CAD and Acute Coronary Syndromes Flashcards
What is Coronary Heart Disease?
- CAD occurs if plaque builds up in the coronary arteries reducing blood flow to the tissues of the heart
- This can lead progressively to ischemia, angina, and infarction of cardiac tissues
What is Acute Coronary Disease (ACD)?
It is a type of ischemic heart disease that has progressed to unstable angina and MI
What is Angina Pectoris?
General term for angina – chest pain
What are the characteristics of Stable Angina?
- Occurs usually during physical exertion
- Episodes of predictable pain tend to be alike
- Usually lasts a short time (5 minutes or less)
- Is relieved by rest or medicine (nitro)
- May feel like chest pain that spreads to the arms, back, or other areas
Outside of physical exertion, what are some other triggers of Stable Angina?
- Emotional stress
- Excessive hot or cold temperatures
- Heavy meals
- Smoking
How does nitroglycerin relive angina?
- relaxes the coronary arteries and other blood vessels,
- reducing the amount of blood that returns to the heart and
- easing the heart’s workload
- By relaxing the coronary arteries, it increases the heart’s blood supply
What are the key points to remember about nitro administration?
- Sublingual to dissolve
- Take every 5mins for 3x’s if not effective, call 911
- Takes 5mins to fully absorb, so don’t spit, rinse or drink while taking
What is Unstable Angina?
- Unexpected, unpredictable chest pain
- Can occur while resting (typically) or active
- Should be treated as an emergency!
What are the s/s of Unstable Angina?
- Often occurs at rest, sleeping, or with little physical exertion
- May last longer than stable angina
- Rest or medicine usually do not help relieve it
- May get progressively worse and lead to MI
Explain the conservative and aggressive treatment for Unstable Angina.
- Conservative
- Lovenox (low dose anticoag)
- Aggressive
- Cardiac catheterization
What are the two types of MI?
- ST- elevation (STEMI)
- Non ST-elevation (NSTEMI)
What is indicated by a STEMI MI?
the artery supplying an area of the heart muscle is completely blocked
What is indicated by a NSTEMI MI?
- the artery is only partly blocked, so only part of the heart muscle supplied by the affected artery is affected
- (NSTEMI can also include unstable angina)
What provides the definitive dx for MI?
EKG
S/S of MI?
- Severe angina/heavy pressure feeling – can last from minutes to hours
- Diaphoresis, nausea, feel faint
- SOB
If a client is having chest pain, what may indicate that it is not angina?
- The pain fluctuates w/ breathing.
- This would indicate pleuritic pain from breathing, not angina
- Angina is not affected by breathing
True or False
It is possible to have a normal ECG even if you have had an MI
True
Besides an EKG, what else would we test for positive MI indication?
Troponin and CK levels
What are the key points to remember regarding the levels of Troponin?
- Definitive test for MI
- Not normally in blood, Released during MI
- Level of troponin increases w/in 4-6hrs after onset of chest pain
- Peaks at 10-24hrs
- Returns to normal level over 10-14days
What are the 3 types of Creatine Kinase (CK)?
- mm (found in skeletal muscle)
- MB (found in cardiac muscle) and
- BB (found in brain tissue)
What are the key points to remember regarding levels of CKMB?
- After cardiac injury, CK and the isoenzyme MB are released into the blood stream at a predictable rate.
- Within a 4 to 6 hour window (post injury) the CKMB level rises above normal and within 24 to 36 hours this level elevates to approximately 5 to 15 times normal
- Within 2 to 3 days the CKMB returns to normal.
- Definitive test for MI
Why do we send for Troponin levels before CKMB?
Trop labs have a faster turnaround
What is the progression of MI treatment?
O2 ➝ Aspirin ➝ Nitro ➝ Morphine
Why does giving Beta blockers and ACE inhibitors help w/ MI?
They help decrease afterload thus the heart doesn’t have to work so hard to get blood to the system
How do morphine and nitro help w/ MI?
They are potent vasodilators which allow more blood to flow, decreasing O2 demand
True or False
Heparin (anticoags) are given to break clots up.
False
They are given to PREVENT clotting
What is the potential danger of nitro use?
hypotension
What is the nursing responsibility regarding admin of nitro?
- Check blood pressure and pulse before each administration of NTG–blood pressure can drop precipitously after a single dose.
- Hold dose if systolic BP < 90 or more than 30 below baseline.
- How is pt responding/tolerating to medication
- Document
- Acetaminophen is generally given PO for relief of headache secondary to NTG therapy
- NOT PROPHYLACTICALLY
What is PTCA – Percutaneous transmural coronary angioplasty?
revascularization procedure that is used to increase the diameter of an artery that has been stenosed due to coronary artery disease
What is required prior to PCTA?
- PTCA - is invasive, needs consent.
- Signed by Pt, Physician, and RN who witnessed consent
What are our Nursing responsibilities during PTCA?
- Monitoring vitals, I/O’s?
- Watch urine OP for signs of blood (Foley catheter needs to be in place to do so)
- Look for any visual signs of bleeding. (IV, skin penetration sites, nose bleeds etc)
- Watching for any signs of embolism
- Observing for pt tolerance of procedure
What are Nursing Responsibilities for f/u care of PTCA?
- Check site for bleeding
- Check for movement
- Check for perfusion
- Check erythema at penetration sites
- Check for inflammatory responses (normal and abnormal)
ACE inhibitors and Calcium channel blockers help…
relax vessels and manage vasoconstriction
What is the purpose of administering fibrinolytics for thrombolytic therapy?
To dissolve thrombi and restore myocardial blood flow
What are the Contraindications to Thrombolytic Therapy?
- Previous intracranial hemorrhage.
- Known structural cerebral vascular lesion.
- Ischemic stroke within 3 months
- Face or and head trauma within 3 months
- Recent internal bleeding
- Current use of anticoagulants
What is PTT?
Partial thromboplastin time (PTT) test measures the time it takes for a blood clot to form.
What is PT?
Prothrombin time (PT) is a blood test that measures the time it takes for the liquid portion (plasma) of your blood to clot
What is INR?
The international normalized ratio (INR) is a calculation based on results of a PT and is used to monitor individuals who are being treated with the blood-thinning medication
What is monitored for use of Heparin, PT, PTT, or INR?
PTT
What is monitored for use of Warfarin/Coumadin, PT, PTT, or INR?
PT and INR
What are the dangers for clotting times that are too short or too long?
- Too short = quick clotting = @risk for clots; stroke, DVT, PE, etc
- Too long = slow clotting = @risk for bleeding out
What methods of administration are used for Heparin?
IV or SubQ ONLY
True or False
PTs are sent home w/ a prescription for Heparin.
- FALSE
- If needed, they are sent home w/ a script for PO WARFARIN/COUMADIN or Lovenox
True or False
Lovenox requires a PTT test.
- False
- Lovenox reqs no blood work for script
What is to be kept in mind it a PT is on Heparin while in the hospital and will be given a script for Warfarin/Coumadin when discharged?
Start Warfarin prior to discharge to give it time to work and then cut off heparin when PT sent home.
What is an Atherectomy?
procedure to remove plaque from an artery (blood vessel).
What is a Rheolytic thrombectomy?
a minimally invasive procedure to break up blood clots.
What is the PT education at discharge for a PT that had a MI?
Self monitor for
- Chest pain
- Types and actions
- Nitro
- How to take and physical position when doing so
- HCP
- When to contact
- ED
- When to hit the emergency dept
- Appropriate edu on specific meds
