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NUR5002 > Cardiovascular system > Flashcards

Cardiovascular system Flashcards

1
Q

Pathophysiology of coronary artery disease

A
  1. Chronic endothelial injury due to HTN, diabetes, tobacco use etc.
  2. Fatty streak formation - lipids accumulate into smooth muscle cells
  3. Fibrous plaque - collagen covers the fatty streak leading to reduced blood flow due to narrowed lumen
  4. Complicated lesion - plaque rupture, thrombus formation or total occlusion of the vessel
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2
Q

Coronary artery disease non-modifiable risk factors

A

Age
Gender (men>women until 60)
Ethnicity
Genetic predisposition and family history

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3
Q

Coronary artery disease modifiable risk factors

A

Serum lipids: elevated triglycerides and LDL, decreased HDL
HTN
Tobacco use
Physical inactivity
Obesity

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4
Q

Coronary artery disease contributing modifiable risk factors

A

Diabetes mellitus
Fasting blood sugar > 6.4mmol/L
Psychological states
Homocysteine levels

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5
Q

Nursing management of coronary artery disease

A

Monitor blood pressure, heart rate and respirations every 5 minutes during anginal attack
Maintain continuous ECG monitoring
Pain assessment
Cardiac and resp assessments

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6
Q

Coronary artery disease diagnostic test

A

Cardiac CT scan

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7
Q

Prevention of coronary artery disease

A

Nutrition: eat more plant-based
Exercise: at least 150 mins of moderate intensity or 75 of vigorous activity each week
Tobacco: quit
Social determinants: housing, food security, transportation, self-image and culture
Aspirin: risk of bleeding

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8
Q

Pathophysiology of angina

A

When the demand for myocardial oxygen exceeds the ability of the coronary arteries to supply the heart with oxygen, myocardial ischaemia occurs
Angina is the clinical manifestation of reversible myocardial ischaemia

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9
Q

Stable versus unstable angina

A

Stable angina is chest pain that occurs intermittently with the same pattern of onset, duration and intensity of symptoms.
Unstable angina is chest pain that is new in onset or has a worsening pattern.
Stable angina usually occurs on exertion, while unstable angina can occur at rest.
Stable angina usually lasts for 3-5 minutes, while unstable angina is unpredictable and is an emergency.

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10
Q

What are the 3 conditions included in acute coronary syndrome?

A
  1. Unstable angina
  2. Non-ST elevation myocardial infarction
  3. ST elevation myocardial infarction
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11
Q

Acute coronary syndrome symptoms

A

Central chest pain
Pain may spread to back, jaw, shoulder, arm
Abdominal pain
SOB, sweating, nausea, palpitations and fainting

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12
Q

Acute coronary syndrome risk factors

A

Age
Family history
Smoking
Diabetes
HTN
High cholesterol
Obesity
Sedentary lifestyle
Unhealthy diets
Psychosocial stress

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13
Q

Acute coronary artery causes

A
  1. Formation of a blood clot in an artery already narrowed by an atherosclerotic plaque
  2. Coronary artery embolism
  3. Coronary spasm
  4. Coronary artery dissection
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14
Q

Which two markers are present in cardiac ischaemia?

A
  1. Troponin
  2. Creatine kinase
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15
Q

How do troponin levels indicate ischaemia?

A

Troponin is released into the bloodstream upon death of cardiac myocytes, occurs within 6 hours.
The amount of troponin is proportional to infarct size

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16
Q

ECG changes in unstable angina

A

Usually normal ECG. Sometimes transient ST depression

17
Q

ECG changes in NSTEMI

A

ST depression
T-wave inversion
ST depression + T-wave inversion

18
Q

ECG changes in STEMI

A

ST elevation
ST depression is opposite ECG leads

19
Q

Which acute coronary syndromes cause increased troponin levels?

A

NSTEMI and STEMI as cardiac cell death occurs

20
Q

Where is the infarction in a NSTEMI?

A

Limited to the inner layer of the ventricular wall

21
Q

Where is the infarction in a STEMI?

A

Extends the entire thickness of the myocardium

22
Q

Interventions for suspected acute coronary syndrome

A
  1. Antiplatelets (aspirin)
  2. Angina medications (GTN)
  3. Supplemental oxygen if required (only if hypoxic)
23
Q

Interventions for confirmed acute coronary syndrome

A
  1. Anticoagulants
  2. Beta blockers
  3. ACE inhibitors
  4. Statins
24
Q

STEMI interventions

A

Emergency (<90mins) percutaneous coronary intervention (PCI) to restore blood flow
If PCI is not available, fibrinolytic therapy is done
Coronary artery bypass graft (CABG)

25
Q

Unstable angina and NSTEMI interventions

A
  • An angiography to identify the site of blockage may be done within 24-48 hours if the pt is clinically stable
  • Done immediately if unstable
  • Fibrinolytic therapies are not indicated for NSTEMI patients
26
Q

What is atrial fibrillation?

A

An irregular heartbeat caused by electrical signals misfiring in the wrong place resulting in irregular contraction of the atria

27
Q

What are the three types of AF?

A

Paroxysmal
Persistant
Permanent

28
Q

AF symptoms

A

Uneven, flopping or racing heart beat
Light headedness
Dizziness
SOB
Fatigue
Chest pain
Palpitations
May not be any symptoms

29
Q

What are the three consequences of AF?

A

Remodelling
- AF can change the size or shape of the heart causing permanent changes
Stroke
- Blood can collect in the atria, forming a clot
Fatigue

30
Q

AF management

A
  1. Stroke prevention
  2. Rate control
  3. Maintenance of normal rhythm
31
Q

What BP indicates HTN?

A

≥140/90

32
Q

Primary HTN

A

Elevated BP with no identified cause

33
Q

Secondary HTN

A

Elevated BP from an identified cause, eg. renal disease

34
Q

Cardiac output formula

A

CO = HR x SV

35
Q

Which four body systems affect BP?

A
  1. Cardiovascular
  2. Endocrine
  3. Renal
  4. Nervous
36
Q

Factors that affect BP

A
  1. Blood volume
  2. Elasticity of blood vessels
  3. Health and age
  4. Strength of heartbeat
37
Q

Nursing considerations of heart failure

A

Fluid restriction, FBC and DW
Monitor vitals
Respiratory assessment
Monitor oedema

NUR5002 (4 decks)

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