CAD Flashcards
CAD
2nd major cause of death in Canada (27.6% of all deaths)
Stages:
Chronic endothelial injury
Fatty streak
Fibrous plaque
Complicated lesion
CAD risk factors
Non modifiable - male sex, older age, ethnicity, family hx,
Modifiable - elevated serum lipid levels, elevated BP, tobacco use, physical inactivity, obesity, diabetes, substance use, psychosocial risk factors (stress)
Chronic Stable Angina
insufficient blood flow due to narrowing of coronary arteries (atherosclerosis) - causing angina.
Angina has a predictable set of symptoms and are aggravated by specific activities.
Lactic acid accumulates and can cause referred cardiac pain to the left shoulder and arm.
Myocardium becomes hypoxic within 10 seconds of coronary artery occlusion.
Chronic Stable Angina Meds
ACE inhibitors - prevent conversion of angiotensin I to angiotensin II (enzyme that narrows blood vessels)
Calcium channel blockers - cause systemic vasodilation
Beta adrenergic blockers - decrease HR and BP
Short acting nitrates - dilate coronary artery vessels. peaks in 3 mins. can cause orthostatic hypotension. e.g. sublingual nitroglycerin.
Long acting nitrates - tolerance can develop so patients should have an 8 hour free period. e.g. transdermal controlled release nitrates.
Chronic Stable Angina DX
ECG
chest radiograph
exercise stress test
echocardiogram
CT or PET scan
coronary angiography
lab studies - lytes, BUN, creatinine, PTT, aPTT, INR, CBC, lipid profile
Acute Coronary Syndrome (unstable angina)
Chest pain is new at onset, occurs at rest or has a worsening pattern.
Medical emergency!
Can be unstable angina/NSTEMI OR STEMI
Unstable angina/NSTEMI
unstable lesion is partially occluded by a thrombus
STEMI
unstable lesion is totally occluded by a thrombus - more serious
Acute Coronary Syndrome DX
electrocardiographic findings - changes in QRS complex, ST segment and T wave.
serum cardiac markers - troponin
coronary angiography
coronary angiography - uses XRAY imaging to see hearts blood vessels.
Acute Coronary Syndrome Meds
Aspirin - antithrombotic. prevents platelet activation and reduces incidence of heart attack (MI)
Heparin - prevents formation of new clots. be cautious of excessive bleeding.
Acute Coronary Syndrome Nursing Management
Bed rest and limitation of activity for 12-24 hours.
Frequent monitoring of vital signs.
O2 admin at 2-4L/min.
Establish IV for drug therapy.
Continuous ECG monitoring
Myocardial Infarction
result of sustained ischemia causing irreversible myocardial cell death.
most often secondary to a thrombus formation.
causes severe immobilizing chest pain not relieved by rest, position change or nitrate admin. may describe as a feeling of heaviness, tightness, burning, contraction or crushing.
