds to 5 minutes Call 911 if need to take a 2 nd dose Patients can re-dose every 5 minutes, MAX 3 tabs
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Anginal Equivalents May occur in absence of discomfort Dyspnea Fatigue Weakness Syncope Commonly occur in women Photo adopted from: http://www.metrohealth.org/body.cfm?id=1484
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Chronic Stable Angina Provoked by exertion or emotional stress Associated with certain level of physical activity Reproducible Pain is at constant level of intensity Promptly relieved with rest or nitroglycerin Caused by fixed obstruction in coronary artery that causes ischemia The majority of patients with chronic stable angina have atherosclerotic heart disease; however, not all patients with atherosclerotic heart disease develop angina
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Variant Angina  Also known as Prinzmetal’s angina or vasospastic angina Coronary artery spasm coronary blood flow Patients may or may not have underlying atherosclerotic disease Characteristics of chest pain Occurs at night or in early morning Occurs at rest Not precipitated by exertion or stress
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