CAD Flashcards
1
Q
Is CAD the most common type of heart disease?
A
Yes
2
Q
What does CAD include?
A
- Chronic stable angina
- Acute coronary syndrome
3
Q
What is Chronic stable angina?
A
Intermittent decreased blood Flow to the myocardium which leads to ischemia causing temporary pain/pressure in chest
4
Q
What brings the pain on in chronic stable angina?
A
Low oxygen usually d/t exertion
5
Q
What relieves the pain in chronic stable angina?
A
Rest and/or Nitro SL
6
Q
What meds are used for treatment of chronic stable angina?
A
Nitroglycerin SL
7
Q
What does nitro cause the body to do?
A
- Venous and arterial dilation
- Dilation of coronary arteries
8
Q
What does venous and arterial dilation cause?
A
Decreased preload and afterload
9
Q
What does dilation of the coronary arteries do?
A
Increase blood flow to the actual heart muscle (myocardium)
10
Q
How often can you take Nitro SL?
A
-1 every 5 min x 3
11
Q
Is nitro ok to swallow?
A
No
12
Q
Where should nitro be kept?
A
Dark, glass bottle in a dry and cool place
13
Q
May nitro burn or fizz?
A
Yes, if not check expiration date
14
Q
What will the clients get after taking nitro?
A
HA
15
Q
How often should you renew nitro?
A
Every 6 months
16
Q
How often should nitro spray be renewed?
A
Every 2 years
17
Q
After nitro what do you expect bp to do?
A
drop
18
Q
Should you ever leave an unstable client?
A
No
19
Q
Take on Nitro SL, after five minutes if chest pain/discomfort is unimproved or worsened, activate what?
A
Emergency response
20
Q
Can BB be used for prevention of angina?
A
Yes
21
Q
What do BB do to BP, P and myocardial contractility?
A
decrease it
22
Q
What do BB do to the world of the heart?
A
decrease it
23
Q
BB block the beta cells which are the receptor sites for what?
A
Catecholamines (epi/norepi)
24
Q
With BB contractility is decreased doing what to CO?
A
decreasing it
25
Do BB decrease the workload of the heart?
YEs
26
Can CO be decreased too much with BB?
Yes
27
BB decrease the work of the heart and the need for oxygen which decreases what?
angina
28
What do CC blockers do to BP?
Decrease it
29
Do CC blocker cause vasodilation of arterial system?
Yes
30
Do CC blockers dilate the coronary arteries?
Yes
31
What are two benefits of CC blockers?
- Decrease afterload
| - increase oxygen to heart muscle
32
Is Acetylsalicylic acid (aspirin) used for chronic stable angina?
Yes, dose determined by HCP
33
Should clients with Chronic stable angina rest frequently?
Yes
34
Should people with chronic stable angina avoid overheating and excess caffeine or any drugs that increase HR?
Yes
35
Should people with chronic label angina wait 2 hours after eating to exercise?
Yes
36
Could any temperature extremes precipitate an attack with chronic stable angina?
Yes
37
Should people with Chronic stable angina smoke? lose weight? avoid isometric exercise? reduce stress?
- No smoking
- Yes, lose weight
- Yes, avoid isometric exercise
- Yes, reduce stress
38
In chronic stable angina should you do everything you can to decrease the workload of the heart?
Yes
39
Can cardiac Cath be used for chronic stable angina?
Yes
40
With Cardiac Cath should we assess if client I s allergic to iodine or shell fish?
yes
41
When using dye what labs should you check?
Kidney function tests
42
What is commonly prescribed before a cardiac Cath procedure to help protect the kidneys?
Acetylcysteine
43
Can dye feel like a hot shot?
Yes
44
Are palpitations after cardiac cath normal?
Yes?
45
Post Cath procedure what should you watch the puncture site for?
Bleeding and hematoma formation
46
Post Cath procedure what should you assess when assessing the distal extremity to the puncture site?
5 p's:
- pulselessness
- pallor
- pain
- paresthesia
- paralysis
47
After cardiac cath the client have to lay flat on bedrest with extremity straight for how long?
4-6 hours
48
What is a major complication post cardiac Cath?
Hemorrhage
49
Should pain post cardiac Cath be reported asap?
Yes, may be developing a hematoma
50
If a client takes metformin how long after a cardiac cath should it be held?
48 hours, worried about kidneys
51
Unstable chronic angina= ?
Impending MI
52
What can acute coronary syndrome encompass?
MI or unstable angina?
53
Decreased blood flow to the myocardium results in?
Ischemia and necrosis
54
Does the client have to be doing anything to have pain from acute coronary syndrome?
No
55
In acute coronary syndrome will nitro relieve the pain?
No
56
What are s/s of acute coronary syndrome?
- Pain (chest discomfort)
- Cold/clammy/bp drops
- CO is going down
- ECG changes
- Vomiting
57
What may chest discomfort in acute coronary syndrome be described as?
- crushing
- elephant on chest
- pressure radiating to neck, jaw, one or both arms, shoulder/shoulder blades
58
With acute coronary syndrome, a client may report tightness or pressure in the chest as well as what?
- Dizziness
- Sweating
- N/V
59
Women usually present with GI signs and symptoms in acute coronary syndrome such as what?
- Epigastric discomfort
- Pain between shoulders
- An aching jaw or a choking sensation
60
In acute coronary syndrome the elderly often report what?
SOB
61
Elderly women, and diabetics likely deny symptoms and delay care because why?
symptoms are vague and less typical
62
Is a NSTEMI or STEMI worse?
STEMI
63
with a STEMI what time is the goal to get patient to Cath lab?
90 minutes
64
Why are NSTEMI clients usually less worrisome?
Partial coronary vessel blockage by a thrombus
65
What labs can determine acute coronary syndrome?
- CPK-MB
- Troponin
- Myoglobin
66
What is CPK-MB?
A cardiac specific isoenzyme
67
Is CPK-MB increased or decreased with damage to cardiac cells?
Increased
68
When does the CPK-MB elevate, peak, and return to normal?
- Elevate: 6 hours
- Peaks: 12-24 hours
- Normal: within 24-36 hours
69
What is troponin?
a cardiac biomarker with high specific to myocardial damage
70
When does troponin elevate? peak? Remain elevated?
- Elevate: 3-4 hours
- Peak: 10-24 hours
- Elevated: for up to 3 weeks
71
When does myoglobin increase with a acute coronary syndrome? peak?
2 hours and peaks 3-15 hours
-negative results= a good thing
72
Which cardiac biomarker is the most sensitive indicator for an MI?
-Troponin
73
Which enzymes or biomarkers are most helpful when the client delays seeking care?
Troponin (stays elevated longest)
74
What untreated arrhythmias will put the client at risk for sudden death?
- Pulseless tach
- vfib
- asystole
75
What is the priority treatment for vfib?
Defib the vfib
76
If defibrillation doesn't work for fib what is the first med or vasopressor we give?
Epi
77
Amiodarone and lidocaine are anti-arrhythmic drugs commonly used when?
When fib and pulseless VT are resistant to vasopressor (epi) and shock (defibrillation) therapy
78
What indicates lidocaine toxicity?
Any neuro changes
79
What are important side effects of amiodarone? and why?
Hypotension (can affect heart and lead to arrhythmias)
80
In acute coronary syndrome what meds are used for chest pain when they get to the ED?
- Oxygen (if <90%)
- Aspirin
- Nitro
- Morphine (vasodilator and pain)
81
Why should a client with acute coronary syndrome have head up position?
Decreases workload on the heart and increases CO
82
Can fibrinolytic therapy be used for acute coronary syndrome?
Yes
83
What is the goal of fibrinolytic therapy?
Dissolve the clot that is blocking blood flow to the heart muscle which decreased size of infarction
84
What meds are fibrinolytic therapy?
- alteplase
- tenecteplase
- reteplase
- streptokinase
85
How soon after onset of myocardial pain should tfibrinolytic therapy be administered?
within 12 hours, the sooner the better
86
Stroke: Time is ?
Brain
87
What are amor complications of fibrinolytic therapy?
Bleeding
88
Is a good bleeding history needed before fibrinolytic therapy?
Yes
89
What are absolute contraindications o fibrinolytic therapy?
- Intracranial neoplasm
- intracranial bleed
- suspected aortic dissection
- Internal bleeding
90
During and after fibrinolytic therapy take what precautions?
Bleeding
91
What are encompasses bleeding precautions?
- Watch for bleeding gums
- hematuria
- black stools
- use electric razor
- soft toothbrush
- no IMs
92
With fibrinolytic therapy should you draw blood when starting IVs?
Yes, decrease number of puncture sites
93
Can you do ABGs if you have done fibrinolytic therapy?
No, too deep of puncture
94
What are medical interventions for acute coronary syndrome?
- PCI
| - CABG
95
What is PCI?
Includes all interventions such as PTCA (percutaneous transluminal coronary angioplasty) and stents
96
What is a major complication of a angioplasty?
MI
97
After a angioplasty could a client bleed from heart Cath site or could they reocclude?
Yes
98
In any problems occur after a angioplasty, what happens?
go back to surgery
99
If there is chest pain after a angioplasty what should you do?
Call HCP asap, may be reoccluding
100
Are there meds given after a angioplasty to help with successfulness and other precautions?
yes
101
Can a CABG be scheduled or emergent?
Yes
102
When is a CABG used?
multiple vessel disease or L main coronary artery occlusion
103
The left main coronary artery supplies the entire what part of the heart?
left ventricle
104
When you think of left main coronary artery occlusion think what?
sudden death or widow maker
105
Does cardiac rehab teach guidelines and lifestyle changes to help with heart disease?
Yes
106
Should you quit smoking in cardiac rehab?
Yes
107
Is cardiac rehab a stepped- care -plan which increases activity gradually?
Yes
108
What diet changes are made in cardiac rehab?
- Low fat
- Low salt
- Low cholesterol
109
In cardiac rehab is it recommended to do isometric exercises?
No, because it increases workload of heart
110
Does cardiac rehab say it is ok to valsalva or strain?
No
111
What time of day is sex recommended in cardiac rehab?
morning b/c they are well rested (8-9am)
112
What is the best exercise for a MI client?
walking
113
What are s/s to teach for HF?
- Weight gain
- ankle edema
- SOB
- Confusion
