CAD, STEMI, NSTEMI, UA

Question 1

risk factors for coronary artery disease

Answer 1

non-modifiable:
- age
- gender
- post-menopausal
- ethnicity
- family hx
modifiable:
- DM
- HTN
- HDL
- metabolic syndrome
- obesity
- smoking
- inactivity
- alcohol/drugs

Question 2

stable angina vs unstable angina

Answer 2

stable angina is relieved with rest and 1-2 doses of nitroglycerin, while unstable angina is not relieved by rest, requires higher doses of nitroglycerin, and worsens even at rest. Unstable angina is due to partial occlusion without ischemia

Question 3

signs and symptoms of coronary artery disease

Answer 3

• chest pain/discomfort
• nausea/vomiting
• dizziness
• SOB
• diaphoresis
• dysrhythmias
• other: fatigue, epigastric pain, jaw pain, syncope, confusion

Question 4

S/Sx & Dx unstable angina

Answer 4

1. chest pain
2. negative biomarkers
3. stress test
4. perfusion test
5. angiogram
6. angiography

Question 5

treatment of unstable angina

Answer 5

1. antiplatelet therapy (clopidogrel)
2. ACEIs (lisinopril)
3. beta blockers (metoprolol)
4. oxygen
5. nitroglycerin or morphine sulfate
6. aspirin
7. d/c NSAIDs
8. statins

Question 6

NSTEMI

Answer 6

severe occlusion with proximal ischemia

Question 7

S/Sx & Dx NSTEMI

Answer 7

• chest pain
• positive biomarkers (CKMB+Troponin)
• ECG - ST depression or no change; little to no arrhythmia
• stress test
• perfusion test
• angiogram
• angiograph

Question 8

NSTEMI Tx

Answer 8

1. antiplatelet therapy (clopidogrel)
2. aspirin
3. nitroglycerin or morphine sulfate
4. oxygen
5. ACEIs (lisinopril)
6. beta blocker (metoprolol)
7. d/c NSAIDs
8. statins

Question 9

side effects of clopidogrel

Answer 9

1. rash
2. GI upset
3. diarrhea
4. pruritis
5. bleeding

Question 10

side effects of epitifibatide

Answer 10

bleeding

Question 11

S/Sx & Dx STEMI

Answer 11

1. chest pain
2. positive biomarkers
3. ECG - ST elevation, arrhythmia, hyperacute T waves, Q wave
4. hemodynamic instability

Question 12

STEMI complications

Answer 12

1. dysrhythmias
2. LT heart failure
3. ventricular aneurysm, rupture
4. cardiogenic shock

Question 13

STEMI treatment

Answer 13

1. PCI reperfusion

Question 14

nursing interventions for PCI procedure

Answer 14

1. preop education, consent, reassurance
2. stabilize patient hemodynamically
3. monitor O2, hemodynamics, telemetry
4. assess response to medications
5. assess for and prevent bleeding
6. post-op follow up care
7. no MRI for >8 weeks
8. home med regimen
9. no bleeding at the hip for >6 hours

Question 15

signs of reperfusion after STEMI

Answer 15

1. relief of chest pain
2. no more ST elevation
3. rapid increase in biomarkers (wash-out)

Question 16

complications of PCI

Answer 16

1. stent thrombosis -> CAD, stroke, late stent thrombosis
2. late restensosis
3. hematoma
4. retroperitoneal hematoma
5. vasovagal reaction
6. contract induced nephropathy
7. dissection of surgical site
8. perforation of coronary artery
9. cardiac tamponade
10. allergy to contrast
11. left heart failure

Question 17

S/Sx retroperitoneal hematoma

Answer 17

1. abdomen distention
2. flank pain
3. hypotention

Question 18

interventions for retroperitoneal hematoma

Answer 18

1. notify cardiologist
2. obtain labs
3. CT abd/pelvis
4. blood transfusion

Question 19

interventions for vasovagal reactions

Answer 19

1. give fluids
2. trendelenburg
3. atropine

Question 20

S/Sx and interventions contrast-induced nephropathy

Answer 20

S/Sx: hyponatremia
Tx: acetylcysteine (mucomyst) + dialysis