CAD + ACS (M4C) Flashcards
1
Q
acute coronary syndrome
A
- group of potentially life threatening disorders resulting from sudden, insufficient blood flow to the heart muscle d/t narrowing or blockage of one or more blood vessels to heart
- unstable angina to MI
2
Q
S&S of ACS
A
- dizziness
- lightheadedness
- chest pain
- upper body discomfort w/ pain
- numbness in one or both arms, wrist, hand
- SOB
- N/V
- sweating
3
Q
angina
A
- typically warning to MI
- vessels narrows and shorter restriction of blood flow
4
Q
types of angina
A
- stable
- unstable
- refractory
- variant
- silent ischemic
5
Q
stable angina
A
- chest pain that occurs with activity or stress; relieved by rest
- stress of heart inc, narrowed vessels become more restricted
- lack of O2 to heart muscle (cell death) –> pain
6
Q
unstable angina
A
- symptoms more frequent and inc in severity
- not relieved by rest or meds
- treated w/ nitroglycerin (helps with acute phases of angina)
7
Q
refractory/intractable angina
A
- severe, incapacitating angina
8
Q
variant/vasospastic angina
A
- anginal pain at rest
- d/t coronary a. vasospasm
- ECG shows S-T segment elevation
- reversible
- treated w/ nitroglycerin
9
Q
silent ischemia angina
A
- info gained by objective data
- monitor stress tests (ECG changes)
- not showing S&S (ex. chest pain, tingling)
10
Q
S&S of MI
A
- neuro: dizzy, restless, lightheaded, anxiety, pain
- CV: chest pain, inc/dec/irreg HR
- resp: SOB, crackles (if HF)
- GI: N/V, burping, heartburn
- integ: cool, clammy, diaphoretic
- psychological: feeling of impending doom or denial that something is wrong
11
Q
Dx of MI
A
- cardiac biomarkers: troponin, CK, myoglobin
- lipid profile
- ECG
- angiogram
- echocardiogram
- EF
- CBC
- renal Fx
12
Q
troponin
A
- specific indicator of myocardial tissue damage
- protein in myocardium
- regulates myocardial contraction process
- critical marker of myocardial injury
- inc in levels of troponin can be detected within 6 hrs (remains elevated for at least 2 wks)
13
Q
lipid profile
A
- total cholesterol
- HDL
- LDL
- triglycerides
14
Q
ejection fraction (EF)
A
- measurement of % of blood leaving heart each time it contracts
- normal = 55-75%
- heart muscle damage d/t injury or disease = dec EF
15
Q
extent of infarction depends on…
A
- degree and duration of obstruction
- collateral circulation
- atherosclerosis
- thrombosis
- coronary a. blood flow reduced at least 75% before symptoms appear
16
Q
O2 demand > O2 supply when…
A
- inc workload on heart when there’s fixed supply
- reduced blood supply to heart
- reduced O2 carrying capacity of coronary a.
17
Q
angina/MI nursing care
A
- thorough pain assessment
- assess for both chest pain and chest discomfort (heaviness, heart feeling squeezed)
- goal = inc O2 supply & dec demand on heart
18
Q
reduce O2 demand by…
A
- rest
- nitrates
- beta blockers
- Ca+ channel blockers
- ACE inhibitors/ARBs
19
Q
inc O2 supply by…
A
- O2 (when indicated)
- aspirin
- thrombolytics
- PCI (stent, CABG)
- heparins (inc O2 supply by inhibiting clots to form)
- antiplatelets
- statins (dec cholesterol levels)
- Ca+ channel blockers
20
Q
management of ischemia
A
- dec activity (dec demand on heart)
- O2 (when indicated)
- nitrates (do not give more than 3 doses of nitro spray/reassess after every dose)
- aspirin
- beta blocker
21
Q
nitrates - action
A
- relax vascular SM in arteries but particularly veins
- reduce preload –> reduce cardiac workload
- ex. nitroglycerine
22
Q
worst ADE of nitrates
A
- vessels dilate too much and blood pools in periphery –> reducing CO
- mnfts as headache
- Tx by filling space w/ isotonic volume
23
Q
nitroglycerine
A
- SL tabs & spray: for immediate angina attacks
- transdermal patches: in active HF
- IV: only in specialty care areas
24
Q
teaching around nitroglycerin
A
- teach about ADE: dec in BP, dysrhythmias, reflex tachycardia
- teach about 3 chances for med to work
25
Q
assessments about nitroglycerin
A
- BP
- pain (repeat pain assessment)
26
Q
aspirin
A
- anti-inflammatory
- antiplatelet (inhibits further growth of thrombus)
- reduces mortality up to 20% for someone w/ MI
- inc avail O2 supply to heart
- ex. ASA
27
Q
worst ADE of aspirin
A
- allergic rxn –> antihistamine/epinephrine
28
Q
beta blockers
A
- reduce CO by blocking beta receptors
- dec HR & contractility –> dec workload/demand on heart
ex. metoprolol, atenolol, propranolol
29
Q
worst ADE of beta blockers
A
- bradycardia, inadequate CO, bronchospasm
30
Q
Ca+ channel blockers
A
- inhibits transportation of Ca+ into myocardial and vascular SM cells
- results in inhibition of excitation-contraction coupling and subsequent contraction
- reduces cardiac workload & inc O2 supply
- do not give with grapefruit juice
- ex. diltiazem, verapamil
31
Q
worst ADE of Ca+ channel blockers
A
- bradycardia (heart block), inadequate CO, HF
32
Q
ACE inhibitors
A
- inhibits conversion of angiotensin I to angiotensin II
- reduces afterload –> reduces cardiac workload
- ex. ramipril, enalapril
33
Q
worst ADE of ACE inhibitors
A
- inadequate cardiac output
- cough (angioedema) from action on vasodilator bradykinins
34
Q
fibrinolytics
A
- “clot busters”
- used for STEMI if it is within 6 hrs of 1st symptoms and PCI is not avail within 90 mins for 1st medical contact
- dissolves body’s fresh fibrin clots
- delivered in critical care areas & close monitoring for bleeding
35
Q
antiplatelets
A
- inhibits platelet aggregation
- prolong bleeding time
- used to prevent MI
- for pts who have stents
- assess: platelet count
- monitor for signs of active bleeding
- inc avail O2 to heart
- thienopyridines & glycoprotein IIb/IIIa inhibitors
36
Q
HMG coenzyme A Reductase Inhibitors (Statins)
A
- inhibit cholesterol production
- raise HDL lvls and lower triglyceride lvls
- dec demand on heart
- inc avail O2 to heart
- ex. atorvastatin
37
Q
worst ADE of statins
A
- liver dysfx (freq LFT & monitoring)
- muscle pain, tenderness and weakness (check CPK)
- N/V, heartburn, abd cramping & diarrhea, memory loss
38
Q
percutaneous coronary interventions
A
- used to open up occluded arteries in acute MI
- promotes reperfusion in areas that have been deprived of O2
- inc avail O2 to heart
39
Q
coronary artery bypass graft (CABG)
A
- take vessels to replace blocked vessels with new vessels
- invasive procedure
40
Q
cardiac rehabilitation phase I
A
- begins w/ Dx of atherosclerosis & ACS symptoms
- low level activities
- pt education: S&S, when to contact 911, medication teaching
- rest-activity balance, follow up appts
41
Q
cardiac rehabilitation phase II
A
- begins after pt discharged
- output program
- ECG monitoring
- exercise and strength training
- support w/ Tx of disease
- lifestyle modifications, risk factor reductions
- short-term and long-term range goals collaboratively
42
Q
cardiac rehabilitation phase III
A
- community based
- focused on maintenance of cardiovascular ability
- self-directed
- not supervised
43
Q
cardiac rehabilitation
A
- 3 phases
- inc survival
- reduces recurrent events
- improves QoL
- dec workload of heart
- limit effects & progression of atherosclerosis + return to normal QoL
- enhance psychosocial status
- encourage physical activity
- pt education
- if can walk 5-1km = can do sexual activities
- positioning
44
Q
pharmacological interventions for CAD
A
- O2 therapy
antianginals: - nitrates (nitroglycerine)
- Ca+ channel blockers (diltiazem, amlodipine)
- beta blockers (metoprolol)
- thrombolytics (alteplase)
- statins (atorvastatin)
