CAD/ACS Flashcards
CAD
Atherosclerosis of coronary arteries
“Hardening of the arteries”
Due to damage to vessel
Risk factors of CAD
Non modifiable
Age: 55+ women 45+ men
FH
Risk factors of CAD
Modifiable risks
Tabacco use
Sedentary lifestyle
stress
HTN
High cholesterol: total:200+ LDL:130+ triglycerides 150+
Obesity
Cholesterol
Total cholesterol normal: <200
HDL:
Females: >50+
Males: >40+
LDL: <100
Triglycerides: <150
Dietary interventions for hyperlipidemia
LDL
activity
Avoid trans/saturated fats and cholesterol in foods
Dietary interventions for hyperlipidemia
Increase HDL
Physical activity
Healthy fats
Modify ETOH intake
Smoking cessation
Weight loss
Dietary interventions for hyperlipidemia
Lower triglycerides
Control blood sugar (if DM)
Avoid excessive ETOH and refined sugars
Physical activity
Tx for hyperlipidemia: drug therapy
On these meds for lifetime
Types:
Statins (lower LDL raise HDL)
Niacin
Fibrates
Bile acid sequestrants
PCSK9 inhibitors
Statins
First line tx (best chance of reducing risk)
Lower LDL and triglycerides
Small increase in HDL
AE:
-Muscle aches
-Rhabdomylosis (DARK URINE, muscle pain, high CK) STOP STATIN
-Increase in AST/ALT
Niacin
B vit
Lower LDL and triglycerides
Increases HDLs
AE: flushin, pruritus
Taken if statin doesnt help enough
(For cholesterol)
Fibric acid derivates (gemfibrozil)
And
Bile acid sequestrants (cholestyramine)
Both work in the gut
Also given if statin doesnt help enough
(For cholesterol)
PCSK inhibitors (evolocumab)
And
Ezetimibe
Just know their also for cholesterol
Added to statins
Angina
Chest pain from myocardial ischemia
(Increase o2 demand or decrease o2 supply)
Blockage causes symptoms
Precipitating factors of angina
Physical exertion
Temp
Emotions
Consuming heavy meal
Tabacco
Sex
Stimulants
(Any thing to increase demand of O2)
Chronic stable angina
Episodic pain
Pattern: provoked by stress and activity
Improves with rwst or NTG
No longer than 15 mins
Unstable angina
New or change pattern
Occurs at rest
Does not imporve with NTG or rest
Emergency!
Prinzmetals angina
Caused by coronary vasospasm
Comorbid with migraines, raynauds, heavy smoking
Diagnostic studies for CAD
12 lead ECG
Labs: cardiac enzymes
Stress test: see if activity causes symptoms
Cardiac catheterization
Cardiac enzymes
Markers of injury
CK total: nonspecific, any muscle injury
Specific:
CKMB: ⬆️ 4-8 hours, peals 12-24 hours
Troponin: ⬆️ 3-4 hours peaks 4-24 hours
Get 3 sets of cardiac enzymes 3-6 hours apart
Cardiac catheterization
Gold standard
PCI
Complications
Gold standard to localized CAD for pt with worsening angina symptoms
PCI (percutaneous coronary intervention) can be done if a block is found
(stent placement)
Complication’s: infection, poke hole in heart, bleeding
Cardiac cath nursing care
Pre and post procedure
Pre procedure:
Allergy: shell fish (contrast dye)
Lab studies: bleeding, kidney function
Post procedure:
Monitor: bleeding, dysrhythmia, chest pain
Nitroglycerin (short acting nitrate)
Why important
MOA
Route
Other use
Cause
First line for acute angina
MOA: vasodilations
Route: SL 1 tab every 5 mins, mac 3 then call EMS
Spray can be on or under tongue
Used Prophlactically in stable angina before activity
HA common (Tylenol), watch BP
Topical NTG
Nitro ointment (nitro-paste)
Ordered by inch
Wear gloves
Transdermal patch
Apply over non-hairy area, occlusive dressing
Long acting nitrates
Used to reduce frequency
Tx for prinzmetals angina
Orthostatic hypotension
Ex: isosorbide
Antiplatelet therapy
Med and dose
Why given
Risk
Use
What else we can give if not tolerant
Low dose ASA (81mg) daily
Decrease platelet to prevent clots
Bleeding risk
Used for primary prevention
Or can give clopidogrel (plavix) if ASa intolerant
MI/ACS
Prolonged ischemia
Non-ST elevation (NSTEMI):
Not as much of a emergency
ST-segment-elevation MI (STEMI): emergency right now
Need pci within 90 mins
ACS clinical manifestations: MI
Severe chest pain not relieved by rest , NTG:
Heaviness, pressure, crushing
Radiate (jaw,neck,shoulder)
Diaphoresis
Tachycardia
Palor
Low grade fever, N/V
ACS clinical manifestations: MI
As it progresses
Low BP
LOC
weak pulse, oliguria
MI diagnositic studies
Test
Gold standard to localize the lesion
ECG: show ST elevation
Cardiac biomarkers: increased CKMB, Troponin
Gold standard to localize the lesion: cardiac catheterization
MI: intitial management
Goal
MONA
Goal: decrease O2 demand/increase O2 supply
Semi fowler
Bed rest
Cardiac monitoring
MONA: morphine, oxygen, nitroglycerin, ASA
Asses pain/VS
Plan for cardiac catheterization
MI med management
Antiplatelet therapay (ASA, clopidogrel)
Anticoagulation (Heparin/LMWH)
Cardiac cath/PCI
May require CABG
Rural hospital may use thrombolytic meds to break up clot due to lack of resources
CABG
Coronary artery bypass graft
Placement of arterial or venous grafts to bypass coronary blockage
Usually: internal mammary, saphenous, or radial artery
Requires STERNOTOMY
CABG postop care
Assess: bleeding, fluid status, dysrhymthmias
Sternotomy site and harvest site would care
Pain management
Prevent VTE
Resp tx: splinting, IS
Post MI nursing management
Cardiac monitoring
VS
Labs/ECG
Bedrest 12-24 hours
Heparin drip
Pain tx
Oxygen
MI complications
Dysrhythmias
HF: pulmonary congestion, dyspnea, edema
Cardiogenic shock: decompensated
Increased HR
Decreased BP
New murmur is emergency post-op
Will need surgery
Discharge teaching
Lifestyle mods
Cardiac rehab
Likely to have another
