CAD / ACS pt. 1 (Exam 1) Flashcards
Terms for Coronary Heart Disease
Coronary Artery Disease
Ischemic Heart Disease
Coronary Heart Disease: Continuum
Chronic ischemic heart disease
(Stable angina)
or
Acute coronary syndrome (ACS)
(unstable angina)
(myocardial infarction)
Chronic Ischemic Heart Disease
Stable Angina
Patient has for years and has been living with it
Acute Coronary Syndrome
Unstable angina
Acute Myocardial infarction
If patients stable angina goes to unstable angina the patient has went from ______ to ______
Chronic ischemic heart disease
to
Acute coronary syndrome (ACS)
Regardless of what CHD the person has, what is typically responsible?
Atherosclerosis (hardening of artery)
Non Modifiable RF for CHD
Age (older)
Gender (male)
Family History
Modifiable RF for CHD (4 most)
- Elevated serum lipids
-Serum cholesterol >200 mg/dl or
-Fasting triglyceride level > 150 mg/dL - Hypertension
- >140/90 or
- 130/80 with DM or CKD - Tobacco Use
-Proportional to number of cigarettes smoked - Physical Inactivity
-Lack of adequate exercise on regular basis
What is elevated serum cholesterol?
What is elevated triglyceride?
Serum cholesterol > 200 mg/dL
Fasting triglyceride > 150 mg/dL
(HDL’s desirable; LDL’s not desirable)
Risk factor: HTN
> 140/90 or
> 130/80 with DM or CKD
Risk factor: Tobacco use
Risk is proportional to number of cigarettes smoked
Risk Factor: Physical Inactivity
Lack of exercise on regular basis
Other modifiable RF for CHD
Obesity
-Apple shape have higher incidence than pear shaped
Diabete Mellitus
Depression / Stress
Patient Teaching RF: Patient with Elevated Serum Lipids
-Low fat diet
-Have lipid levels checked regularly
-Statins
Patient Teaching RF: Patient with High blood pressure
-Check often
-Antihypertensive meds
-DASH diet
Patient Teach RF: Tobacco
Do not start
Stopping = Immediate Change
Patient Teaching RF: Patient is Physically Inactive
If middle age or history of problems: Check HCP before starting
Exercise periods should be at least 40 minutes long with 10 minute warmup and 5 min cool down
If cant exercise 3-4 times week, walk daily for 30 minutes at comfortable pace
If cannot walk daily, walk any distance you can (park farther away from a site necessary)
Patient Teaching RF: Obesity
Avoid fad diets
Restrict saturated fats
Avoid sweets and cholesterol foods
Increase Physical Activity
Patient Teaching RF: DM
Monitor Glycemic index foods; regular serum HbA1C checked often
Angina Location
Substernal
Substernal (neck)
Substernal (radiate lower arm)
Epigastric
Neck
Midscapular
NOT PREDICTABLE
Chronic stable angina occurs with
moderate to prolonged exertion in a pattern familiar to patient
Chronic stable angina: Frequency, duration, intensity
Remain same over several months
Chronic stable angina results in
only slight limitation in activity
Chronic stable angina is associated with
fixed atherosclerotic plaque
Chronic stable angina relieved by _____ or ______ and is managed long term by _______
NTG and or rest
Drug therapy
Does chronic stable angina require aggressive therapy?
Rarely
How do we diagnose Stable Angina?
Through physical exam + complete history
ECG/EKG
Stress test
-exercise or pharmacological stress
Echocardiogram
TEE
Stress test of stable angina results help determine if
low and intermediate risk = manage without intervention
high-risk patient = coronary angiography (cath) and revascularization with either percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG)
Stress test determines patient is high-risk, what is next?
coronary angiography (cath) and revascularization with either percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG)
Goal for Chronic Stable Angina
Decrease O2 demand and increase O2 supply
Reduce risk factors as appropriate
Medications (Reduce risk factors)
Medications to reduce chronic stable angina RF’s
Antiplatelet (ASA) (75-325 daily)
-per day
Lipid-lowering agents (statin)
Medications to relieve angina
Beta blockers
-Only classification proven to prevent re-infarction and to improve survival for MI patients
CCB
-Given with BB
Nitrates
-SL = first line treatment for acute angina symptoms
-Use at onset or prophylactically
Ranolazine
-New therapy
When should patients take nitrates
At the beginning of chest pain or prophylactically (before known trigger)
Nitrate: Most Recent Guidelines
If chest pain has not improved or has worsened 5 minutes after taking the first nitro, the patient should
Call 911
Chew 325 mg aspirin immediately
(antiplatelet effect begins within 1 hour and continues through several days)
Nitroglycerin Sublingual
Nitrostat
Nitroglycerin IV
Tridil
5mcg/min then increase as needed
Nitroglycerin: Skin Patch
Transderm-Nitro
Nitroglycerin: Ointment
Nitro bid
Notes on Nitroglycerin for the nurse
Translingual = on the tongue
Use gloves to apply and remove ointment or patch (will vasodilate)
Do not discharge defibrillator over patch
Do not use with erectile dysfunction drugs
IV form in glass bottle with special tubing
Patient Education: Sublingual Nitroglycerin (Nitrostat)
Works in 3 min
Should keep easily accessible AAT
Protect from light
Should tingle
Use prn (only as needed) can build tolerance
Replace bottle every 6 months
Nitroglycerin: Side Effects
Vasodilate
H/A
Dizziness
Flushing
Hypotension
Before giving nitroglycerin you should
Take blood pressure
If blood pressure is low hold nitroglycerin and
give morphine
