CAD, MI, angina

Question 1

coronary artery disease (CAD)

Answer 1

• chronic endothelial injury d/t hypertension, tobacco use, hyperlipidemia, infections, diabetes
• fatty streak occurs when lipids accumulate and migrate into smooth muscle cells
• collagen covers fatty streak causing lumen to narrow
• plaque can rupture which causes thrombus formation

Question 2

developmental stages of CAD

Answer 2

• fatty streak
• fibrous plaque
• complicated lesion
• collateral circulation

Question 3

non-modifiable risk factors of CAD

Answer 3

• age
• sex
• ethnicity
• family history
• genetics

Question 4

modifiable risk factors for CAD

Answer 4

• elevated serum lipid levels
• elevated BP
• tobacco use
• physical inactivity
• obesity
• diabetes
• elevated blood glucose
• psychosocial (stress levels, occupation, etc.)
• substance use

Question 5

nursing management for CAD

Answer 5

• health promotion
• nutritional therapy
• cholesterol-lowering medication therapy (statins, fibrates)

Question 6

saturated fats (use sparingly)

Answer 6

• animal fat (bacon, egg, yolk)
• some oils (coconut, palm)
• butter
• cream cheese
• sour cream

Question 7

monosaturated fats

Answer 7

• fish oil
• some oils (canola, peanut, olive)
• avocado
• nuts (almonds, peanuts)
• olives

Question 8

polysaturated fats (use primarily)

Answer 8

• vegetable oils (corn, soybean, cottonseed, flaxseed)
• some fish oil
• some nuts (walnuts)
• seeds (pumpkin, sunflower)
• margarine

Question 9

chronic stable angina

Answer 9

• primary reason is atherosclerosis
• myocardium becomes hypoxic within 10 seconds
• with total occlusion, contractility ceases after several minutes
• anaerobic metabolism begins causing the accumulation of lactic acid which causes cardiac pain

Question 10

signs of chronic stable angina

Answer 10

• chest pain intermittently over a long period with same pattern of onset, duration, and intensity
• may be no pain
• indigestion or burning in epigastric region

Question 11

short acting nitrates - medications for angina

Answer 11

• nitro
• relives pain within 3 minutes
• duration of action is 30-60 minutes
• if unchanged after 5 minutes patient should call EMS
• side effects; increased HR, headache, dizziness, orthostatic hypotension
• teach to not change positions quickly after taking nitro
• patient should feel a tingling sensation in their mouth when nitro is administered

Question 12

long acting nitrates - medications for angina

Answer 12

• transdermal controlled-release nitrates
• reduce incidence of anginal attacks
• predominant side effect is headaches due to dilation of cerebral blood vessels
• orthostatic hypotension
• tolerance to nitrates can develop

Question 13

dx chronic stable angina

Answer 13

• history
• physical (heart murmurs, BP, how are they perfusing, edema)
• ECG, chest radiograph
• exercise stress test
• echocardiogram
• CT, PET
• coronary angiography
• labs – lytes, BUN, creatinine, FBG, HbA1C, PTT, aPTT, PT, INR, CBC, lipid profile

Question 14

acute coronary syndrome

Answer 14

• develop when myocardial ischemia is prolonged
• NSTEMI, STEMI
• associated with deterioration of atherosclerotic plaque
• plaque ruptures exposing intima to blood and stimulating platelet aggregation and local vasoconstriction
• may partially occluded by a thrombus (NSTEMI) or totally occluded by a thrombus (STEMI)

Question 15

unstable angina

Answer 15

• chest pain with new onset, occurs at rest or ha worsening pattern
• unpredictable
• emergency

Question 16

MI

Answer 16

• result of sustained ischemia causing irreversible myocardial cell death
• secondary to thrombus formation

Question 17

MI CM

Answer 17

• pain
• sympathetic nervous system stimulation
• cardiovascular manifestations
• n&v
• fever
• complications; dysrhythmias, heart failure, cardiogenic shock

Question 18

dx unstable angina and MI

Answer 18

• ECG
• serum cardiac markers – troponin, CK
• coronary angiography

Question 19

management of acute coronary syndrome

Answer 19

• rapid diagnosis to prevent cardiac muscle
• establish IV
• sublingual nitro
• morphine for pain
• O2 2-4 L/min
• transfer to CCU
• monitor vitals
• bed rest for 12-24 hour
• anticoagulants/antiplatelet in case of UA or NSTEMI
• PCI or thrombolytic therapy

Question 20

aspirin and CAD

Answer 20

• prevents platelet activation and reduces incidence of MI and death
• dose: 160-325mg when diagnosis is made then 81-325 mg QD
• can be taken if already on NSAIDS
• may need proton pump inhibitor (omeprazole) prescribed to prevent GI issues

Question 21

heparin

Answer 21

• prevents formation of new clots
• use with unstable angina to reduce risk of MI
• bolus IV then continuous infusion: dose based on result of aPTT
• bleeding precautions

Question 22

coronary surgical revascularization

Answer 22

• coronary artery bypass graft: minimally invasive, off-pump coronary artery
• trans myocardial laser revascularization