CAD Flashcards
atherosclerosis starts with (NOT inflammation for this one)
a fatty streak sticks
total cholesterol (cholesterol has your fav numbers)
< 200 low risk
200-239 borderline
>239 high risk
HDL (H High at 35)
> 35 low
< 35 high
LDL (29, 30, and 59 are liddle old)
<129 low
130-159 medium
>159 high
triglycerides (try 201 units to get high)
<200 low
201-399 high
400-1000 very high
>1000
how atherosclerosis forms
inflammation, formation of fibrous cap, if thrombus, it’s just a ruptured plaque.
blood sugar with athleroscoloris should be
right at 100
signs of CAD (Caddy is 4th) - AND BP and heart rhythm? (CAddy can be high or low)
4th heart sound, tachycardia, hypotension, HTN, angina
signs of CV disease (my CV has some pulses and headaches)
Diminished carotid pulses, carotid artery bruits, focal neurological deficits, headaches
signs of PVD
Decreased peripheral pulses, peripheral artery bruits, pallor, peripheral cyanosis, gangrene, ulceration, difficulty ambulating, pain with ambulation
signs of AAA
Pulsatile abnormal mass, peripheral embolism, circulatory collapse, pre/syncope, weakness
Atheroembolism (if Athens is blocked, it will fall off the map)
Gangrene, cyanosis, ulceration
athero risk factors (DH LAGGS in athens)
Risk factor assessment (diabetes, HLPD, gender, LV function, provocation of angina, genetics, stress)
athero - Echocardiography (The echo in athens is my liver EF)
to assess LV function, EF, predicts survival
athero diagonostics (the 2 Es and a C in Athens)
ECG, CXR, Echo, labs
CAD
RCA, L main, LAD (left anterior descending), circumflex
cause of supply demand imbalance
thromus or embolus, spasm, hypovolemia, anemia, HR up or down, BP up or down
prevention of CAD
Control cholesterol, diet, physical activity, medications, quit smoking, manage HTN, control diabetes
angiography risk assessment (Angie is high, med, low - that’s it)
just know that there is risk assessment for high, medium, and low
angina pectoris - cause?
A syndrome characterized by episodes or paroxysmal pain or pressure in the anterior chest caused by insufficient coronary blood flow
angina pectoris - Physical exertion or emotional stress
increases myocardial oxygen demand, and the coronary vessels are unable to supply sufficient blood flow to meet the oxygen demand
Chronic Stable Angina (stable will disappear with rest)
Decreased blood flow to myocardium usually caused by CAD
Temporary pain/pressure
Predictable, long term, familiar pattern
Resolves with nitroglycerin, oxygen or rest. This ALWAYS goes away with rest, etc.
exertion angina (thanksgiving ppl) - how long does it last? (exert for less than 15 min)
Resolves with rest or NTG (nitrogycerin)
Lasts < 15 minutes
May radiate to arm, shoulder, back, jaw, neck, wrists
Variant or atypical or Prinzmetal angina
Not caused by exertion
Often caused by coronary artery spasm
Often there is no coronary artery blockage or atherosclerosis
angina described as
May be described as tightness, choking, or a heavy sensation
symptoms of angina - and what time of day usually?
dyspnea, SOB, dizziness, nausea, vomiting. will often wake up feeling this way.
angina pain is where? (Not chest)
retrosternal and may radiate to neck, jaw, shoulders, back or arms (usually left)
does angina pain subside with rest?
yes, or NTG
anxiety and angina?
usually happen together
unstable angina requires
medical intervention!
if ppl have to take 2 TNG,
call EMS.
assessment of chest pain
Scale of 1-10
Quality
Severity
Frequency
Location and radiation
Duration
Precipitating factors
Relieving factors
most common areas of pain for angina (just 4 places - most obvious)
left arm, left chest, around neck, middle of back
angina in males (men have chest pain, stomach pain and they sweat)
typical spots, chest pain, stomach pain, sweating,
angina in females
anxiety, N/V, back of shoulder, dizziness, feels like a pulled muscle
angina - Gerontologic Considerations
Diminished pain transition that occurs with aging may affect presentation of symptoms
“Silent” CAD
Teach older adults to recognize their “chest pain–like” symptoms (i.e., weakness)
Pharmacologic stress testing; cardiac catheterization
Medications should be used cautiously!
could have target organ damage
angina management - 3 Goals (gyna gets aspirin)
Identify and respond ASAP - rest the patient, call for help and give them an aspirin
Establish prophylactic drug regimen
Widen or circumvent narrowed arteries
angina treatment - HOB
decrease myocaridal O2 demand and increase 02 supply, reduce and control risk factors, medications, reperfusion therapy, HOB 30 degrees
meds for angina
NTG, beta-adrenargic blockers, calcium channel blockers, antiplatelet and anticoagulants
aspirin
Acetylsalicylic Acid
Antiplatelet effect
81-325 mg
Chewable. chew it, they need it fast!
NGT (Nitro dilates everything)
Causes venous and arterial dilation and dilation of coronary arteries, resulting in decreased preload, afterload and increased blood flow to the myocardium
NGT dosing
Take 1 every 5 minutes X 3 doses sublingually
Don’t swallow
Take out cotton ball in container as it absorbs the drug
Keep in a dark, glass bottle, dry, cool & renew every 6 months
Usually burns/fizzes under tongue
HA
NGT before administration
Check BP before and after administration
NGT - after meds have been given
AHA recommends contacting EMS (911) after the client takes the first dose of NTG. Don’t wait more than 5 minutes to call 911
NGT almost always causes a
headache from the vasodilation
morphine
decreases cardiac workload
Analgesic effects decreases the sympathetic response thereby decreased diaphoresis lightheadedness, & Decreases HR, BP and venous return
Stimulates local histamine mediated responses
Might inhibit or delay of antiplatelet absorption
beta blockers - what about the liver?
(beta1 selective
Decrease BP, P and myocardial contractility
Improve LV function
Calcium Channel Blockers (Calcium dilates)
Decrease BP and dilate coronary arteries
angina patient education - exercise?
Avoid isometric exercise
Rest frequently
unstable angina - when does it occur? How long does it last?
Change in pattern = ⇧ severity or > time
Not relieved by NTG or rest
Occurs at rest or awakens patient at night
> 15 minutes
acute coronary symptoms - WBC and temp? (Aces raises my WBCs)
Pain
Cold and clammy
Increased WBC and increased temp
ECG changes
N & V
serial cardiac enzymes
CPK (creatinine), LDH, troponin
acute coronary syndrome - Common Precipitating Factors - what triggers it? (A cute coronary in my sleep)
Exercise 13%
Unusual exertion 18%
Surgery 6%
Rest 51%
Sleep 8%
signs and symptoms of acute coronary syndrome (ACS) - how long? (Play aces for less than 30 min)
coronary pain < 30 min severe. Not relieved by NTG and/or rest.
N/V
anxiety, apprehension, denial.
dyspnea, diaphroesis, palpitations, dysthrmias, orthopnea, weakness/fatigue, dizziness
ACS diagnosis (Aces is inverted)
Patient history
Signs & Symptoms
Type of pain
ECG changes
Inverted T waves
ST elevation
Q waves
Other tests
Cardiac enzymes
Cardiac markers
ACS treatment (Aces gets hobs, then fiber)
meds first, HOB, Fibrinolytics
ACS - Fibrinolytics
not first choice. Goal is to dissolve the clot that is blocking the blood flow to the heart and thereby decreasing the size of the infarction
Fibrinolytics - nursing considerations (fiber bleeds)
Detailed H & P are critical (bleeding and time of onset)
Initiate bleeding precautions, assess ECG, minimize anything that causes bleeding
Must be given in a compressible site
can’t use Fibrinolytics if BP is…
BP is higher than 180 or 100 diastolic
Fibrinolytics nursing considerations - when can you use an invasive device?
closely monitor, control high BP, avoid invasive device for 24 hrs, observe response, screen with provider all antiplatet or anticoagulants Rx
what labs to monitor with fibrolytics
hemoglobin, hematocrit, platelets, anti-Xa, PTT, INR/PT, fibrinogen
nursing management ACS/MI
Oxygen and medication therapy
Frequent VS assessment
Physical rest in bed with head of bed elevated
Relief of pain helps decrease workload of heart
Monitor I&O and tissue perfusion
Frequent position changes to prevent respiratory complications
Report changes in patient’s condition
Evaluate interventions!!!!
invasive coronary artery procedures
Percutaneous transluminal coronary angioplasty (PTCA)
Coronary artery stent
Coronary artery bypass graft (CABG)
Cardiac surgery
chest pain after PCI - percutaneous coronary intervention (basically just a stent) - could mean
stent moved.
PCI (Angie is PCP)
Known as balloon angioplasty or percutaneous transluminal angioplasty
PCI
Known as balloon angioplasty or percutaneous transluminal angioplasty
PCI - invasive or not?
non invasive
PCI used to treat
CAD, angina, acute MI in order to re-perfuse and save cardiac muscle. often combined with stent.
Coronary Artery Bypass Graft (CABG) (Cab in my thorax)
type of thoracic surgery
The choice of bypass graft depends on
where the blockage is, how much, size of arteries.
Left ventricular assist device (LVAD)
is a pump
Patients will only have a MAP, no pulse
exertion angina - causes (my hypo is exerting my hyper)
Exercise, stress anxiety, large meals, tachycardia, anemia, hypoglycemia, hyperthyroidism
angina - eating?
Avoid overeating
Avoid excess caffeine or any drugs the increase HR
Lose weight if overweight
Diet modifications/changes
small meals
angina - how long to wait after eating before exercise?
Wait 2 hours after eating to exercise
angina - how to dress?
Dress warmly in cold weather
Adhere to medication regimen
Take NTG prophylactically
Stop smoking
Manage diabetes
can’t use fibrinolytics with…
CNS disease or CVD
no fibrinolytics if pt had trauma or stroke how soon?
last 3 weeks
no fibrinolytics if pt had surgeries within
surgeries within 4 weeks
no fibronolytics if pt has what type of bleeding? And liver?
intercranial bleed, blood thinners, kidney liver disease, pregnant
after removing a client’s femoral sheath after cardiac catheterization, have what med available?
atropine. can cause vagal stimulation and bradycardia
