Coronary Artery Disease Sec 3

Your HeartYour Heart and How it Worksand How it Works

Make a fist. Your heart is about this size. It is located in the center of your chest, and its function is to pump blood, oxygen and nutrients throughout your body.

Look at the illustration. As you can see, the Look at the illustration. As you can see, the heart is divided into four chambers: the heart is divided into four chambers: the two top chambers two top chambers (the right atrium and the left atrium) are receiving chambers. are receiving chambers.

The bottom chambers The bottom chambers (the right ventricle and the left ventricle) are pumping chambers. are pumping chambers.

Cross Section of the HeartCross Section of the Heart

The right side of the heart receives oxygen-poor blood from the body and pumps it to the lungs. As the blood flows through the lungs, it picks up oxygen and returns to the left side of the heart.

The heart consists ofThe heart consists of two pumpstwo pumpsThe left side of the heart pumps the oxygen-rich blood to the body and to the coronary arteries, which feed the heart muscle itself. Because the left ventricle must pump blood to the whole body, it is the most muscular chamber.

Four valves (tricuspid, pulmonary, mitral and aortic) between the heart’s chambers control and direct the flow of blood forward.

Arteries are blood vessel which carry oxygen and nutrient-rich blood from the heart to the body.

Veins are blood vessels with carry “used” or oxygen-poor blood back to the right side of the heart. The right ventricle pumps this blood into the lungs.

In the lungs, oxygen, we inhale is absorbed in the blood.

The heart produces a pulse (heart rate) as it contracts and pumps the blood through the blood vessels. Counting your pulse lets you know how many times the heart is beating (pumping) each minute.

In your heart, specialized cells carry impulses In your heart, specialized cells carry impulses along a specific pathway in much the same way along a specific pathway in much the same way as electrical wiring carries current. When the as electrical wiring carries current. When the impulse completes its course along the impulse completes its course along the pathway, it causes the ventricles to contract, pathway, it causes the ventricles to contract, pumping blood through the aorta to the rest the pumping blood through the aorta to the rest the body.body.

Each contraction of the heart begins with a Each contraction of the heart begins with a single electrical impulse that is started in the single electrical impulse that is started in the sinoatrialsinoatrial or or SASA nodenode, located in the upper right , located in the upper right atrium of the heart. The SA node is called the atrium of the heart. The SA node is called the heart’s “natural pacemaker” because it begins heart’s “natural pacemaker” because it begins each impulse and sets the timing between the each impulse and sets the timing between the impulses that cause the heart to contract.impulses that cause the heart to contract.

When the SA node begins an impulse, the When the SA node begins an impulse, the impulse travels along the electrical pathways in impulse travels along the electrical pathways in the heart’s atria to the the heart’s atria to the atrioventricularatrioventricular or or AV AV nodenode, located between the heart’s atria and , located between the heart’s atria and ventricles. Here the impulse pauses briefly ventricles. Here the impulse pauses briefly before continuing down the electrical pathways before continuing down the electrical pathways throughout the ventricles.throughout the ventricles.

How the heart knows when to

The pathways in the ventricles are called The pathways in the ventricles are called bundle branchesbundle branches: the right branch : the right branch stimulates the right ventricle, and the left stimulates the right ventricle, and the left branch stimulates the left ventricle.branch stimulates the left ventricle.

When the impulse reaches the end of the When the impulse reaches the end of the these branches in the ventricles, it these branches in the ventricles, it causes the heart muscle to contract. causes the heart muscle to contract. Each contraction pumps blood through Each contraction pumps blood through the aorta to the rest of the body. the aorta to the rest of the body.

The contraction of the heart produces a The contraction of the heart produces a pulse (heart beat) that you can feel at pulse (heart beat) that you can feel at specific points on your body.specific points on your body.

How the heart knows when to (continued)

The SA node normally initiates an electrical impulse 60 to 100 times a minute, resulting in 60 to 100 heart beats per minute. During exercise or when you are excited or stressed, the SA node will initiate more impulses per minute in order to speed up the flow of blood throughout the body. After you relax again, impulse frequency or heart rate should return to a rate of 60 to 100 per minute.

An abnormal heart rate can occur if something happens to disturb the regular function of the SA node, AV node or the impulse flow along the pathways. There are a variety of causes for abnormal heart rhythm, and most are easily treatable. If your doctor discovers that you experience abnormal heart rhythm, you will receive more specific information about its cause and your treatment.

How the heart knows when to contract (continued)

Coronary arteriesCoronary arteries

are the vessels that supply oxygen-rich blood to the are the vessels that supply oxygen-rich blood to the heart muscle itself. heart muscle itself.

The The right coronary arteryright coronary artery supplies blood to the right supplies blood to the right side, bottom (inferior) and back (posterior) of the heart.side, bottom (inferior) and back (posterior) of the heart.

The The left coronary arteryleft coronary artery divides into two vessels that divides into two vessels that supply blood to the heart’s major pumping chamber, the supply blood to the heart’s major pumping chamber, the left ventricle:left ventricle:The left The left anterior descending artery supplies blood to supplies blood to the front (anterior) of the heart.the front (anterior) of the heart.

The The left circumflex arteryleft circumflex artery delivers blood to the side delivers blood to the side (lateral) of the heart.(lateral) of the heart.

Blood Pressure

Blood pressure is the amount of force necessary to pump blood through the body. Blood pressure is measured at two levels:

When the heart is contracting (called the systolicsystolic reading or the top number). When the heart is relaxing between contractions (called diastolicdiastolic reading

or the bottom number).

Blood pressure is recorded with the maximum pressure (systolic) first and the least amount of pressure (diastolic) last.

For example, if 120/80 is written 120 is the systolic pressure, For example, if 120/80 is written 120 is the systolic pressure, and 80 is the diastolic pressure (mmHg).and 80 is the diastolic pressure (mmHg).

Imagine a pipe with rust buildup inside. As the rust thickens, less water is able to flow through the pipe. Atherosclerosis is the medical term for a similar condition in the arteries.

Atherosclerosis is a gradual narrowing of the arteries. Smoking, lack of exercise, a high-fat diet, stress, age and other risk factors can damage the elasticity and the lining (intima) of the arteries. Fatty substances in the blood collect in the damaged arteries and form layers, called plaque. As the plaque thickens, the passage through the artery narrows, slowing the flow of blood.

Atherosclerosis can develop in various parts of the body, most often affecting the heart, brain or legs. When it affects the heart, a heart attack may occur. When arteries that supply the brain are affected, a stroke may result. Atherosclerosis in the legs can cause pain (especially when walking), loss of circulation and tissue death if untreated.

Though it is a serious condition, there are many treatments. If you have been diagnosed with atherosclerosis, ask your doctor or nurse about your specific treatment.

This disease occurs with the narrowing of a coronary artery, usually as a result of atherosclerosis.

Plaque buildup in the coronary arteries can reduce or even block flow of blood to the heart. This narrowing can cause chest discomfort or pain (angina) or a heart attack because the heart is deprived of its normal supply of blood.

The exact cause of coronary artery disease is not known. But we do know of a number of risk factors that can increaserisk factors that can increase the likelihood of developing it:

Smoking High blood pressure

High blood cholesterol Lack of exercise

Obesity Diabetes

If you reduce your risk factor, you can decrease your risk for coronary artery disease.

Before leaving the hospital, you will learn what you can do to control your risk factors.

When the flow of blood through a coronary artery becomes blocked for a period of time, the result is a heart attack (myocardial infarction of MI). A heart attack causes part of the heart muscle to die, leaving the heart weaker and the damaged muscle “irritable” and inflamed. This can cause irregular and less effective pumping. Healing takes place gradually as the inflammation clears and scar tissue forms over the infarcted area of heart muscle. During this time, with proper rest, the heart produces a strong, durable scar. Scar tissue formation takes 6 to 8 weeks.

Infarcted” refers to dead muscle tissue.Infarcted” refers to dead muscle tissue.

““Injured” and “ischemic” refer affected areas of the heart Injured” and “ischemic” refer affected areas of the heart musclemuscle

surrounding the dead muscle tissue. surrounding the dead muscle tissue.

When the flow of blood through a coronary artery becomes blocked for a period of time, the result is a heart attack (myocardial infarction of MI). A heart attack causes part of the heart muscle to die, leaving the heart weaker and the damaged muscle “irritable” and inflamed. This can cause irregular and less effective pumping. Healing takes place gradually as the inflammation clears and scar tissue forms over the infarcted area of heart muscle. During this time, with proper rest, the heart produces a strong, durable scar. Scar tissue formation takes 6 to 8 weeks.

Infarcted” refers to dead muscle tissue.Infarcted” refers to dead muscle tissue.

““Injured” and “ischemic” refer affected areasInjured” and “ischemic” refer affected areas of the heart muscle surrounding the dead of the heart muscle surrounding the dead muscle tissue. muscle tissue.

Heart valves can be damaged at birth or may become weak and damaged with illness or age. Defective valves may not open or close properly, causing the heart to work harder and less efficiently.

If the valve opening is narrower than normal, the condition is know as stenosisstenosis. If a valve does not close completely, it is described as insufficient, a condition know as regurgitation. Many factors can damage heart valves, including a heart attack.

Valve Valve DiseaseDisease

When the heart muscle becomes weak, it cannot pump blood forcefully to all parts of the body. This condition, called congestive heart failure (CHF), can be caused by a heart attack, high blood pressure, valve problems, coronary artery disease or a number of other conditions.

Congestive heart failure means that the heart is weakened and cannot pump enough blood to meet the needs of the lungs and body tissues. It does not mean death will soon follow. If appropriate measures are taken CHF can be controlled and you can lead a relatively normal life.

Congestive Heart FailureCongestive Heart Failure

Congenital Heart DiseaseCongenital Heart Disease

Congenital heart disease is a term used to describe an abnormal heart condition that your were born with. Symptoms related to these abnormalities can appear at any point in a lifetime.

Cardiac Rehabilitation

Your doctor may order cardiac rehabilitation for you. Inpatient cardiac rehabilitation is an education and monitored exercise program that will prepare you for leaving the hospital. The cardiac rehabilitation nurse will give you and our family instructions, activity guidelines and other important information. She will also work with you to gradually increase your activity level while you are in the hospital by walking the hallways with you and monitoring your heart during these exercise periods.

Heart Heart ProblemsProblems

If your doctor has warned you about coronary artery disease or

atherosclerosis, you’ll want to become familiar with the following information.

Any time your heart does not get enough oxygen-rich blood, you may experience angina, or angina pectoris, as it is medically described.

Angina is a warning sign, or symptom, of coronary artery disease. Your symptoms and the frequency of your angina may be different than those experienced by other people you know who have coronary artery disease.

You might feel a pain in your chest, jaw, back or neck that may radiate down one or both arms.

The discomfort has often been described as a squeezing, tight, heavy pressure, burning or aching sensation and may be accompanied by shortness of breath.

The pain is often confused with indigestion.

It may only last a few minutes, and it often follows exercise, exertion or emotional stress.

Doctors frequently prescribe nitroglycerin tablets to relieve these symptoms

Angina Angina

Angina is not a heart attack:is not a heart attack:

It usually last less than five minutes and is relieved by rest and/or medication. Still, you should not ignore or deny the symptoms; they may be indicators of serious coronary artery serious coronary artery diseasedisease and could lead to a heart attackheart attack.

Your doctor can help you understand how angina might affect you and can prescribe a treatment to control it.

Your doctor may prescribe nitroglycerin tablets to relieve the discomfort of angina. These tablets work by quickly dilating blood vessels to increase the blood supply to year heart.

Carry your nitroglycerin tablets with you at all times. Sit or lie down when you take nitroglycerin tablets because they can make you dizzy or light-headed. They may also cause a headache. The tablets are light-sensitive and will lose effectiveness unless they are kept in their original prescription bottle. Your prescription should be replaced within 6 months for maximum effectiveness. Nitroglycerin is also prescribed in a spray. Use as directed.

NitroglycerinNitroglycerin

If you think you are experiencing angina, follow these steps:

1. Immediately stop what you are doing and sit down.

2. Place a nitroglycerin tablet under your tongue and allow it to dissolve. Try to remain calm. This should give you relief within 1 to 5 minutes.

3. If you still have angina after 3 to 5 minutes, place a second tablet under your tongue.

4. If the discomfort continues another 3 to 5 minutes, place a third tablet under your tongue.

5. If the discomfort persists after taking a total of 3 tablets in 15 minutes, call your Emergency Response Number (911). If there is no Emergency Response Number in your area, have someone drive you to the nearest emergency facility. Never attempt to drive yourself.

What To Do If You What To Do If You

Have Chest PainHave Chest Pain

If the location of your angina changes, or if it increases in frequency or severity, you need to notify your doctor.In addition to the immediate treatment of chest pain, there are several things your doctor can do to treat your angina.

Angina Angina TreatmentTreatment

Medical treatment and risk factor modification Your doctor may prescribe medical therapy and risk factor modification to improve the function of your heart. A broad range of medications is available, and your doctor will work closely with you when deciding on medications Angioplasty, athectomy, coronary rotablator; or stentYour doctor may advise balloon angioplasty (PTCA), coronary rotablator or stent to reduce the blockage in your coronary artery, increasing blood flow to that part of your heart. You will receive more information about this procedure if your doctor recommends it for you.

Coronary artery bypass surgeryIn this procedure, your doctor will use a healthy vein or artery from another part of your body – usually your leg – to create a new passage for blood around (or bypassing) the affected area of the coronary artery. You will receive more information about this procedure if your doctor recommends it for you.

Before proceeding with any treatment, your doctor will discuss your condition Before proceeding with any treatment, your doctor will discuss your condition and options with you. Be sure to ask questions and express your concerns at and options with you. Be sure to ask questions and express your concerns at that timethat time.

Angina TreatmentAngina Treatment (cont.)(cont.)

A heart attack is the result of total blockage in one of the coronary arteries. The blockage has stopped the flow of blood to a section of the heart long enough to cause permanent damage. The damaged heart muscle is weaker and pumps less effectively. Your doctor may also refer to your heart attack as a “coronary”, a “myocardial infarction” or an “MI”. The coronary artery can become blocked, stopping the flow of blood, in several ways:

Atherosclerosis Fatty cholesterol deposits build up in the artery to the point where little blood can flow through to nourish the heart.

Thrombosis A blood clot forms in an artery already narrowed by fatty buildup, blocking the flow of blood through the vessel.

Spasm The coronary artery can spasm or constrict, limiting blood flow.

Heart attack symptoms are usually more severe than angina. They last longer, and rest offers no relief from pain. Nitroglycerin tablets will not relieve the pain and symptoms of a heart attack as they do for angina. If your doctor has prescribed nitroglycerin tablets, you should always take them if you have chest pain. If 3 tablets do not relieve your pain, call 011 or have someone drive you to the nearest emergency department.

You may be having a heart attack.You may be having a heart attack.

Here are the classic signs of a heart attack:Here are the classic signs of a heart attack:

Pressure, squeezing, tightness, burning or aching that may begin at Pressure, squeezing, tightness, burning or aching that may begin at the center of your chest and may radiate into your jaw, neck, the center of your chest and may radiate into your jaw, neck, shoulder, shoulder, back or arms. back or arms.

Indigestion, nausea or vomiting. Indigestion, nausea or vomiting.

Shortness of breathShortness of breath

A feeling of general weaknessA feeling of general weakness

Sudden sweatingSudden sweating

Stop what you are doing.Stop what you are doing.

Sit or lie down.Sit or lie down.

If your doctor has prescribed nitroglycerin If your doctor has prescribed nitroglycerin tablets, take them as ordered.tablets, take them as ordered.

1. Place a nitroglycerin tablet under your tongue and allow it to dissolve. Try to remain calm. This should give you relief of symptoms within 1 to 5 minutes.

2. If you still have symptoms after 3 to 5 minutes, place a second tablet under your tongue.

3. If the symptoms continue another 3 to 5 minutes, place a third tablet under your tongue.

4. If the discomfort persists after taking a total of 3 tablets in 15 minutes,

call 911call 911If 911 is not available in your area, have someone drive you to the nearest emergency facility. Never attempt to drive yourself.

Too many people put off calling the emergency number because they are afraid it might be a false alarm. That can be a fatal mistake.

Seeking early medical treatment can reduce the degree of damage and potential complications of a heart attack.

It can give your doctor more treatment options.

It can save your life!

Write the Emergency Response Number for your area here.

It is extremely important that you seek help It is extremely important that you seek help immediately if you are experiencing symptoms of immediately if you are experiencing symptoms of a heart attack. Your doctor will determine a heart attack. Your doctor will determine whether thrombolytic therapy is the best option whether thrombolytic therapy is the best option for you.for you.

.

If your doctor chooses thrombolytic therapy for you, there will be much activity around you for a short period of time. This is to ensure that you receive the medication as quickly as possible

IVs will be inserted in your arm.

You will receive medication for chest pain.

Your heart and blood pressure will be monitored continuously, usually with special equipment.

In addition to receiving “clot-buster” medication, you will be given a blood-thinning medication called heparin through your IV for 2 to 3 days. Heparin decreases the potential for your body to develop additional blood clots.

Heart Attack Treatment

.

There are many different treatments for heart attack. You and your There are many different treatments for heart attack. You and your doctor will decide which of these treatments is best for you doctor will decide which of these treatments is best for you depending on your conditiondepending on your condition

Thrombolytic TherapyThrombolytic TherapyHeart attacks often occur because a blood clot (thrombosis) has blocked one of your coronary arteries. Doctors can administer clot-dissolving medication to restore blood flow and reduce the amount of damage to the heart. This medication, called a thrombolytic, is given intravenously. Thrombolytic therapy is most effective when given as soon as possible after the onset of symptoms, so it is extremely important to seek immediate medical attention.

Medical treatment and risk factor modificationMedical treatment and risk factor modification

Your doctor may prescribe medical therapy and lifestyle changes (risk factor modification) to improve the function of your heart. Many medications are available, and your doctor will work closely with you when deciding on medications.

Heart Attack Treatment (cont.)

.

Angioplasty or atherectomyAngioplasty or atherectomy

Your doctor may advise balloon and angioplasty (PTCA) or coronary atherectomy to reduce the blockage in you coronary artery and increase blood flow to that part of your heart. You will receive more information about this procedure if your doctor recommends it for you.

Coronary artery bypass surgery Coronary artery bypass surgery

In this procedure, your doctor will use a healthy vein or artery from another part of your body – usually your leg – to create a new passage for blood around (or bypassing) the affected area of the coronary artery. You will receive more information about this procedure if your doctor recommends it for you.

Before proceeding with any treatment, your doctor will discuss your condition and options with you. Be sure to ask questions and express your concerns at that time.

ABNORMAL HEART RHYTHMMost heart rhythm disturbances (arrhythmia) are aware of an occasional irregular heart rhythm. In other cases, people describe an occasional rapid heart beat or “fluttering” feeling. Whenever the impulse that signals the heart muscle is interrupted or distorted in some way, heart rhythm will be irregular and the heart may not pump blood effectively. Talk to your doctor if you frequently experience any of these symptoms:

• a “fluttering” feelinga “fluttering” feeling

• a fast heart ratea fast heart rate

• light-headednesslight-headedness

• dizziness dizziness

There are simple diagnostic procedures that can determine frequency, location and extent of heart rhythm disturbances. In most cases, the condition can be controlled with medication and/or lifestyle changes.

ATRIAL FIBRILLATION

ATRIAL FIBRILLATION (cont.) You can see from a normal EKG that the pattern is regular and even. Following an impulse from the SA node, the upper chambers (atria) of the heart gently contract and pump blood into the more powerful lower chambers (ventricles). Then a stronger contraction in the ventricles pumps the blood into the aorta and throughout the body.

When artrial fibrillation occurs, the atria do not contract in an even pattern. Instead, the muscles quiver. Irregular contractions mean the the amount of blood pumped from the heart to the body varies from beat to beat.

Artrial fibrillation is a common condition following heart surgery and is usually temporary. If you have rheumatic heart disease, you may have long-term (chronic) atrial fibrillation.

You may experience one or several of the following symptoms:You may experience one or several of the following symptoms:

a feeling of weakness chest discomfort

palpitations light-headedness

shortness of breath

You may not experience any symptoms at all.

ATRIAL FIBRILLATION (cont.)

Keep your doctor or nurse fully informed about your symptoms and concerns.

Your health care providers may use medication or electrical cardioversion to return your heart to its normal rhythm. Your doctor may also prescribe blood-thinning medications to reduce your risk of stroke, a possible complication of atrial fibrillation.

Though millions of Americans experience atrial fibrillation, treatment differs according to each individual’s needs.

Premature Ventricular Contractions (PVCs)

PVCs are early contractions that start in the heart’s ventricles. They occur both in the healthy people and people with heart

disease. They may be harmless or the beginning of more serious arrhythmias.

PVCs are common in all age groups. Anxiety, excessive caffeine and certain drugs can cause occasional PVCs even in young adult. However, frequent PVCs indicate the need to search for an underlying cause.

PVCs may also occur with any type of heart disease: valvular disease, hypertensive disease, or ischemic heart disease with or without a heart attack.

PVCs are the most common arrhythmia to occur with heart attack (acute myocardial infarction) and may lead to ventricular tachycardia and ventricular fibrillation.

You may experience one or several of the following symptoms:

weakness palpitationsweakness palpitations

chest discomfort light-headednesschest discomfort light-headedness

shortness of breathshortness of breath

You may not experience any symptoms at all.

Keep your doctor or nurse fully informed about your symptoms and concerns.

Treatment of PVCs varies according to each individual’s needs. Your doctor will discuss possible treatment options with you. There are many medications that your doctor may prescribe to prevent frequent PVCs.

Serious Arrhythmias

Heart rhythm abnormalities that prevent the ventricles from contracting and pumping blood effectively are life-threatening. If you have suffered a life-threatening abnormal heart rhythm, your doctor will order a series of diagnostic tests and will recommend further treatment.

If the SA node is damaged for some reason or if there is a blockage in the pathway along which the impulse travels, the doctor may recommend surgery to implant a battery-operated pacemaker. This small machine take over the role of the SA node, the heart’s natural pacemaker, and initiates impulses to the heart at a regular, pre-set rate.

If you suffer any type of abnormal heart rhythm, your doctor or nurse will discuss the diagnostic tests and treatment option available to you.

Congestive Heart Failure

When the heart muscle becomes weak, it cannot pump blood forcefully to all parts of the body. This condition, called congestive heart failure (CHF), can be caused by a heart attack, high blood pressure, valve problems, coronary artery disease or a number of other conditions.

Congestive heart failure means that the heart is weakened and cannot pump enough blood the meet the needs of the lungs and body tissues. It does not mean death will soon follow. If appropriate measures are taken CHF can be controlled and you can lead a relatively normal life.

Symptoms of Symptoms of

Congestive Heart FailureCongestive Heart Failure

Because the heart does not pump normally, blood and fluid may collect in the lungs and other tissues. This can cause the following symptoms:

Swelling in your legs, ankles and/or feet

Shortness of breath with activity

Waking up short of breath during the night

Difficulty breathing or sleeping when lying flat

Weakness, tiredness and difficulty exerting yourself

Persistent dry cough

Symptoms of Congestive Heart FailureSymptoms of Congestive Heart Failure(cont.)(cont.)

Early treatment may prevent a hospitalization. Notify your doctor or health caregiver as soon as possible if you experience any of the following:

Sudden weight gain (2 – 5 pounds in 1 to 4 days)

Shortness of breath when you are at rest (not with activity)

Increased inability to sleep lying flat (need to prop up with more pillows)

Extreme and constant tiredness and shortness of breath

Weakness or dizziness, nausea, loss of appetite or palpitations.

Managing Congestive Heart FailureManaging Congestive Heart Failure

Activity Some activity every day can help you feel better, so don’t let congestive heart failure stop you from being active. On days that you feel good, plan an extra activity in addition to your normal routine. Stop and rest if you feel tired or short of breath. Fatigue and shortness of breath with activity are expected symptoms of heart failure.

You should not experience worsening of symptoms such as increasing shortness of breath with activity, shortness of breath while lying down or having to sit up to catch your breath. If you do experience any of these symptoms call your doctor or nurse immediately.


RestResting allows your heart muscle to regain its strength. Plan frequent rest periods alternating with your activities throughout the day.

Put your feet upfor a few minutes every couple of hours to help reduce angle swelling

Please refer to the Leaving the Hospital section of this book for further guidelines.

Daily weightA sudden weight gain is a sign that the body is holding sodium and water.

Weigh yourself daily and record your weight.

Get on the scale first thing in the morning after you urinate and before your eat or drink.

Call your doctor if you gain 2 to 5 pounds in 1 to 4 days. Rapid weight gains may be a sign that you are retaining fluids and need a change in your treatment plan.

To be consistent, weigh yourself with the same amount of clothing each day.


Medications Four general categories of medicine are generally prescribed for congestive heart failure:

diuretics, diuretics,

digitalis, digitalis,

ace inhibitors ace inhibitors andand

potassium.potassium.

Your doctor may prescribe a single medication or a combination for you. Here is a general explanation of the medications and their possible side effects. Ask your doctor or nurse if you have questions about how to take your medications.


Diuretics (water pills)help your kidneys make urine, which washes sodium and water from blood. Examples of diuretics include Lasix, Bumex and Dyazide.

Less sodium and water in the blood make it easier for the heart to pump.Less sodium and water in the blood make it easier for the heart to pump.

You may notice that you have to urinate more often, especially during the nightYou may notice that you have to urinate more often, especially during the night

If you experience any of the following side effects, call your doctor:If you experience any of the following side effects, call your doctor:

Dizziness or light-headedness

Extreme thirst

Severe weakness

Severe leg cramps.


Digitalis (Digoxin or Lanoxin) strengthens your hearts ability to pump.Your doctor may have you continue taking this medication even after you feel better because it helps the heart pump efficiently.

If you experience any of the following side effects, call your doctor:

Nausea, vomitingNausea, vomiting

Heart palpitations or feeling that your heart is skipping Heart palpitations or feeling that your heart is skipping beatsbeats

Loss of appetite, distaste for food. Loss of appetite, distaste for food.

A bad taste in your mouthA bad taste in your mouth

A yellow or blue tint to your visionA yellow or blue tint to your vision


Ace Inhibitors (blood pressure pills) (blood pressure pills) relax and widen the blood vessels. This lowers blood pressure and allows more blood to pass through the vessels. It also decreases your heart’s workload. Examples include Vasotec and Capoten.

If you experience any of the following side effects, call your doctor:

Dizziness, light-headedness, or weaknessDizziness, light-headedness, or weakness

A flushed, burning feelingA flushed, burning feeling

Heart palpitations, rapid heart beatHeart palpitations, rapid heart beat

A bad taste in your mouthA bad taste in your mouth

Persistent or prolonged headachePersistent or prolonged headache


Potassium is an important mineral that helps regulate the heart’s rhythm. Diuretics can drain it from your body along with excess fluids and sodium. Your doctor may prescribe extra potassium to replace the amount lost because of the diuretic.

Many foods are good sources of potassium:Many foods are good sources of potassium:Raisins, prunes und prune juice, apricots and apricot juice, dates, bananas, oranges and orange juice, strawberries, grapefruit juice, cantaloupe, watermelon, potatoes, beets, greens spinach, broccoli, tomatoes, sweet potatoes, brussel sprouts, dried beans and peas, turkey, fish decaffeinated coffee. Avocadoes and beef are also good sources, but hey are high in fat. Salt substitutes are largely potassium.

Some people need only a small amount of potassium replacement and cant take it in tablet form. Others need more in powder or liquid form.

Liquid or powdered potassium is bitter tasting and can cause an upset stomach. Dilute this form of potassium in a cup of fruit juice or water and take it with food.

Always check with your doctor before taking over the counter medication.

Nutrition for Congestive Nutrition for Congestive Heart Failure PatientsHeart Failure Patients

Sodium is a mineral needed by the body in small amounts to function properly. However, most Americans consume significant more sodium than the body needs. Excess sodium can build up in the body causing increasing blood pressure, fluid retention (edema), weight gain and shortness of breath. Most of the sodium, which is preferred as “salt” comes from salt added to food during or after cooking and in processing. Food preservatives, condiments and other seasonings are other high sources of sodium. One teaspoon of salt contains 2300 milligrams (mg) of sodium. It is recommended that your diet be limited to 2000 milligrams of sodium daily.

Do not trust your sense of taste in choosing foods to eat as there may be more sodium in the food than you realize. It will be very important to read and check food labels. The dietitian will be available to help you and your family make positive food choices.

Some people use salt substitute which does not contain sodium. The sodium replaced with potassium and may not be safe for everyone.

Before using a salt substitute, Before using a salt substitute, contact your doctor or dietitian. contact your doctor or dietitian.

Diagnostic TestsDiagnostic Tests

There are number of tests commonly used to diagnose heart disease. Every patient has different needs, and each condition warrants different test. Your specific symptoms and condition determine the types of tests that you should have. Your doctor will decide which tests are appropriate for your condition.

The following section briefly explains each test and the reason for its use.


History And Physical ExamUnderstanding your symptoms and knowing your health history will help your doctor diagnose and treat your disease. It’s important that you answer questions as completely and clearly as you can. You can expect the doctor to ask specific questions about your daily habits, previous diseases and family health history.

This information determine what other diagnostic test your doctor will order. Chest X-ray

Your doctor may order a chest X-ray to provide information about the size of your heart, its position and the condition of your lungs.


Electrocardiogram (EKG or ECGThe EKG records the heart’s electrical activity and detects abnormal heartbeats (rhythms). It may even show a heart attack in progress

An EKG technician will position small sensors, called electrodes, on your chest, arms and legs.

You will not experience any discomfort.

The test takes about 5 minutes and can be performed in your room.

Your doctor may ask to have EKG’s repeat at intervals to show the changes that may occur as you recover.


Laboratory TestYour doctor will probably order a series of blood tests to help diagnose your heart disease:

A cardiac enzyme count will help determine if the heart muscle has been damaged. This test may be repeated several times during your hospital stay.

Cholesterol levels, triglyceride levels and glucose (blood sugar) levels can help identify your risk factor for heart disease.

Blood sample will be taken several times during your stay in the hospital.


Cardiac Stress Test (Treadmill Test)The stress test involves walking on a treadmill. The test evaluates your heart’s response to increased activity. Your doctor may use it in several ways: to diagnose coronary artery disease, to monitor the progress of your treatment or as part of a routine physical.

The test takes about 45 minutes and is done in the hospital’s cardiac department.

You may not be allowed to eat before the test. Check with your doctor.

Do not drink beverages containing caffeine – coffee, tea, cocoa or colas – for 4 hours before the test.

Certain medications may be held until you’ve completed the test.

Your chest will be shaved if necessary, then cleaned with alcohol.

The technician will place electrodes on your chest and a blood pressure cuff on your arm to monitor your heart rhythm and blood pressure throughout the test.


Cardiac Stress Test (Treadmill Test) cont.

As you walk on the treadmill, the speed and incline are gradually increased. This will force you to exercise harder. The test will be stopped when one of the following occurs:

You become too tired or short of breath to continue.

You start to feel chest pain or other symptoms.

You or your doctor asks to stop the test.

Please try to go as long as possible on the treadmill. Results are most accurate with your maximum effort.

After you complete the exam, you will rest until your heart rate and blood pressure return to normal. At this time the technician will remove the electrodes.

Your doctor will discuss the result of the test with you later.


Nuclear Cardiology

Your doctor may order a cardiac stress test using Thallium 201 or Cardiolite. These tests are similar to the treadmill test with the addition of an IV injection of a radioactive isotope that will allow us to take clear images of your heart after exercise and at rest. Your doctor will determine which of the following tests you should have.


Nuclear Cardiology

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You will not be allowed to eat before the test.

Certain medications may be held until after you’ve completed the test.

If you don’t already have an IV, one will be started in your arm prior to the test.

You will exercise on the treadmill. Just as you reach a predetermined heart rate, the isotope will be injected through the IV.

Thallium is a weak radioactive isotope used in very limited quantities to “trace” cardiac abnormalities.

After the treadmill portion of the test is completed, you will be taken to the nuclear medicine department for a scan.

Scanning takes only about 30 minutes.

You will return in 3 to 4 hours for another series of images of your heart at rest. You will not be allowed to eat between these tests.

Your doctor may order another series of scans after 24 hours. (You may eat during this 24-hour period).

Your doctor will share the results of the test with you Your doctor will share the results of the test with you later.later.


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If you don’t already have an IV, one will be started in your arm prior to the test.

This test has two parts: a resting portion and an exercise portion. For each portion you will receive Cardiolite through an IV and have and image scan.

For the resting portion, you will receive an IV injection, and an hour later you will have your first scan.

For the exercise portion, you will walk on a treadmill. Just as you reach a predetermined heart rate, the isotope will be injected.

After completion of exercise, you will be instructed to eat a fatty meal and return in an hour for another scan.

Cardiolite is a weak radioactive isotope given in very limited quantities to “trace” cardiac abnormalities.

Your doctor will share the results of the test with you Your doctor will share the results of the test with you later.later.


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Like the treadmill test, this test evaluates your heart’s response to increased activity. The test is designed for patients who are unable to walk on the treadmill; medications such as Adenosine or Persantine stress your heart the same way physical exercise does.



A medication to stress your heart will be given through an IV.

Your EKG and blood pressure will be recorded continuously while you are receiving medication.

During the administration of this medication, you may experience one or several of the following symptoms: Your doctor will share Your doctor will share the results of the test the results of the test with you later.with you later.

A warm, flushed feeling

Light-headedness

Headache

Chest pain

Mild shortness of breath

Any or all of these symptoms will occur for only a very short period of time (a few minutes) and will then go away.

After the EKG portion of the test is completed, you will be taken to the nuclear medicine department for scan.

Scanning takes only about 30 minutes. You will have to return after about 4 hours for a series of images of your heart at rest.


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Cardiac catheterization (also called coronary angiography or heart catheterization) provides more detailed information about the function of the heart and its arteries than can other diagnostic tests. No other test can provide this information. By combining the information from other tests, catheterization with information from other tests, your doctor can most accurately diagnose your condition and choose the most effective treatment.

A cardiologist in the cardiac catheterization lab (cath lab) will perform the test. It involves inserting a thin plastic tube (catheter into a large blood vessel in your groin or arm, the guiding it to the heart to monitor pressures and take pictures. The cardiologist will also inject a contrast material into the coronary arteries and take special X-rays to determine if blockages or any other problems exist.


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Before the testA nurse or your doctor will explain the test and ask you to sign consent forms.

Do not eat or drink for 6 to 8 hours before the test.

You may have blood drawn and a chest X-ray taken.

The nurse will insert an IV in your arm to allow medications and/or fluids to be given before and/or during the test.

Medications to help you relax may be given by mouth or through the IV before or during the test.


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During the test

The entire test, including transport to the cath lab, takes about 2 hours.

Your family may accompany you to the cath lab waiting area.

You will be taken to a special room containing X-ray equipment and heart monitoring devices.

You will be asked to lie flat on the X-ray table and your body will be covered with a sterile sheet. Please keep your hands under this sheet.

Your heart rate and blood pressure will be monitored continuously during the test.

The area chosen for the catheter insertion (your groin our arm) will be shaved and washed with and antiseptic solution.

continued


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During the test (cont.)

The cardiologist will give you a local anesthetic to numb the insertion area. The area will sting for a few moments, then become numb.

The doctor will place plastic “introducer” sheats through your skin at the insertion sites to allow access to the artery.

If you have any discomfort in the area of insertion or any chest pain, tell the doctortell the doctor. Additional medication can be given through your IV to ease any discomfort.

Catheters will be used to inject a contrast agent into the coronary arteries and left ventricle.

During the test, you will be asked to hold your breath momentarily to ensure clear pictures. You may be asked to cough.

continued


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During the test (cont.)

You may feel a warm sensation (flush), nausea or have the urge to urinate when the contrast material is injected to the heart chamber. These sensations pass quickly.

After pictures have been taken, the doctor will remove the catheter.

The sheaths may also be removed and pressure will be applied over the insertion sites for 15 to 20 minutes to prevent bleeding. The nurse will then apply a pressure bandage.

Or the sheaths may remain in place until you and your doctor make a decision about your treatment.


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After the test

You will return to your room to a special monitoring area, and your family may visit.

The nurse will frequently check your blood pressure, pulse and the site where the catheter was inserted for bleeding.

You will be asked to lie flat and not bend your arm or leg for several hours following the test. To relieve stiffness, you may move your ankle and wiggle your toes. The head of your bed may be raised slightly. You will be able to bend your other arm or leg.

You will be able to eat shortly after You will be able to eat shortly after returning to your room.returning to your room.

Drink plenty of fluids to flush to Drink plenty of fluids to flush to contrast material from your body.contrast material from your body.


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After the test (cont.)

If you notice any bleeding or a warm, wet feeling at an insertion site, your should apply pressure to the area and call the nurse call the nurse immediately. immediately.

If you have any chest, arm or neck discomfort, nausea, numbness or tingling in your leg or foot, call the nurse immediately.call the nurse immediately.

After the period of bed rest, you will be permitted to get out of bed and walk with nurse’s help.

Do not bend over, strain or lift heavy objects (10 pounds or more) for the next 24 hours. Avoid climbing stairs.

If you have to sneeze or cough, place your fingers over the bandage and hold it firmly.

Your doctor will discuss the findings Your doctor will discuss the findings with you soon after the test.with you soon after the test.


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Outpatient Instructions

If you have the test as an outpatient, you may be able to go home in 6 to 8 hours, depending on your doctor’s instruction.

You will be discharged from the hospital in a wheelchair. You will need to have a friend or relative drive you home and stay with you for the next 8 to 12 hours.

During the first 8 to 12 hours, limit you activity. Wear loose clothing and stay in bed, on the sofa or in a recliner with your feet up. If the catheter was inserted in your arm for the test, you should stretch and bend the arm, but avoid strenuous movement.

Do not bend over, strain or lift heavy objects (10 pounds or more) for the next 24 hours. Avoid climbing stairs.

If you have to sneeze or cough, place your fingers over the bandage and hold it firmly.


Outpatient Instructions (cont.)

If you notice any bleeding (bright red blood from the dressing, or severe swelling, place your fingers over the site and press firmly to apply pressure.

Have your helper call EMS (911 in the Phoenix area) for immediate help.

Write your Emergency Response number here:

Phone #: ___________________________________________

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If you experience severe pain, call your doctor immediately.

Do not go for long walks or lift heavy objects for 3 days following the test.

Leave the pressure bandage on your groin or arm until the next day. As your doctor when it will be OK to take a shower.

Removing the bandage can be painful. It is best to remove it in the shower.

Soak the area thoroughly using soap.Gently peel the bandage away from the skin a little at a time.

A black and blue bruise or a bump under the skin may form at the catheter insertion site. This is normal, and the bruise or bump should disappear within 2 to 3 weeks.

Ask your doctor when you can return to your normal activities and whether there are any specific restrictions. Usually people are able resume normal activities a few days after the test.

Make an appointment to see Make an appointment to see your doctor for a follow-up your doctor for a follow-up visit.visit.


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If you experience severe pain, call your doctor immediately.

Do not go for long walks or lift heavy objects for 3 days following the test.

Leave the pressure bandage on your groin or arm until the next day. As your doctor when it will be OK to take a shower.

Removing the bandage can be painful. It is best to remove it in the shower.

Soak the area thoroughly using soap.Gently peel the bandage away from the skin a little at a time.

A black and blue bruise or a bump under the skin may form at the catheter insertion site. This is normal, and the bruise or bump should disappear within 2 to 3 weeks.

Ask your doctor when you can return to your normal activities and whether there are any specific restrictions. Usually people are able resume normal activities a few days after the test.

Make an appointment to see Make an appointment to see your doctor for a follow-up your doctor for a follow-up visit.visit.

Medical Treatment of Valve DiseaseMedical Treatment of Valve Disease

If you have valve disease, your doctor may recommend treating your condition with medication rather than surgery. Here is a list and description of the types of medications your doctor may prescribe.

Medical Treatment of Valve Disease Medical Treatment of Valve Disease (cont.)(cont.) Antihypertensives are drugs that lower blood pressure and decrease the heart’s workload.

Ace Inhibitors are drugs that lower blood pressure and help the heart pump more efficiently.

Calcium Channel Blockers are drugs that reduce the heart’s workload, decrease blood pressure and control heart rhythm.

Digitalis is a drug that strengthens the heart and improves its efficiency. It is also used to control heart rate.

Diureticswork in the kidneys to reduce the fluid retention. They also reduce blood pressure.

Your doctor or nurse will explain each medication with you before you leave the hospital.

An important part of medical treatment is risk factor reduction.(See Risk Factors section of this book.)

Medical Treatment of Valve Disease Medical Treatment of Valve Disease (cont.)(cont.) O

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Open heart surgery refers to any surgery during which a heart-lung bypass machine temporarily replaces the normal function of the heart and lungs. During the surgery, the blood is diverted from the heart to the machine which performs the same function as the heart and lungs. The most common open heart procedures are coronary artery bypass and valve replacement or repair surgery.

Medical Treatment of Valve Disease Medical Treatment of Valve Disease (cont.)(cont.) C

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Coronary artery bypass graft surgery is the most frequently performed heart operation today. There are many reasons why it is recommended, but the goal in each case is the same – to route the blood around the blockage in the artery or arteries.


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Reasons for surgeryReasons for surgeryLife-threatening coronary artery blockage

Complications following a heart attack

Angina that can no longer be controlled by medication.

GoalGoal

Coronary artery bypass surgery provides a new route for blood to flow around, or bypass, the blockage in the coronary artery. The surgeon will use a healthy vessel from your leg or chest wall to supply blood to your heart muscle. One end of this blood vessel is attached to the aorta and the other end to the coronary artery beyond the point of blockage. The number of bypasses needed and the amount of heart muscle affected.

The vessel most often used for replacement is the saphenous vein which is located in the inner part of the leg. After the vein is removed, your body will develop new vessels in the area.


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During the surgeryDuring the surgery

When you arrive in the operating room, the surgical staff will move you to the operating table, and the anesthesiologist will administer a sedative (anesthesia) to put you to sleep.

A number of tubes and drains need to be inserted during surgery:

A breathing tube and respirator (breathing machine) will ensure that you breathe regularly during surgery and until you are fully awake.

A nasogastric (NG) tube from your nose to your stomach will empty stomach secretions.

A catheter will be inserted into the natural opening through which you urinate. This catheter will keep the bladder empty and allows us to measure your urine output exactly.

An IV will be inserted into a major vein in your neck. During and after surgery, monitoring equipment attached to this line will help the doctors and nurses monitor the pressures within your heart. The line will also provide IV fluid and medications.


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During the surgery During the surgery (cont.)(cont.)

A chest tube (or tubes) will drain the chest cavity of normal post-operative bleeding.

A temporary pacing wire may be placed in your heart to increase your heart rate if necessary.

When the anesthesiologist is sure that you are asleep, the surgeon will make an incision down the center of your chest. Then he will cut down the center of the breast bone (sternum)(sternum) and spread it apart, allowing access the your heart.

The surgeon may take the internal mammary arteryinternal mammary artery from your chest or a long vein from your leg (the saphenous vein)the saphenous vein) to use as the bypass for your coronary artery. If the surgeon uses the saphenous vein, you will have an incision on the inside of your leg.

One end of this vessel will be grafted (sewn) to the major artery leaving your heart (the aorta)(the aorta) and the other end to the coronary artery below the blockage.

When the surgeon is sure that the bypass is secure, the surgical team will check that blood flows through it correctly, the secure your breast bone with surgical wires and suture the chest incision.


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The length of time you will be in surgery depends on the number of bypasses you need.

During the surgeryDuring the surgery


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Coronary Artery Disease Sec 3

Health & Medicine

Transcript of Coronary Artery Disease Sec 3