Title CARDIOVASCULAR SYSTEM (2).pdf ✅

Cardiovascular System (2) Medical - Surgical Nursing 1 (Lecture) Bachelor of Science in nursing |Prof. Rianzares | FIRST SEM 2024-2025 Transcribed by: AVANTE, Mia Ysabella T., CABAEL, Jasmine, CAMINO, Cristine Joyce A., DAVID, Alyanna Jade S, LLARENAS, Abigail P., MACARAIG, Jahziel John A. (3-1) October 01, 2024 | Lecture Yung mga angina, chest pain, decreased oxygen saturation are just manifestations and signs and symptoms of a certain pathological condition. All of these are starting with CAD (Coronary Artery Disease) - It refers to a variety of different pathology CORONARY ARTERY DISEASE (CAD) ❖ Cause narrowing or obstruction of a coronary artery that will result to reduction/decreased blood supply into the myocardium (heart muscle) ❖ The magnitude of the problem, not just in the Philippines, but worldwide, 18 million people in the US have CAD ❖ Lifetime risk 40-50 yo in men, menopausal age in women ❖ Major causative factor in atherosclerosis Mas mataas ang chances in men, it only happens during the reproductive stage. After the reproductive stage of a female population, nagiging equal na yung chances of developing atherosclerosis disease. MODIFIABLE RISK FACTORS ● Stress ● Nicotine - cause vasoconstriction ● Diet ● Exercise - coupled with obesity, lack of movement ● DM ● Obesity ● Hyperlipidemia ● Oral contraceptives After developing atherosclerosis dahil nagkaron ka ng CAD due to atherosclerosis, manifestation is angina pectoris or myocardial ischemia (these are common manifestations of atherosclerosis, nagkakaron ng plaque formations yung ugat ng isang tao) Whenever you have dislipidemia (very high low density lipoprotein/cholesterol) LDLC ❖ High density cholesterol = good cholesterol ❖ Low density cholesterol = the one who plaque the coronary arteries ➢ Mataas si low density tapos mataas din si high density = good (not super good, pero atleast nalaban ang katwan kasi may good cholesterol, nag babalance) In the event na masyado mababa si good cholesterol, mas higher yung chances to develop cardiac problems Everytime a patient develops a certain consequence of atherosclerosis, nag cacalcify ang ugat, nagiging rigid. Nag iincrease yung tragility or yung pag rupture because that is a fibroscaptic. Yung ugat nagkakaron ng exposure into a thrombogenic material = mag cicirculate (platelets and coagulants) and will lead into actual thrombosis Pag may thrombosis, nagkakaron ng total occlusions doon sa blood vessels. Pag nag occlude, hindi makakapasok yung oxygenated blood = necrosis, you may develop angina or myocardial infarction May mga pagkakataon na yung mga plaque formation ay nauuwi sa hemorrhage (si dacerna, yung nag bar tas namatay) Yung pagkakaroon ng atherosclerosis, nagkakaron ka nung tinatawag natin na distal immobilizations of the fragmented atheromatous plaque. Pwede sumama sa circulation, can go in the brain = stroke. Pag sa lungs pumunta and nag occlude sa vessels don = pulmonary embolism Pag sa mga ugat sa heart pumunta = myocardial infarction Atherosclerosis - weakens the vessel wall into your lumen. Pag mataas ang pressure, mag eexpand kasi hindi na kaya mag dilate = aneurysm (could lead to rupture and hemorrhage) common cause of death in certain people MYOCARDIAL ISCHEMIA ❖ Ischemic heart disease ➢ Hindi pa to Myocardial Infarction 1
❖ Still under CAD ❖ Unstable angina, acute coronary syndrome, sudden cardiac death, chronic ischemic heart disease with congestive heart failure ANGINA PECTORIS ❖ Severe, constricting pain because of reduced arterial blood flow ❖ Described by sharp pericardial pain directly associated with cardiac ischemia ● Myocardial Ischemia - kinulang pa lang sa oxygen, naayos pa. ● Myocardial infarction - cell death na, patay na yung part ng heart (heart attack), hindi na naayos. Infarcted area will remain infarcted RISK FACTORS ❖ Family history ❖ Lifestyle Angina = chest pain - Has associations with certain activity/exertion - Is the pain radiating? Sa jaw, back, scapula, sa kamay - Has associations with nausea and diaphoresis? If yes, hindi na to basta angina, this is MI na = medical emergency - Is there shortness of breath/dyspnea? When does it occur, is it exertional, resting? Orthopnea, certain positions? Paroxismlal nocturnal dyspnea (bigla nalulunod in the middle of the night) May criteria para malaman yung determinants of myocardial O2 consumption [not so important, pero sinasabi niya para daw alam natin] ❖ Kinukuha yung ventricular wall stress, that is in line with the heart rate (pressure radius) ❖ Tinitignan kung maganda ang contractility ng heart (pwedeng mabilis ang heart rate, pero that does not mean na there is good contractility) ❖ Kinukuha ang myocardial O2 consumption because we want to know the coronary artery perfusion. Tinitignan yung pressure dif erential between the ostea (aortic diastolic) and the coronary sinus (right atria of the heart) ❖ >75% of the lumen ang may occlusion = hindi na nag di-dilate yung blood vessels to accommodate oxygenated blood during increased physiological needs (pag akyat ng hagdan, naglilinis, naglalakad) Mataas ang perfusion diastolic pressure = mataas ang peripheral constrictions = masikip na vascular resistance = mataas na blood pressure Kapag ba mataas ang blood pressure, maganda na ang circulation? No. mas mabilis lang ang pressure/sirit ng dugo Kapag meron ka na nung 75% occlusion rate = mas nagiging commonest initiating event in coronary syndrome that will cause digestion of collagen cap in the ateroma. Yung mga ateroma (macrophages), tatangkain nila tanggalin (by digesting yung mga collagen cap sa ateroma), pag kinain, mae-expose yung thrombogenic lipid dun sa collagen initiate ng macrophages = nag co-coagulation cascade (makikita ng dugo na parang sugat) that will lead to thrombosis and embolism if the thrombus dislodge into the artery = mag aatract ng platelet = occlusion Bakit may chest pain ang px pag walang oxygen supply = vasospasm. Kumokonti yung dugo na pumupunta doon sa area ng puso = mas-stimulate yung adrenergic stimulations apag meron ka na nung 75% occlusion rate = mas nagiging commonest initiating event in coronary syndrome that will cause digestion of collagen cap in the ateroma. Yung mga ateroma (macrophages), tatangkain nila tanggalin (by digesting yung mga collagen cap sa ateroma), pag kinain, mae-expose yung thrombogenic lipid dun sa collagen initiate ng macrophages = nag co-coagulation cascade (makikita ng dugo na parang sugat) that will lead to thrombosis and embolism if the thrombus dislodge into the artery = mag aatract ng platelet = occlusion Bakit may chest pain ang px pag walang oxygen supply = vasospasm. Kumokonti yung dugo na pumupunta doon sa area ng puso = mas-stimulate yung adrenergic stimulations 31:02 ako start para di putol 30:57 - 1:01:54 -tin - Increase of prostacyclin (PG 12), pag ito ang nangyari magkakaroon ng pain sensation, mas magiging sensitive ang area into the pain. Nag-iincrease din ang endothelin, so ang ability ng mga vessels ay nasisira – ability of vessels to dilate. Later on magkakroon ng problem sa blood vessels leading to more susceptibility to develop plaque formations. Itp ang reason ba’t nasisira ang mga endothelial lining ng mga ugat. - Other pathogenesis: Vasculitis - whenever you develop kawasaki disease (especially sa mga bata), need ng continuous follow up sa cardiologist. This 2