CAD Flashcards
Arteriosclerosis
thickening and hardening of the arterial walls. It encompasses various conditions that lead to the loss of elasticity and stiffening of the arteries
Atherosclerosis
buildup of fatty deposits (plaques) within the arterial walls. This buildup leads to narrowed arteries and reduced blood flow
risk factors of CAD
age
family hx
male gender, females in menopause
lipid levels: high LDL, high cholesterol, low HDL
smoking
HTN
DM
obesity
sedentary lifestyle
chronic inflammation
causes of CAD
SODDA
s: stress, stimulants
o: obesity, BMI >25
d: DM, HTN
d: diet
a: african-am. males, >50
chronic stable angina
> 6 months
pain with exertion, stress induced
relieved with nitroglycerin and rest
acute coronary syndrome
chest pain at rest and with exertion
can lead to MI
NSTEMI
ST low, low O2
medical emergency
treatment: immediate revascularization
NSTEMI 1
occlusive thrombus
NSTEMI 2
imbalance of oxygen supply
emergency care for pt with CP
ABCs
continuous EKG
description of pain
VS
IV access
medical relief
oxygen
notify HCP, rapid response team
s/s of MI
Fear/anxiety
Pale, dusky skin
disorientation/confusion
CP radiating to left arm
jaw, back, shoulder , abd pain usually in AM relieved only by opioids
NV
diaphoresis
fatigue
palpitations
epigastric distress (heart burn)
diminished/absent pulses
how to diagnose MI
troponin T and I
lipid panel
12 lead ECG
medications for ACS
Platelet Inhibitors: 81mg baby aspirin daily; Clopidogrel (Plavix) prevents platelet aggregation (clumping)
Beta Blockers: Metoprolol slow HR and decrease force of cardiac contraction. Prolongs diastole and increases
myocardial perfusion.
Statins: reduce risk of developing recurrent MI, all patients with ACS should be on high-intensity statins. Atorvastatin
or Rosuvastatin
ACE inhibitors or ARB’s: Lisinopril or Losartan Give within 24 hours of ACS to prevent ventricular remodeling and
development of heart failure.
Thrombolytic Therapy: dissolves thrombi in coronary arteries and restores myocardial blood flow tPa
CCB (calcium channel blocker): Amlodipine promotes vasodilation and myocardial perfusion
MI treatment
O2
aspirin
nitroglycerin
morphine
tPa- clot busters
PCI
CABG
Cardiac Stress Test
Treadmill vs Pharmacologic
STOP immediately for chest pain or ST
changes
Before Test: avoid C’s (cigarettes, teas,
sodas, coffee, cardiac meds like beta
blockers) this can relax heart too much and
alter results
Cardiac Catheterization
A diagnostic tool that uses radiography and IV contrast dye to view the coronary circulation to identify the location and severity of the blockage in the coronary arteries(s)
Patients are sedated
Need to look at creatinine since dye is used
Can place stents (mesh like structure that stays in the artery) or perform balloon angioplasty during the procedure to open up the occluded arteries (coronary revascularization)
potential complications of cardiac cath
bleeding
Infection
Re-occclusion of the coronary artery
Coronary spasm
Dye allergy
Dysrhythmias
Not always able to “fix” coronary lesions with angioplasty or stents
CABG
Occluded arteries are bypassed with patient’s own venous or arterial blood vessels or synthetic graft.
* last option
* >3 blockages
Priority Nursing Diagnosis for ACS
- Decreased myocardial tissue perfusion due to interruption of arterial blood flow
- Acute pain due to imbalance between myocardial oxygen supply and demand
- Potential for dysrhythmias due to ischemia and ventricular irritability
- Potential for heart failure due to left ventricular dysfunction
Long Term Complications of MI
Pericarditis- inflammation of the lining, fever
Dead cardiac cells become electrically silent
* Dysrhythmias; Electrical instability -> pacemaker
* Increased risk for Sudden cardiac death (SCD)
Decreased stroke volume -> increased HR; increased workload
* Left ventricular dysfunction (LV hypertrophy) -> Heart Failure
Decreased cardiac output -> less perfusion to organs
* Kidney
* Fatigue
* Shortness of breath
Sudden Cardiac Death
- Unexpected death resulting from variety of cardiac causes
- Disruption in heart function producing abrupt loss of cardiac output and cerebral
flow - Patients that survive this will need follow up to determine cause and treatment
