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critical care exam 2 but better > CAD, ACS, and MI > Flashcards

CAD, ACS, and MI Flashcards

1
Q

What is the most common cause of coronary artery disease?

A

Atherosclerosis → repeated inflammatory response

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2
Q

what are examples of nonmodifiable risk factors

A

Family history, age, gender, race

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3
Q

what are examples of modifiable risk factors

A

Hyperlipidemia, smoking, hypertension, diabetes, metabolic syndrome, obesity, physical inactivity, PVD

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4
Q

why is diabetes a major factor in CAD

A

Insulin is inflammatory

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5
Q

what is angina pectoris

A

pain

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6
Q

what is the most common manifestation of myocardial ischemia

A

angina pectoris

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7
Q

what causes angina pectoris and why

A

Anaerobic metabolism, a byproduct is lactic acid → burning

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8
Q

what are factors associated with angina pectoris

A

Physical exertion, exposure to cold, eating a heavy meal, stress

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9
Q

why does eating a heavy meal increase angina pectoris

A

Blood flow to heart is decreased because blood is going to stomach
1

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10
Q

what effect do catecholamines (norepi, epi, and dopamine) have

A

increase blood pressure and myocardial workload

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11
Q

what are the antiplatelet meds

A

aspirin and plavix

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12
Q

what are the anticoagulants

A

heparin and lovenox

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13
Q

what are the reperfusion procedures

A

PCI and CABG

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14
Q

what is stable angina

A

Predictable and consistent pain that occurs on exertion and is relieved by rest or nitroglycerin

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15
Q

what does nitroglycerin do

A

Relaxes smooth muscle, dilating primarily the veins and to a lesser extent the arteries
Reduces preload and afterload

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16
Q

how is nitroglycerin administered

A

SL every 5 minutes up to three times

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17
Q

what is unstable angina

A

attacks that increase in frequency and severity, not relieved by rest or nitro

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18
Q

what is a normal q wave

A

Less than 0.04 seconds, low amplitude
Wider Q waves in V1, V2, 3, and aVf1 can be normal

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19
Q

what is an abnormal Q wave

A

Greater than 0.04 secs in leads 1,2,3, aVf or leads V3-V6

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20
Q

how is acute coronary syndrome assessed

A

ECG and cardiac biomarkers

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21
Q

what does assessment find for unstable angina

A

NO ST elevation or abnormal biomarkers

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22
Q

what does assessment find for an NSTEMI

A

No ST elevation but there are elevated biomarkers

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23
Q

what does assessment find for a STEMI

A

ST elevation and elevated biomarkers

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24
Q

what are the cardiac biomarkers

A

CK MB, Troponin 1 and T, and myoglobin

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25
Q

Where is CK MB found

A

heart muscle

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26
Q

what does CK MB do

A

indicates an acute MI, increased within a few hours

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27
Q

when does CK MB peak

A

24-48 hours

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28
Q

where is troponin found

A

myocardium

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29
Q

what does troponin do

A

indicates a recent MI elevated within a few hours during acute MI

30
Q

how long does troponin remain

A

As long as 2 weeks

31
Q

what does myoglobin do

A

A negative result can rule out an MI but positive doesn’t prove anything

32
Q

when does myoglobin peak

A

within 12 hours

33
Q

what is the treatment for MI

A

MONA
morphine
oxygen
nitroglycerin
aspirin

34
Q

what is the first step of treatment for MI

A

oxygen

35
Q

What does morphine do for MI

A

vasodilation and reducing myocardial oxygen demand

36
Q

what are the adverse effects of morphine

A

respiratory depression, NV< hypotension

37
Q

what are we worried about MI patients on IV beta blockers

A

cardiogenic shock

38
Q

what is the ending for thrombolytics

A

plase

39
Q

when are thrombolytics given for Mi

A

if unable to do a PCI

40
Q

what are contraindications for thrombolytics

A

recent surgery, hemorrhagic stroke, prolonged CPR, pregnancy

41
Q

what do we do as a precaution for patient on thrombolytics

A

have at least two patent IVs

42
Q

what should be done post MI t decrease metabolic rate and preserve brain function

A

hypothermia treatment

43
Q

what are the early complications of acute MI

A

Bradydysrhythmias, tachydysrhythmias, AV blocks, bundle branch blocks, sudden cardiac death

44
Q

what are the embolic complications of acute MI

A

Stroke, DVT, pulmonary embolism

45
Q

what is the inflammatory complication of acute Mi

A

pericarditis

46
Q

what are the ischemic complications of acute MI

A

angina, reinfarction, infarct extensions

47
Q

what is infection extension

A

A myocardial infarction that has spread beyond the original area, usually a result of the death of cells in the ischemic margin of the infarct zone

48
Q

what does a percutaneous transluminal coronary angioplasty (PTCA) do

A

Improve blood flow within a coronary artery by compressing the atheroma (plaque)

49
Q

What is a success for a PTCA

A

improvement in blood flow and a residual stenosis <30%

50
Q

what is a PTCA used for

A

angina, ACS, and blocked CABGs

51
Q

What may happen when the balloon of a PTCA is inflated?

A

Chest pain and ST changes

52
Q

Where should a PCI be done and why?

A

Radial, easily compressible

53
Q

What is the post procedure care for PTCA?

A
  • Remain flat in bed and keep the affected leg straight until the sheaths are removed and then for a few hours afterward to maintain hemostasis
  • Sheath removal and the application of pressure on the vessel insertion site may cause the heart rate to slow and blood pressure to decrease (Vasovagal response)
  • The patient is instructed to monitor the site for bleeding or development of a hard mass indicative of hematoma
54
Q

what are the complications of a PTCA

A

Bleeding, circulation (distal pulses), and immobilization

55
Q

what is an intracoronary stent implantation/ coronary artery stent

A

A metal mesh that provides structural support to a vessel at risk of acute closure and coated with medications to minimize the formation of thrombi or scar tissue within the stent

56
Q

what medications must a stent patient be placed on

A

aspirin and plavix

57
Q

how long must a stent patient be on plavix after a stent procedure

A

up to a year following

58
Q

what are indications for a coronary artery bypass graft

A

Alleviations of angina that cannot be controlled with medication or PCI
Treatment for left main coronary artery stenosis or multivessel CAD
Prevention of and treatment for MI, dysrhythmias, or heart failure
Treatment for complications from an unsuccessful PCI

59
Q

why are CABG procedures performed less in women

A

Smaller vessels → higher risk of complications

60
Q

What diseases would a CABG be the preferred treatment

A

Severe triple vessel CAD, ventricular dysfunction, and diabetes

61
Q

What is the criteria for a CABG

A

70% occlusion in any of the coronary arteries or 50% in the left main coronary artery and artery must be patent beyond the area of blockage

62
Q

which grafts are preferred for CABG, arterial or venous and why

A

Arterial, don’t develop atherosclerotic changes as quickly

63
Q

what arteries are used for a CABG

A

Right and left internal mammary arteries are recommended (Mammary arteries may not be long enough if multiple bypasses are needed)
Can also use radial and gastroepiploic

64
Q

what veins are used for a CABG

A

First: greater saphenous
Second: lesser saphenous
Third: cephalic and basilic

65
Q

what are adverse effects of a CABG vein removal

A

Edema or atherosclerotic blockages

66
Q

what are the complications of CABG

A

Hemorrhage, dysrhythmias, and MI

67
Q

what is a cardiopulmonary bypass used for

A

Extracorporeal circulation → mechanically circulates and oxygenates blood for the body while bypass the heart and lungs
Allows surgeon to compete the grafting in motionless, bloodless surgical field
During the procedure, hypothermia is maintained at a temperature of 28 C (82 F) to reduce the body’s basal metabolic rate and decrease the demand for oxygen

68
Q

how is an off pump CAB performed

A

without CPB, a standard median sternotomy incision
a myocardial stabilization device used to hold the site still

69
Q

what medication is given during an off pump CAB

A

beta blocker

70
Q

what is the difference between and on pump CAB vs off pump

A

Graft patency rate is higher and long term mortality may be lower

71
Q

what is the CABG post op assessment:

A

neurological: Impaired cerebral perfusion
-Hypoperfusion or microemboli during or
following cardiac surgery may produce
injury to the brain
- Brain function depends on a continuous
supply of oxygenated blood
- The brain does not have the capacity to
store oxygen and must rely on adequate
continuous perfusion of the heart
Cardiac status: maintaining cardiac output
- renal function is related to CO
- urine output of less than 1 mg/kg/hr may
indicate decrease in cardiac output and
inadequate fluid volume
Respiratory status
Peripheral vascular status
Renal function
Fluid and electrolyte
Pain

72
Q

what is the CABG post op care

A

bleeding
-chest tube should have less than 200 mL/hr
drainage in the first 4-6 hours
Postcardiotomy delirium
- Transient perceptual illusions
- Visual and auditory hallucinations
- Disorientation
- Paranoid delusions
- Physiologic factors that contribute to this
reaction include
- Long periods of extracorporeal
circulation
- Arterial hypotension during surgery,
emboli, and post op cardiac output
- Age, and the type of severity of heart
impairment are also factors
- Delirium is fostered by sensory
overload (or deprivation) in the
recovery room and intensive unit,
and by staff tension
- Delirium resolves after the patient is
transferred from the unit

critical care exam 2 but better (8 decks)

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