CAD, ACS, and MI Flashcards
What is the most common cause of coronary artery disease?
Atherosclerosis → repeated inflammatory response
what are examples of nonmodifiable risk factors
Family history, age, gender, race
what are examples of modifiable risk factors
Hyperlipidemia, smoking, hypertension, diabetes, metabolic syndrome, obesity, physical inactivity, PVD
why is diabetes a major factor in CAD
Insulin is inflammatory
what is angina pectoris
pain
what is the most common manifestation of myocardial ischemia
angina pectoris
what causes angina pectoris and why
Anaerobic metabolism, a byproduct is lactic acid → burning
what are factors associated with angina pectoris
Physical exertion, exposure to cold, eating a heavy meal, stress
why does eating a heavy meal increase angina pectoris
Blood flow to heart is decreased because blood is going to stomach
1
what effect do catecholamines (norepi, epi, and dopamine) have
increase blood pressure and myocardial workload
what are the antiplatelet meds
aspirin and plavix
what are the anticoagulants
heparin and lovenox
what are the reperfusion procedures
PCI and CABG
what is stable angina
Predictable and consistent pain that occurs on exertion and is relieved by rest or nitroglycerin
what does nitroglycerin do
Relaxes smooth muscle, dilating primarily the veins and to a lesser extent the arteries
Reduces preload and afterload
how is nitroglycerin administered
SL every 5 minutes up to three times
what is unstable angina
attacks that increase in frequency and severity, not relieved by rest or nitro
what is a normal q wave
Less than 0.04 seconds, low amplitude
Wider Q waves in V1, V2, 3, and aVf1 can be normal
what is an abnormal Q wave
Greater than 0.04 secs in leads 1,2,3, aVf or leads V3-V6
how is acute coronary syndrome assessed
ECG and cardiac biomarkers
what does assessment find for unstable angina
NO ST elevation or abnormal biomarkers
what does assessment find for an NSTEMI
No ST elevation but there are elevated biomarkers
what does assessment find for a STEMI
ST elevation and elevated biomarkers
what are the cardiac biomarkers
CK MB, Troponin 1 and T, and myoglobin
Where is CK MB found
heart muscle
what does CK MB do
indicates an acute MI, increased within a few hours
when does CK MB peak
24-48 hours
where is troponin found
myocardium
what does troponin do
indicates a recent MI elevated within a few hours during acute MI
how long does troponin remain
As long as 2 weeks
what does myoglobin do
A negative result can rule out an MI but positive doesn’t prove anything
when does myoglobin peak
within 12 hours
what is the treatment for MI
MONA
morphine
oxygen
nitroglycerin
aspirin
what is the first step of treatment for MI
oxygen
What does morphine do for MI
vasodilation and reducing myocardial oxygen demand
what are the adverse effects of morphine
respiratory depression, NV< hypotension
what are we worried about MI patients on IV beta blockers
cardiogenic shock
what is the ending for thrombolytics
plase
when are thrombolytics given for Mi
if unable to do a PCI
what are contraindications for thrombolytics
recent surgery, hemorrhagic stroke, prolonged CPR, pregnancy
what do we do as a precaution for patient on thrombolytics
have at least two patent IVs
what should be done post MI t decrease metabolic rate and preserve brain function
hypothermia treatment
what are the early complications of acute MI
Bradydysrhythmias, tachydysrhythmias, AV blocks, bundle branch blocks, sudden cardiac death
what are the embolic complications of acute MI
Stroke, DVT, pulmonary embolism
what is the inflammatory complication of acute Mi
pericarditis
what are the ischemic complications of acute MI
angina, reinfarction, infarct extensions
what is infection extension
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
what does a percutaneous transluminal coronary angioplasty (PTCA) do
Improve blood flow within a coronary artery by compressing the atheroma (plaque)
What is a success for a PTCA
improvement in blood flow and a residual stenosis <30%
what is a PTCA used for
angina, ACS, and blocked CABGs
What may happen when the balloon of a PTCA is inflated?
Chest pain and ST changes
Where should a PCI be done and why?
Radial, easily compressible
What is the post procedure care for PTCA?
- 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
what are the complications of a PTCA
Bleeding, circulation (distal pulses), and immobilization
what is an intracoronary stent implantation/ coronary artery stent
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
what medications must a stent patient be placed on
aspirin and plavix
how long must a stent patient be on plavix after a stent procedure
up to a year following
what are indications for a coronary artery bypass graft
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
why are CABG procedures performed less in women
Smaller vessels → higher risk of complications
What diseases would a CABG be the preferred treatment
Severe triple vessel CAD, ventricular dysfunction, and diabetes
What is the criteria for a CABG
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
which grafts are preferred for CABG, arterial or venous and why
Arterial, don’t develop atherosclerotic changes as quickly
what arteries are used for a CABG
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
what veins are used for a CABG
First: greater saphenous
Second: lesser saphenous
Third: cephalic and basilic
what are adverse effects of a CABG vein removal
Edema or atherosclerotic blockages
what are the complications of CABG
Hemorrhage, dysrhythmias, and MI
what is a cardiopulmonary bypass used for
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
how is an off pump CAB performed
without CPB, a standard median sternotomy incision
a myocardial stabilization device used to hold the site still
what medication is given during an off pump CAB
beta blocker
what is the difference between and on pump CAB vs off pump
Graft patency rate is higher and long term mortality may be lower
what is the CABG post op assessment:
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
what is the CABG post op care
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
