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Nursing 232 > CAD Essentials > Flashcards

CAD Essentials Flashcards

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1
Q

Atherosclerotic heart disease…

What is the effect?

A
  1. Narrows the lumen of the vessel
    Reducing blood flow to the area supplied by the artery
  2. Reduces elasticity
    Making it less resilient in the face of volume or pressure changes.
  3. Increases risk of plaque rupture & subsequent
    clot formation
    with further occlusion & potential embolization
  4. Increases risk of vasospasm
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2
Q

Atherosclerosis risk factors:

A

Non-modifiable:
- Heredity (family Hx of premature CV disease)
- Age
o Men older than 45
o Women older than 55 – postmenopausal
- Race (higher incidence in black)
- Sex (men develop CAD earlier than women)

Modifiable:

  • HTN
  • Hyperlipidemia
  • DM
  • Smoking
  • Stress
  • Obesity
  • Sedentary lifestyle
  • Depression
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3
Q

ACS?

A

Inclues MI, unstable angina, and sudden cardiac death

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4
Q

How far does coronary artery blood flow have to be obstructed before symptoms appear?

A

75%

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5
Q

Under what circumstances does the 02 demand become greater than the 02 supply in the heart?

A

1) Increased workload on the heart in the face of a fixed supply. (eg: hypertension, aortic stenosis, increased metabolic demand)
2. Reduced blood supply to the heart. (eg: atherosclerosis coronary artery vasospasm thrombus/embolus)
3. Reduced oxygen carrying capacity of coronary arteries (anemia, hemodilution, acute blood loss)

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6
Q

How to reduce O2 demand on heart in plan of care for patient experiencing CAD/angina?

A

Rest
Oxygen
Nitrates
Morphine

Beta blockers
Ca channel blockers
ACE Inhibitors/ARB
**Reduce workload of heart

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7
Q

How to inc O2 supply available in care for a patient with CAD/angina?

A

Aspirin 160-325 mg chewed
Fibrinolytics
PCI (Percutaneous Coronary Interventions)
Coronary Artery Bypass

Heparins
Antiplatelets
HMG Coenzyme A Reductase
Inhibitors (Statins)

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8
Q

General actions for management of ischemia?

A

MONA

Morphine
Oxygen
Nitrates
Activity / Aspirin
** NOT necessarily in this order!
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9
Q

What do nitrates do?

A

relax vascular smooth muscle ie arteries (including coronary arteries) but particularly veins…reducing preload and consequently reducing cardiac workload.

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10
Q

Worst case scenario in taking nitrates? How to know? What would you do?

A

Vessels dilate too much and blood pools in periphery&raquo_space; reducing CO
… fill the space with isotonic volume.
headache

adverse effects =
headache, tachycardia, postural hypotension

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11
Q

What does morphine do to help with angina?

A

opiod narcotic analgesic…reducing SNS activity

relaxes vascular smooth muscle, particularly veins…reducing preload
»>consequently reducing cardiac workload.

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12
Q

What is the worst thing that can happen if someone takes morphine? How would you know? What would you do?

A

Vessels dilate too much and blood pools in periphery&raquo_space; reducing CO
Respiratory depression&raquo_space; arrest
»> Naloxone

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13
Q

What do Beta blockers do?

A

reduction in cardiac output (stroke volume) by blocking beta receptors

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14
Q

Worst case scenario with beta blockers? What would you do?

A
  • bradycardia
  • inadequate cardiac output
  • bronchospasm ( in non-selective beta blockers)
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15
Q

What do calcium channel blockers do?

A

relaxation of vessel walls through blocking of calcium ion channels
»> reduce afterload & consequently cardiac workload

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16
Q

Worst case scenario with calcium channel blockers?

A
  • bradycardia (heart block)
  • inadequate cardiac output
  • heart failure
17
Q

Which drug cannot be mixed with grapefruit juice?

A

Ca channel blockers

18
Q

Worst case scenario with ACE inhibitors?

A
  • inadequate cardiac output

- cough (angioedema) from action on vasodilator bradykinins

19
Q

Worst case scenario with aspirin? (ASA)

A

Allergic reaction&raquo_space; antihistamine/epinephrine

bleeding? (not in slides)

20
Q

What does ASA do to aid with ischemic pain/angina/CAD?

A

Anti-inflammatory
Anti-platelet

Reduces mortality by up to 23% (ISIS 2)

21
Q

When are fibrinolytics used for STEMI?

A

For STEMI if /s onset is within 12 hours and PCI is not available within 90 minutes of first medical contact

22
Q

Why to be cautious with fibrinolytics?

A

Dissolves body’s fresh fibrin clots…all of them!! (risk for bleeding of other clots in place post surgery, etc for healing)
&raquo_space;> the diagnosis has to be right!
* Typically delivered in critical care settings

23
Q

What is percutaneous conoary interventions?

A

Ex: putting in stent (angioplasty)

24
Q

LMWH advantages?

A

Less likely to cause thrombocytopenia

Duration of action is 2- 4x’s longer than regular Heparin od vs. bid

LMWH’s produce a more stable response than heparin

Hence, less follow-up lab tests are needed

25
Q

What do antiplatelets do?

A

Reduce platelet aggregation

26
Q

What do Statins do? (HMG Coenzyme A reductase inhibitors)?

A

inhibit cholesterol production

20-40% reduction in LDL, raise HDL levels, and lower triglycerides

27
Q

What is the worst thing that can happen if someone takes statins?

A

liver dysfunction can occur – LFT tests need to be done prior/3months post
Muscle pain, tenderness and weakness – check CPK – Creatinine phosphokinase – may d/c drug
n/v, heartburn, abdominal cramping and diarrhea – give with meal in evening.

28
Q

Diagnostic tests for CAD?

A

-CK
-CK-MB
-Myoglobin
-Troponin I and T (Specific cardiac markers)
-ECG
- Echocardiogram (see EF)
- Stress testing
- Angiogram
-

29
Q

Does Troponin I and T evelate immediately after MI?

A

Enzyme detected 2-6 hrs. after MI, peaks 15-24 hrs, returns to normal within 7 days.

30
Q

ECG

Does this give info about heart damage?

A

Measures the electrical activity of the heart, not the mechanical

Looks at the rhythm of the heart

Can give information of areas of the heart that are damaged (**but NOT best indicator for detecting extent of damage…look at troponin)

Used to help diagnose acute coronary syndrome (ACS)

31
Q

What does an echocardiogram show?

A

Sound waves create an image of the heart in motion to …

1) Evaluate heart wall motion
2) Identify valvular disease
3) Evaluate the heart under stress
4) Identify & quantify pericaridal fluid

**Can see Ejection Fraction

32
Q

What is measured during cardiac stress test?

A

Patients ECG and BP are monitored during exam.

33
Q

WHat is cardiac stress testing done for?

A

Used to evaluate possible heart damage or to evaluate the potential risk of future heart damage

34
Q

Goal in medical management of CAD/angina?

A

to dec O2 demand to heart and inc O2 supply

Nursing 232 (12 decks)

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