CAD, STEMI, NSTEMI, UA Flashcards
risk factors for coronary artery disease
non-modifiable:
- age
- gender
- post-menopausal
- ethnicity
- family hx
modifiable:
- DM
- HTN
- HDL
- metabolic syndrome
- obesity
- smoking
- inactivity
- alcohol/drugs
stable angina vs unstable angina
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
signs and symptoms of coronary artery disease
- chest pain/discomfort
- nausea/vomiting
- dizziness
- SOB
- diaphoresis
- dysrhythmias
- other: fatigue, epigastric pain, jaw pain, syncope, confusion
S/Sx & Dx unstable angina
- chest pain
- negative biomarkers
- stress test
- perfusion test
- angiogram
- angiography
treatment of unstable angina
- antiplatelet therapy (clopidogrel)
- ACEIs (lisinopril)
- beta blockers (metoprolol)
- oxygen
- nitroglycerin or morphine sulfate
- aspirin
- d/c NSAIDs
- statins
NSTEMI
severe occlusion with proximal ischemia
S/Sx & Dx NSTEMI
- chest pain
- positive biomarkers (CKMB+Troponin)
- ECG - ST depression or no change; little to no arrhythmia
- stress test
- perfusion test
- angiogram
- angiograph
NSTEMI Tx
- antiplatelet therapy (clopidogrel)
- aspirin
- nitroglycerin or morphine sulfate
- oxygen
- ACEIs (lisinopril)
- beta blocker (metoprolol)
- d/c NSAIDs
- statins
side effects of clopidogrel
- rash
- GI upset
- diarrhea
- pruritis
- bleeding
side effects of epitifibatide
bleeding
S/Sx & Dx STEMI
- chest pain
- positive biomarkers
- ECG - ST elevation, arrhythmia, hyperacute T waves, Q wave
- hemodynamic instability
STEMI complications
- dysrhythmias
- LT heart failure
- ventricular aneurysm, rupture
- cardiogenic shock
STEMI treatment
- PCI reperfusion
nursing interventions for PCI procedure
- preop education, consent, reassurance
- stabilize patient hemodynamically
- monitor O2, hemodynamics, telemetry
- assess response to medications
- assess for and prevent bleeding
- post-op follow up care
- no MRI for >8 weeks
- home med regimen
- no bleeding at the hip for >6 hours
signs of reperfusion after STEMI
- relief of chest pain
- no more ST elevation
- rapid increase in biomarkers (wash-out)
complications of PCI
- stent thrombosis -> CAD, stroke, late stent thrombosis
- late restensosis
- hematoma
- retroperitoneal hematoma
- vasovagal reaction
- contract induced nephropathy
- dissection of surgical site
- perforation of coronary artery
- cardiac tamponade
- allergy to contrast
- left heart failure
S/Sx retroperitoneal hematoma
- abdomen distention
- flank pain
- hypotention
interventions for retroperitoneal hematoma
- notify cardiologist
- obtain labs
- CT abd/pelvis
- blood transfusion
interventions for vasovagal reactions
- give fluids
- trendelenburg
- atropine
S/Sx and interventions contrast-induced nephropathy
S/Sx: hyponatremia
Tx: acetylcysteine (mucomyst) + dialysis
