心内科冠心病的护理查房.pptVIP

* Deoxygenated blood from the heart collects in the cardiac veins which turn into the coronary sinus then empty into the right atrium. The artery that reaches and crosses the “crux” (where right and left atrioventricular groove crosses the posterior interatrial and interventricular grooves) is “dominant”. The graphic displays a right dominant system. * * * This illustrates the RCA resembling a capital “C”, therefore, is an LAO view. * This illustrates the RCA resembling a capital “L”, therefore, is an RAO view. * PTCA - Percutaneous Transluminal Coronary Angioplasy A catheter is inserted through the artery, past the obstruction. A balloon on the catheter is inflated to compress the plaque and overstretch the vessel. PTCA causes a controlled injury to the vessel wall. In atherosclerotic lesions, plaque fracture and arterial wall stretching are the mechanisms enlarging the lumen. Enlarging the narrowed vessel restores blood and oxygen flow to the tissue. * When the balloon is inflated, the vessel is totally blocked, which results in ischemia. The patient may have angina or experience a drop in blood pressure as well as arrhythmias. An ECG is continuously and carefully watched on the monitor, as well as the blood pressure which is recorded via the guiding catheter. The number of balloon inflations as well as the time per inflation is recorded. In most cath labs there is one physician performing the procedure, assisted by an additional physician, or a nurse, and one nurse who is monitoring the vital signs and recording the necessary data. This nurse or technician also can handle any complications that may occur. * * Since the advent of the first Palmaz-Schatz Stent, there have been significant improvements in design and ease of use. Because of these factors, stent use has come from an initial 10% to a current 80% of procedures. * Stents are mounted on a balloon catheter, which is advanced to the lesion site and then inflated. The balloon pushes the stent into t