ACŪTE CØRØNARY ARTERY DISEASE

Question 1

What is the primary cause of Chronic Stable angina?

Answer 1

Insufficient blood flow to the coronary arteries due to atherosclerosis.
Typically occurs when artery is 75% stenosed

Question 2

How does pain manifest in Chronic Stable Angina?

Answer 2

Lasts only 3-5 minutes

Ø pain at rest

Subsides when precipitating factors are relieved

Question 3

How is Chronic Stable Angina appear on an ECG?

Answer 3

ST segment depression

Question 4

How do you treat Chronic Stable Angina?

Answer 4

Medications

*Nitrates
*Beta-Blockers - Decrease contractility
*Ca+ Channel Blockers - Systemic vasodilators
ACE-Inhibitors - Dilation of arteries.

Question 5

What is Angina Decubitus?

Answer 5

Chest pain when supine. relieved by sitting up

Question 6

What causes Acute Coronary Syndromes (Unstable Angina, MIs)

Answer 6

Deterioration of a stable plaque that stimulates platelet formation and local vasoconstriction with thrombus formation.

Plaque dislodges and moves to coronary artery with aggregates attached.

Question 7

Explain the Healing process of an MI.

Answer 7

Neutrophils and macrophages remove necrotic tissue by 2nd or 3rd day

Development of collateral circulation occurs in areas with poor perfusion

10-14 days later, scar tissue is still weak and vulnerable to stress

6 weeks, scar tissue completely replaces necrotic tissue.

Question 8

What are common complications of an MI?

Answer 8

1. Dysrhythmias - most common complication and cause of death in pre-hospital periods
2. Heart Failure - Occurs due to decreased pumping power of the heart
3. Cardiogenic Shock - Due to poor blood flow to heart
4. Papillary muscle function - Mitral valve regurgitation of blood
5. Ventricular Aneurysm - myocardial wall becomes thinned and bulges at contraction
6. Acute Pericarditis - Inflammation of pericardium, can result in compression of heart, can be heard on auscultation

Question 9

WHich Cardiac marker peaks at 24-48 hours?
A/ Myoglobin
B/ CK-MB
C/ Troponin

Answer 9

C. Troponin

Question 10

WHat cardiac marker is cardiac specific?
A/ Myoglobin
B/ CK-MB
C/ Troponin

Answer 10

B/ CK-MB
and
C/ Troponin

Question 11

What does Myoglobin also show/represent?

Answer 11

Muscle Damage (non-specific)

Question 12

What is a Coronary Artery Bypass Graft?

Answer 12

A bypass that redirects blood from the Left subclavian (Aorta) to the affected coronary artery of the heart… bypassing the bloackage.

Question 13

What nursing care would you expect to give to a client suffering from Acute coronary syndrome?

Answer 13

O2 therapy
Nitro
Morphine/pain mgmt
ECG, pulse Oximetry
Continuous monitoring
Auscultate
Check I and O

Question 14

A patient come in with the following vitals:

B/P: 139/72
Resp. 20
Temp 37.3
Pulse: 118 regular
SaO2: 96%

They aren’t complaining of any pain. What should you do?

Answer 14

Nothing.

Although Tachycardic, they have no symptoms. Monitor and what for changes

Question 15

A patient come in with the following vitals:

B/P: 118/77
Resp. 14
Temp 37.7
Pulse: 126 regular
SaO2: 92%

They are complaining of dizziness and mild chest pain. Whatcha gunna do?

Answer 15

Apply O2

IV Access

12-Lead ECG

Fluid replacement prn

Place on Falls Risk*

Question 16

A patient come in with the following vitals:

B/P: 145/98
Resp. 16
Temp 36.6
Pulse: 54 irregular
SaO2: 99%

They feel weak, but no pain. What do you do?

Answer 16

Monitor rate and rhythm of breathing to see if it is affecting heart rate.

IV access for Atropine because Bradycardic-dysrhythmic

*FALL RISK

Question 17

A patient come in with the following vitals:

B/P: 110/97
Resp. 12
Temp 36.9
Pulse: 49 regular
SaO2: 97%

What do you do?

Answer 17

Check patency of Airway

Elevate HOB

Apply O2, monitor Sats

IV access - administer fluids - Atropine to increase HR

12-lead ECG

Monitor for Syncope - *FALL RISK