ch 33 coronary artery disease and acute coronary syndrome Flashcards
nonmodifiable risk factors for CAD (4)
- increasing age
- gender (most = middle aged men)
- ethnicity (white)
- genetic predisposition and family history
modifiable risk factors for CAD (9)
- increased serum lipids (diet and exercise)
- smoking
- obesity
- metabolic syndrome
- HTN
- physical immobility
- diabetes
- psychologic states
- hemocysteine level
examples of beginning injuries that cause atherosclerosis (3)
- HTN
- T2 DM
- smoking
recommended HDL levels for male and female
M >40
F>50
HDL levels that indicate low risk CAD
> 60
HDL levels that indicate high risk CAD
<40
recommended LDL levels
<100
LDL levels that indicate moderate risk CAD
130-159
LDL levels that indicate high risk CAD
> 160
first line meds for high cholesterol
antihyperlipidemics (statins)
purpose of statins (2)
lowers cholesterol
lowers risk MI and stroke
what should you monitor in pts on statins
liver enzymes (creatinine)
common side effects of statins
muscle soreness/aches
complication of statins
rhabdomylosis: breakdown of skeletal muscle, leads to renal failure
med: cholesterol absorption inhibitor
inhibits absorption cholesterol in GI
side effect: diarrhea
ezetimibe
side effect of niacin and how to prevent it
severe facial flushing after taking
-prevent: take 81 mg aspirin 30 mins before
med that reduces triglyceride levels (fibrates)
fenofibrate
med that inhibits absorption cholesterol in intestines (bile acid sequestrant). usually given to prevent diarrhea after cholecystectomy
cholestyramine
2 alternative therapies for treating high LDLs
high doses garlic
red yeast rice
what should you watch for with pt taking high doses garlic supplements
increased bleeding time
lack of bloodflow to area of heart, demand O2>supply
ischemia
what diseases are associated with silent ischemia (2)
- HTN
- T2 DM
2 types angina
- chronic stable
- unstable
intermittent chest pain with exertion over period of time in predictable fashion, relieved with rest
- more likely in men
- at risk for MI
chronic stable angina
new onset chest pain that occurs at rest or with increasing frequency/duration
unstable angina
what med treats chest pain when it occurs in chronic stable angina
nitroglycerin (short acting nitrate)
what med prevents chest pain with chronic stable angina
nitroglycerin ointment or patch
isordil (long acting nitrates)
what meds can you give for chronic stable angina
- nitroglycerin
- nitroglycerin ointment/patch
- b blocker (slows HR)
- calcium channel blocker (slows HR)
- ACE inhibitor (lowers bp)
what should you educate pts about when taking nitroglycerin for chronic stable angina (6)
- take with 1st signs angina
- if 1st dose doesn’t help, call 911 before taking 2nd dose
- keep med in vial bc sunlight breaks it down
- replace q6months
- put paste on upper chest
- only wear patch during day
type of angina not due to atherosclerosis
caused by coronary artery spasms causing decreased bloodflow, usually during sleep
prinzmetals angina
treatment prinzmetals angina
calcium channel blockers
diagnostic options for coronary artery disease (2)
- ECG
- stress test
what med should you hold before stress test for CAD
b blocker
what meds can be given instead of running for stress test to diagnose CAD (2)
dobutamine
lexiscan
2 ways to prevent MI with diagnosis of CAD after stress test
- cardiac catheterization
- percutaneous coronary intervention (balloon or stent)
preop nursing considerations for cardiac cath (4)
- NPO 8 hrs before
- hold ED meds 48 hrs before
- clip hair at site
- check allergies: shellfish (if DM hold metformin)
postop nursing considerations for cardiac cath
AT HIGH RISK FOR MAJOR BLEED
- sandbags, pressure dressing, or c-clamp on femoral site
- assess site for bleeding q15 mins
- assess VS q15 mins for 1st hour
2 types acute coronary syndrome
- ST-elevation MI (STEMI)
- non-ST-elevation MI (NSTEMI)
what is acute coronary syndrome
MI
difference between STEMI and NSTEMI
STEMI: 100% occlusion coronary artery
NSTEMI: significant blockage but <100%
3 areas of damage after MI
- area of infarction (irreversible)
- area of injury
- area of ischemia
S+S unstable angina (ACS) (6)
- new/change in/worsening of chest pain
- chest pain at rest
- SNS response: increased HR and bp
- S3 and S4 heart sounds
- N/V
- fever, fatigue, sweating
how does scar tissue affect heart after MI healing
dysrhythmias and decreased cardiac output
scar tissue doesn’t conduct impulses or contract the same
complications of MI
- dysrhythmias
- HF
- cardiogenic shock (severe hypotension)
- papillary muscle dysfunction (heart valves don’t work)
- ventricular aneurysm (bulge and rupture of ventricle)
- acute pericarditis (dressler syndrome: 6 weeks after MI)
diagnosis of unstable angina and MI (3)
- ECG
- cardiac markers (CK-MB)
- if normal cardiac markers, exercise stress test
what is included in CK-MB
- creatine kinase (peaks late in MI)
- troponin T + I (peaks early in MI)
emergency management unstable angina/MI
(MONA) Morphine O2 Nitroglycerin Aspirin (325 mg, CHEW)
3 treatment options unstable angina/MI
- fibrinolytic therapy
- coronary artery bypass graft (CABG)
- percutaneous coronary intervention (stent or balloon)
what are pts high risk for after CABG (2)
- dysrhythmias
- tamponade
meds for acute ACS
- antiplatelet (aspirin) or clopidogrel (plavix)
- nitroglycerin
- morphine
meds for post MI
- b blocker
- ACE/ARB
- antidysrhythmic drug
- statin
- stool softeners
nutrition considerations for post MI pt (3)
- low salt
- low sat fat
- low cholesterol
what can aspirin toxicity cause (2)
tinnitus
reyes syndrome in children <12
risk factors for sudden cardiac death (SCD) (7)
- smoking
- HTN
- DM
- family history
- cardiomyopathy (in peds patients)
- hypercholesteremia
- coronary artery disease
causes stable angina (8)
- physical exertion
- temperature extremes
- strong emotions
- consumption of heavy meals
- smoking
- sexual activity
- stimulants
- circadian rhythm patterns (morning)
