CAD/MI Flashcards
Hat are non-modifiable risk factors for CAD?
Age Gender Family Hx Diabetes 1 Ethnicity
Describe the physiology of coronary artery dz.
Coronary risk factors Get fatty streak formation CAD- build up of plaque Plaque rupture- can bleed and cause Platelet aggregation Thrombus If thrombus moves it is an embolism, then goes into lung=PE or brain= stroke
What are the modifiable risks of CAD?
HTN Elevated lipids Tobacco and alcohol Obesity Diabetes 2
What are the three types of angina?
Variant or Prinzmetal’s angina
Chronic stable angina
Unstable angina called Acute Coronary Syndrome
Describe unstable angina (acute coronary syndrome)
Chest pain is new in onset, occurs at rest, or has a worsening pattern
Unpredictable
Easily provoked by minimal or no exertion.
WOMEN
-unusual symptoms of fatigue, SOB, indigestion and anxiety.
What is variant or Prinzmetal’s angina?
Caused by vasospasm. Not caused by plaque blocking vessels.
Vasodilator and is fine. Probably some cardiac dz but not plaque
What is chronic stable angina?
Chest pain that is predictable. Can walk up 1 flight of stairs but know if do 2 will have chest pain. Take a dilator and will be fine.
Acute myocardial infarction is
Area of a wall that dies, if chest pain lasts more than 20 minutes.
Irreversible
What are the clinical manifestations of AMI?
Pain- unless fast death Nausea+ vomiting Diaphoresis- heart working hard SOB- low oxygen to heart muscle Fever - cells go in to clean up dead tissue debris
What is the work up for an AMI?
Hx and Physical exam 12 lead EKG Labs drawn Chest X-ray Coronary angiogram Echocardiogram
How do you decrease the work load of the heart?
Bed rest with bathroom privileges Decrease stress Avoid large meals Avoid valsalva maneuver Medications Avoid extreme temperature changes
How do you increase oxygen supply to heart
Give O2
Aspirin chew -anti platelet
PCI( per cutaneous interventions)/ CABG
Thrombolytics
What do we do for stable angina?
Medications- lipid lowering( statins)
- anti platelet
- beta blocker
- nitroglycerin
Teach regarding management of risk factors to reduce plaque and increase blood flow - slow building activity
- coronary angiography for evaluation
“Elective” coronary revascularization considered
What is done for a acute coronary syndrome/ unstable angina/AMI?
12 lead EKG
O2
Medication
Emergency coronary revascularization
What is the medication therapy for ACS/unstable angina/AMI?
Lipid lowering agents Anti platelet Nitroglycerin Morphine sulphate Beta blockers Calcium channel blockers
In an acute situation what meds will be given?
Anti platelets Nitro Morphine for pain Beta blockers help prevent another- take for at least 6 wks after CCB- help protect kidneys
What is the classification of atorvastatin ( Lipitor) and how does it work?
Decreases lipids
Blocks synthesis of cholesterol…decreases LDL and triglycerides
Side effects of Lipitor or statins?
GI upset- mess with fat breakdown
Change in LFT’s ( fats are metabolized in liver)
Long term muscle weakness and fatigue, don’t go away once it happens
Can potentiate digoxin-can become digtoxic
What are the nursing implications of Statins?
Check LFT’s
Check digoxin levels
Liver does most of its work at night so give in evening
Watch alcohol intake
What is the classification of aspirin (ASA, ECASA), what does it do?
Anti platelet stops aggregation
Side effects of aspirin
Ulcers, bleeding, GI bleeding
Nursing implications with aspirin
Take with food or full glass of water
Check for bleeding
Classification and action of nitroglycerin
Nitrate, fast acting vasodilator, mostly on Coronary arteries as well.
Decreases preload and afterload.
Used with MI, CAD, CHF, angina
Side effects of nitro
Low blood pressure
HA- will go away with time
Postural hypotension
Increased heart rate
Nursing implications for nitro
Can give sublingual-HA and tingling of mouth and tongue
Tablets deteriorate in sunlight…keep in brown bottle and dry.
Take one, wait 5 min call 911, then take a second, third in ambulance if it gets there in time.
Hold if BP < 90
What are nursing implications for transdermal nitro?
Slow release
Don’t put over boney prominence
Rotate sites
Farther away you get from heart, less HA.
What do you do if given nitro IV?
Watch closely, have on continuous EKG
When is nitro contraindicated
BP<90
Taken erectile dysfunction meds for 24 hrs
Classification and use for isosorbide mono nitrate ( Imdur)?
Long acting nitrates
For chronic chest pain,
Vasodilator, decreases afterload, decreases venous return, decreases preload and work load of the heart.
Same thing as nitro but long acting..for chronic
Side effects of isosorbide (Imdur)?
Increased heart rate- volume going through heart is less so it works harder
HA,
Low BP
Nursing implications for isosorbide (Imdur)?
Sit up slowly
Long acting so don’t crush
Take pill in morning
Classification and use of morphing sulphate
Narcotic, Blockes receptors causes vasodilation= decreases afterload and work load of heart #1 choice for pain. Not the first thing you give bcs of CNS depression, RR drops
Side effects of morphine sulfate
CNS depression constipation
Decrease RR
What happens in cath lab?
Goes in left femoral artery, sits in aortic arch where coronary artery is, sits in coronary vessels, injects contrast to see blood flow. Do balloon to open vessel and flatten plaque..temporary….painfull when balloon is enflated. Tell them it is tempory
How do they do a stent?
Put stent over balloon, opens balloon to open cage, then removes ballon. Cage stays open.
What is involved with a CABG?
Take the left mammary artery and sow it to the top of subclavian artery and put in below the area of the blockage to bypass clot.
What are the A,B,C’s of MI?
A-angina, give anti platelets
B-blood pressure-give beta blockers
C-stop cigarettes, decrease cholesterol, give CCB
D- check diabetes, change diet, low fat, low sodium
E- education, exercise
F-flu shot
What do you do if MI and no cath lab?
TPA- clot buster, can’t do anything after…bleeding
