CAD Flashcards
CAD
- asymptomatic possible
- chronic stable angina
- unstable angina and MI more serious = ACS
Atherosclerosis
- soft deposits of fat (atheromas) that harden with age
- leads to collateral circulation
CAD Modifiable Risk factors
- elevated serum lipids
- HTN
- tobacco use
- physical inactivity
- diabetes and obesity
HDL Level
- Recommended = Male > 40mg/dl & Female > 50 mg/dl
- ≥ 60 mg/dl – low risk for CAD
- < 40 mg/dl – high risk for CAD
LDL Level
- Recommended = < 100 mg/dl
- > 160 = High risk for CAD
Familial Hyperlipidemia
- autosomal dominant disorder
- leads to increased levels of LDL
- heterozygous less severe homozygous
Health-Promoting Behavior
-FITT: 30 min > 5 days/wk
Antihyperlipidemics
- Statins
- lower cholesterol & LDL, increases HDL
- contra: pregnancy & hep
- SE: myopathy-rhab & hepatotoxicity
- precautions: liver disease & excessive alcohol use
Statins Nursing Implications
- instruct client to report unexplained muscle pain/tenderness
- monitor liver function
- admin in evening
Simvastatin
Increased risk for rhabdomyolysis when also used with gemfibrozil (Lopid) or niacin.
Cholesterol Absorption Inhibitors
- Ezetimibe (Zetia)
- Common addition to statin
- Contra: hypersensitivity, severe hepatic disease
- tabs 10 mg
Niacin
- decreases cholesterol & LDL
- flushing (face & neck) may occur in 20 min and last for 30-60 min
- can premed with aspirin or NSAID 30 min before
Fibrates
- reduce triglyceride & VLDLs
- tricor & lopid
- may increase risk of bleeding with wartfarin
- may increase effects of antihyperglycemic drugs
How do … Bile Acid Sequestrants work?
Bind with acids in intestine
Binding results in removal of LDL and cholesterol
Example: Cholestyramine (Questran)
Bile Acid Sequestrants Nursing Implications
GI upset
Interfere with absorption of other drugs
Give other drugs an hour to absorb before giving
Give questran 4 hours to absorb before giving other drugs
What complementary & alternative therapies are used to lower lipid levels?
Garlic (not very effective but enhances warfarin)
Omega-3 fatty acids (fish and flaxseed oil)
Fiber (pectin, oat bran, psyllium, fruits, beans)
Phytosterols (nuts, seeds, soybeans, veg oils)
Soy
Milk Thistle, Hawthorn, Coenzyme Q10,
Silent Ischemia
- asymptomatic
- associated with DM, diabetic neuro, HTN
- ECG changes
Chronic Stable angina
Chest pain that appears intermittently over a period of time in a predictable fashion
- O2 demand > supply
- pain lasts 3-5 min
- ST depression and/or T inversion
Unstable Angina
New onset, occurs at rest or occurs with increasing frequency or duration.
Chronic Stable Angina Meds
- short acting nitrates:
- long acting: NTG & Isosorbide
Nitrates & Angina
. Dilates venous and arterial vessels – which decreases preload and afterload.
Dilates coronary artery vessels
Lowers B/P
NTG
Call 911 !!!! After 1st dose before taking 2nd dose
If significantly improved - Repeat in 5 minutes X 2 more doses (3 total max
Proper use of NTG
Carry at all times
Keep in original container
Replace every 6 months
Should cause fizzing or tingling under tongue
Side Effects: headache, dizziness, flushing, hypotension (monitor for orthostatic hypotension)
Prinzmetal Angina
- at rest
- with history of migrains & raynaud’s
- ST elevated
- T: calcium blocker or mod exercise
CAD Diagnostics
- homocysteine: high = risk for thrombi
- EKG
- stress test: exercise, meds (dobu or lexi), stress EKG
- cardiac catheter
Cardiac Catherization Post
- bedrest for 4-6 hrs
- keep insertion site straight
- pressure dressing
- 5-10lb sand bags
- assessments q 15 min x 4 then hourly
Acute coronary syndrome
- deterioration of once stable plaque -> thrombus
- partial occlusion: UA & NSTEMI
- total: STEMI (ST elevated)
- AKA heart attack or MI
MI Healing Process
- 24 hrs: WBCs infiltrate
- 10-14 days: scar tissue weak
- 6 wks: necrotic tissue replaces
- ventricular remodeling
Complications of MI
- dysrhythmias
- HF
- cardiogenic shock
- papillary muscle dysfunction
- ventricular aneurysm
- acute pericarditis
- dessler syndrome
Heart Murmurs Causes
Stenosis of valve Partial obstruction Aortic regurgitation Mitral regurgitation Septal defect
Serum Cardiac Markers
- > 4%-6% creatinine kinase
- > 2.3 troponin
Treatment of MI
Morphine
Oxygen (1st)
Nitroglycerine
ASA or Plavix
ACS Care
- emergent PCI
- fibrinolytic therapy
- CA bypass graft
- CABG: first 24-36 hrs
Thrombolytics
- for MI
- SE: streptokinase
- admin within 4-6 hrs
- monitor I&O and Hct
- maintain bed rest
thrombolytics contraindications
•Cerebrovascular disease and pregnancy
•Active bleeding, aortic dissection, pericarditis
•History of intracranial hemorrhage
•Recent major surgery
•History of gastrointestinal (GI) bleeding
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CABG
Assessing the patient for bleeding (e.g., chest tube drainage, incision sites)
Monitoring fluid status
Replacing electrolytes PRN
Restoring temperature (e.g., warming blankets)
ACS Acute
Antiplatelet
IV nitroglycerin
Morphine sulfate
ACS Post Acute
β-adrenergic blockers Angiotensin-converting enzyme inhibitors Antidysrhythmia drugs Cholesterol-lowering drugs Stool softeners
ACS Nutritional Therapy
Low-salt
Low-saturated fat
Low-cholesterol
Antiplatelt therapy
- low dose ASA (81 mg)
- Plavix
- 1st line for angina
- give with heparin or asprin
Improve Perfusion
- PCI
- cardiac monitoring
Sudden cardiac death (SCD)
Unexpected death from cardiac causes
Rapid CPR, defibrillation with AED, and early advanced cardiac life support increase survival rates
Death usually within 1 hour of onset of acute symptoms
Most caused by ventricular dysrhythmias
SCD risk factors
Left ventricular dysfunction (EF 30%)
Ventricular dysrhythmias after MI
