CAD

Question 1

MI symptoms:

Answer 1

• Neuro: Dizziness, restlessness, lightheaded, anxiety, pain
• CV: Chest pain, increased jugular vein distension (JVD) if in heart failure (HF), increased heart rate, decreased heart rate, or irregular heart rate
• Resp: SOB, dyspnea, crackles (in HF)
• GI: Nausea, vomiting, burping, heartburn
• Integ: Cool, clammy, diaphoretic

Question 2

medically modifiable risk factors:

Answer 2

o Hypertension
o Hyperlipidemia
o Diabetes mellitus

Question 3

CAD diagnostics:

Answer 3

• Troponin
• Myoglobin
• ECG
• Angiogram
• Echocardiogram
• Ejection fraction
• Lipid profile

Question 4

ECG:

Answer 4

• Measures the electrical activity of the heart, not the
mechanical
• Looks at the rhythm of the heart
• Can give the information of the areas of the heart that
are damaged
• Used to help diagnose acute coronary syndrome
(ACS)

Question 5

Left anterior descending artery supplies…

Answer 5

right ventricle, left ventricle and interventricular septum

Question 6

Left marginal artery supplies…

Answer 6

left ventricle

Question 7

Right coronary artery supplies…

Answer 7

right atrium and right ventricle

Question 8

Right marginal artery supplies…

Answer 8

right ventricle and apex

Question 9

Coronary angiogram:

Answer 9

• Allows x-ray visualization of the coronary arteries following the injection of contrast medium (dye).
To see if there is there a blockage in one or more artery

Question 10

echocardiogram:

Answer 10

• Sound waves create an image of the heart in motion to
• Evaluate heart wall motion
• Ventricular function
• Identify valve disease
• Evaluate the heart under stress
• Identify and quantify pericardial fluid
• Ejection fraction: Amount of blood that will be pumped out of the heart as it contracts.

Question 11

What is ejection fraction:

Answer 11

end diastolic volume divided by end systolic volume = %
o 55-70% ejection fraction is normal.
o When ejection fraction is low, the ability to perfuse the heart and rest of the body is impeded.

Question 12

Lipid profile - Total cholesterol:

Answer 12

Total cholesterol: This test measures all of the cholesterol in all the lipoprotein particles.

Question 13

Lipid profile - High-density lipoprotein cholesterol (HDL-C):

Answer 13

Measures the cholesterol in HDL particles; often called “good cholesterol” because it removes excess cholesterol and carries it to the liver for removal.

Question 14

Lipid profile - low-density lipoprotein cholesterol (HDL-C):

Answer 14

Low-density lipoprotein cholesterol (LDL-C): Calculates the cholesterol in LDL particles; often called “bad cholesterol” because it deposits excess cholesterol in the walls of blood vessels, which can contribute to atherosclerosis. Usually, the amount of LDL-C is calculated using the results of total cholesterol, HDL-C, and triglycerides.

Question 15

What does the amount of damage depend on?

Answer 15

• The degree and duration of obstruction
• Collateral circulation
• The atherosclerotic process itself reduces blood supply -> progressively reducing blood to the myocardium.
• The development of a clot around a ruptured atherosclerotic plaque causes a sudden occlusion -> acutely reducing myocardial oxygen supply (thrombus)
• Coronary artery blood flow must be reduced by at least 75% before symptoms appear.

Question 16

effects of oxygen demand > oxygen supply:

Answer 16

1) increased workload on the heart in the face of a fixed supply.
D/t: Hypertension, aortic stenosis, increased metabolic demand

2) Reduced blood supply to the heart.
D/t: atherosclerosis, vasospasm, thrombus/emobolus

3) Reduced oxygen carrying capacity or coronary arteries.
D/t: anemia, hemodilutiojn, acute blood loss

Question 17

Nursing care for Angina/MI for reduced o2 supply:

Answer 17

o	Rest (sitting up – easier to breathe than lying flat)
o	Nitrates (vasodilator)
o	Morphine (pain)
o	Beta blockers (decrease BP)
o	Ca channel blockers (vasodilator)
o	ACE inhibitors / ARB (dec. BP)
- Give oxygen

Question 18

mg given of aspirin for acute MI:

Answer 18

160-325mg chewed

Question 19

Which drug should not be taken with grapefruit juice?

Answer 19

Calcium channel blockers

Question 20

action of heparin:

Answer 20

• Lengthening clotting time, prevents thrombus formation/growth, inhibits certain clotting factors

Question 21

difference between heparin and LMWH:

Answer 21

• works similar to heparin accept that its inhibition is specifically on factor X
• less likely to cause thrombocytopenia
• 2-4x longer duration of action
• more stable response

Question 22

classification of maintenance pharmaco’s

Answer 22

Statins

Question 23

HMG Coenzyme A Reductase inhibitors (lipitor)

Answer 23

• inhibit cholesteroal production

- 20-40% reduction in LDL, raise HDL levels, lower tri’s

Question 24

worst thing that could happen with someone staking HMG coenzyme reductase inhibitor:

Answer 24

• liver dysfxn
• muscle pain discomfort
• nausea/ vomiting (give with meal in evening)