Cca Case Study

The following summary is an updated case study of a 47 year old male patient, Jim who was diagnosed with Coronary Artery Disease. The patient did receive information on what CAD is and was informed that test were needed to fully diagnose and be evaluated for underlying conditions (high blood pressure, high blood cholesterol levels, diabetes and blockage. I will discuss the type of test needed for this condition and tests for any underlying conditions that are related to this disease. The type of treatment needed to control and lower his risk factor. I will also give the patient information about complementary and alternative medicine so the patient will be well informed about different types of treatment. The patient will be informed about the prognosis of the disease, and the options that the patient has to succeed in the changes in his lifestyle that are needed.

You are working in the internal medicine clinic of a large teaching hospital. Today your first patient is 70-year-old J.M, a man who has been coming to the clinic for several years for management of CAD and HTN. A cardiac catheterization done a year ago showed 50% stenosis of the circumflex coronary artery. He has had episodes of dizziness for the past 6 months and orthostatic hypotension, shoulder discomfort, and decreased exercise tolerance for the past 2 months. On his last clinic visit 3 weeks ago, a CXR showed cardiomegaly and a 12-lead ECG showed sinus tachycardia with left bundle branch block. You review his morning blood work and initial assessment.

Coronary Artery Disease, also known as CAD, is the most common form of heart disease. (Heart and Stroke Foundation, 2009) Coronary Artery Disease obstructs the blood flow in vessels that provides blood to the heart which is caused by the buildup of plaque on the artery walls. (Rogers, 2011, p.87) (Heart and Stroke Foundation, 2009) Plaque is a yellow substance that consists of fat substances, like cholesterol, and narrows or clogs the arteries which prevents blood flow. (Heart and Stroke Foundation, 2009) Plaque can build up in any artery but usually favors large and medium sized arteries. (Heart and Stroke Foundation, 2009)

Facilities, performing coronary CTA, should develop and adhere to evidence based coronary CTA protocols for optimal, high quality, cost-effective, patient-centered care. A comprehensive review of the literature was performed using CINAHL, PubMed, MEDLINE, and Medscape search engines, and with the terms ?coronary CTA?, ?protocols?, ?guidelines?, ?radiation?, ?contrast?, ?beta-blockers?, and ?radiology nursing?.

Angiograms are for diagnostic purposes so in the x-ray imaging one would look for a narrowing of the artery/vein. The x-ray moves takes 2-5 second videos from five different angles of the heart. During this time they surgeon and those in the control room look for any potential plaque blockages where the vessel becomes restricted and the color of the dye is not as dark. Of the eight angiograms five needed stents or valve replacements. They also pump a large amount of dye into the left ventricle of the heart to see the strength at which it is pumping. The first angiogram procedure I saw was on this 350lb man who was having heart arrhythmias and through this procedure they were able to determine that there was a 70% blockage in one of his arteries. However, Dr. Reichard wanted to do further investigation to see how much blood was getting through to determine if

These two left arteries feed the front and left side of the heart. The division of the left coronary artery is the reason why doctors usually refer to three main coronary arteries.

Cardiac catheterization is often referred to as coronary angiography or a coronary angiogram. It is a radiographic procedure that is used to look at and visualize the heart and the coronary arteries. During a cardiac catheterization it is possible for the cardiologist performing the procedure to see how effectively blood is flowing through the coronary arteries. In addition, this procedure allows the cardiologists to see how blood is moving through the chambers of the heart and how effective the heart valves are functioning. A cardiac catheterization can also allow for the visualization of the movement of the walls of the heart to see if the pumping action of the heart is normal.

A CAT scan can detect calcium deposits found in atherosclerotic plaque present in the coronary arteries of patients with heart disease. Because technology has advanced greatly, a CAT scan also has the ability to effectively detect coronary calcification from atherosclerosis even before the symptoms begin to advance. If a large amount of coronary calcium is found, this gives a doctor the indication of more coronary atherosclerosis, suggesting a greater likelihood of significant narrowing that is present within in the coronary system and indicating that the patient has a higher risk of potential cardiovascular problems. If calcium is detected within the arteries, the computer will create what is known as a calcium "score". This “score” approximates

Coronary artery bypass grafting (CABG) this surgical procedure is used with patients who have severe coronary heart disease (CHD), it's improve and increase the flow of the blood to the heart.

Recently, coronary CT angiography has been increasingly used for assessment of coronary stent patency or restenosis. However, imaging of coronary stents by multislice CT is more difficult than imaging of a native coronary artery. This is because of the presence of metal within the stents which can cause artifacts interfering with the interpretation of lumen patency. While the accuracy of stent lumen analysis was low or modest with 4- and 16-slice CT scanners, 64-slice CT (single-source and dual-source) scanners allow for more accurate stent visualization and characterization owing to increased spatial and temporal resolution. Recent meta-analyses of the diagnostic value of CCTA in coronary stenting showed that the diagnostic value of 64-slice CT angiography is significantly higher than that of 16-slice CT angiography (91 vs 81%) as a result of the increased spatial and temporal resolution. Stent diameter and beam hardening artifacts are two common factors that affect the visualization of coronary stents or in-stent restenosis. Thus, the inclusion of coronary stents of >3.0 mm and the use of dedicated edge-enhancing convolution kernels improve the diagnostic accuracy of CCTA in the follow-up of coronary stenting (Sun et al, 2012).

Computed tomographic pulmonary angiography or CTPA is the last choice of method. Patients with a pending confirmed diagnosis and a questionable D-dimer result are deemed candidates (15). Advantages of CTPA include higher diagnostic accuracy, ability to provide a clear result, fast acquisition time, and readily available in most hospitals (15). Patients with renal failure, allergy to contrast medium, possible pregnancy, critically, requires ventilation support and those who suffered from a recent myocardial infarction are contradicted from having a CTPA.

Besides echocardiography, cardiac magnetic resonance (CMR) and Multi-slice computed tomography angiocardiography (MSCT) have gained particular importance. (8) The presence of image degrading artifacts from implanted metal, such as intravascular stents and embolization coils; higher cost; limited availability; contraindication in imaging of

Because the spatial resolution of MSCT is lower than that of CCA, detection of stenosis may be more difficult in thickened segments, because the artery lumen is already smaller in a diffuse fashion. Such findings in heart transplant patients should lead to careful analysis before excluding significant narrowing, and in some cases, CCA may be required for confirmation. Eight stenoses were correctly diagnosed by MSCT in 10 evaluable segments, but three were missed in non-evaluable vessels 1.5 mm. In addition, two cases of ISR were missed. Intrastent analysis was not reliable with 16-slice CT, because only three (33%) of nine of the stents could be correctly visualized. Our study clearly indicates that the only reliable tool for detection of ISR

In this study, the Assessment of The Last Advanced Non-Thrombogenic Angioplasty Stent (ATLANTA) enrolled 55 patients with:1) stable or unstable angina, 2) documentation of myocardial ischemia attributable to native coronary artery stenosis, 3)amenable to treatment by percutaneous stenting from May 2007 to August 2007.[1] The standards of enrollment are:1) patients age must between 30 to 70 years old with up to 2 de novo type A and/or B American Heart Association/ American College of Cardiology lesions to be treated with the Catania stent in a vessel with a reference diameter 2.5 and 3.5 mm by visual assessment.[1] This clinical study was completed based on Declaration of Helsinki. The Primary end points of this study are: Stent Thrombosis, non- target lesion revascularization, target lesion revascularization, target vessel revascularization, index vessel-related nonfatal myocardial infraction and cardiac death. Secondary end points are:

Cardiovascular diseases account for most of the non-contagious diseases at a total of 17.5 million people a year. Cardiovascular disease can include many different problems; one of the more common ones is called atherosclerosis, which is the build up of plaque in the walls of the arteries. Once this plaque builds up it will make it difficult for blood to flow through the arteries and can lead to things such as heart attack, or ischemic stroke. These diseases are life threating and even if the victim does survive the procedures they will be faced with life style changes including medications on the daily and not being able to do daily task.