CAD/Angina (Module 4) Flashcards
CAD Patho
impaired blood flow through coronary arteries most commonly by arethomas
atherosclerosis (usually occurs at points of turbulence aka vessel bifurcation)
plaque grows, blood vessel narrows, not enough oxygenation blood gets to the heart
Angina Pectoris
pain varies ranging from vague to crushing (sometimes may present as pressure, gas, or bloating)
substernal but may radiate to shoulder blade, arm or jaw
women and elderly may present atypically (malaise, SOB, anxiety and fatigue)
1 Modifiable Risk of CAD Is…
SMOKING
(and diabetes)
Nonmodifiable Risk Factors of CAD
age
genetics and ethnic background
male gender
CAD Labs
troponins (indicate heart tissue death)
homocysteine (>17)
highly sensitive C-reactive protein (hsCRP): inflammation marker but not specific to cardiac (>0.175 mg/L)
Unstable Angina
crescendo or rest angina (new onset)
acute coronary syndrome manifestation (may progress to MI)
typically due to unstable atherosclerosis plaque rupture
pain refractory to nitroglycerin
Stable Angina
exertional angina (5-15 min)
typically due to a stable but tight obstructive coronary artery stenosis
relived by rest or nitroglycerin
Prinzmetal Variant Angina
rest/nocturnal angina
due to coronary artery spasm
triggered by smoking and increased lvls of some substances like histamine
Decubitus Angina
angina when laying down
typically due to left ventricular dysfunction resulting in redistribution of pulmonary fluids and thus increased CO
Silent Ischemia
absence of angina in presence of documented ischemia
may occur with coronary artery or microvascular dysfunction
Syndrome X Angina
includes classical syndrome X, microvascular angina, coronary slow flow phenomenon
prolonged episodes of exertional or rest angina
typically due to coronary microvascular dysfunction
Microvascular Angina
MI secondary to microvascular disease affecting small distal branches of coronary arteries
more common in women; triggered by ADLs and treatment may include nitroglycerin
CAD Diagnostics and Procedures
ECG
Stress Testing
multislice helical computed tomography (CT) or positron-emission tomography (PET) (gold standard to determine myocardial perfusion or assess LV function)
cardiac catheterization with angiography
percutaneous coronary intervention (PCI)
Stress Testing
treadmill/bike: exercise to stress the heart and look for symptoms of decreased perfusion
pharmocologic: uses dobutamine (increases contractility) or dipyridamole (coronary artery dilator) to stress heart
Right Heart Cath
fem vein
IVC or R basilic vein
SVC
R atrium
R ventricle
pulm artery to assess lung pressures
Left Heart Cath
fem
brachial or radial artery (most common)
aorta
aortic valve
L ventricle (stroke volume, EF)
Coronary Arteriography
entry same as L heart cath
aortic arch
L/R coronary artery
Pre-Procedure Considerations
look for consent, check for metformin use or allergies to iodine/shellfish (contrast medium)
assess baseline nuerovascular assessment, heart and breath sounds and vitals
conscious sedation: may feel flushing/warmth when dye is injected
Neurovascular Assessment P’s
Pain
Pulse
Paralysis
Pallor
Parasthesia
Pressure
Post Procedure Considerations
sheath removal: bedrest, keep extremely straight
Post Procedure Complications
contrast-induced renal dysfunction leads to more fluids to flush out contrast; monitor BUN/creatinine, O
hematoma/bleeding: assessment compare to baseline and catheter insertion site, pulses distal to insertion site, any pulse is ok as long as it’s felt; bruising is normal, but ones that get larger are a problem (circle bruise to monitor)
restenosis leads to dysrhythmias, CP leads to cardiac monitor
pt education re:discharge meds
Percutaneous Coronary Intervention (PCI)
balloon angioplasty: balloon inflated to open artery
intracoronary stent placement: stent deployed to keep artery open
Meds (Nitrates)
potent vasodilator; lowers preload and afterload (watch BP and orthostatic changes)
don’t administer to pts taking drugs used to treat sexual dysfunction
check expiration date because efficacy decreases over time and should be replaced every 3-5 months
Transdermal Nitroglycerin
minitran, nitro dur, nitrek
apply patch to a clean, dry, hairless area because med will be better absorbed
rotate application sites to prevent irritation
remove patch before defibrillation to prevent burns
remove patch after 12-14 hrs each day to prevent drug tolerance
HA common; hypotension and dizziness ADE; lie or sit down to avoid fainting
Sublingual Nitroglycerin
teach pt to carry NTG at all times
keep tablets in glass light resistant container
replace every 3-5 months
Management of Chest Pain at Home
keep fresh nitroglycerin available for immediate use
place one nitroglycerin tablet or spray under your tongue, allowing it to dissolve
repeat nitroglycerin and wait 5 more minutes while waiting for EMS
Beta Blockers
lowers HR (monitor!!); indirectly lowers BP, contractility and CO
don’t administer is HR is <50-60 BPM
hold for systolic <90-100 mmHg
observe for HF signs like cough, edema, SOB, weight gain
assess for wheezing and SOB because can cause bronchoconstriction
NEVER STOP ABRUPTLY; CAN CAUSE REBOUND HTN
Calcium Channel Blockers
low HR! non-DHP
lowers contractility, lowers afterload BP
orthostatic hypotension
Antiplatelets
aspirin (ecotrin, asaphen)
p2y12 inhibitors (clopidogrel (Plavix), prasugrel (Effient))
inform pts to report any unusual bleeding or bruising because bleeding is a SE
Statins (Simvastatin (Zocor))
reduce cholesterol synthesis in the liver and increase clearance of LDL-C from blood
CI in pts with liver disease because can cause muscle myopathies and marked decreases in function
discontinued if pts have muscle cramping or elevated liver enzymes
AVOID GRAPEFRUIT
Prevention of CAD Self-Management
statins
avoid all animal-based foods like milk, eggs, and cheeses to lower cholesterol
