chapter 13 exam 3 Flashcards
recognize risk factors for atherosclerotic development
non-modifiable: age, sex, ethnicity, family hx
modifiable: diabetes mellitus and pre-diabetes, HTN, smoking, obesity, physical inactivity, diet, alcohol use, stress
additional: metabolic syndrome, CKD, chronic infections, non-alc fatty liver disease, flu
metabolic syndrome
3 of these 5 components:
- elevated waist circumference (> 88 cm women, > 102 cm men)
- elevated triglycerides (>150 mg/dL) or drug treatment for elevated triglycerides
- low HDL cholesterol (<40 men <50 women) or drug treatment for HDL
- elevated bp (>130 systolic or >85 diastolic) or HTN drug treatment
- elevated fasting glucose (>100) or drug treatment for elevated glucose
identify and differentiate between anginas (stable, unstable, variant, refractory)
stable: predictable and consistent pain that occurs on exertion and is relieved by rest.
unstable: symptoms occur more frequently and last longer than in stable. the threshold for pain is lower, and pain may occur at rest.
variant: aka prinzmetal angina, pain at rest with reversible ST-segment elevation; thought to be caused by coronary artery vasospasm.
refractory: severe incapacitating chest pain.
causes, manifestations, and assessment findings of angina
causes: usually caused by atherosclerotic disease. physical exertion or emotional stress increases myocardial oxygen demand, and the coronary vessels are unable to supply sufficient blood flow to meet the oxygen demand.
manifestations/assessment findings: tightness, choking or a heavy sensation. retrosternal, poorly localized, may radiate to neck, jaw, shoulders, back or arms (usually left). anxiety frequently accompanies the pain. also, dyspnea, sob, dizziness, pallor, n/v
medication therapies for angina and ACS (indication, patient education, nursing management, and complications/management)
treatment seeks to decrease myocardial oxygen demand and increase oxygen supply
positive inotrope: a medication that increases myocardial contractility (force of contraction)
negative inotrope: a medication that decreases myocardial contractility
positive chronotrope: a medication that increases heart rate
negative chronotrope: a medication that decreases heart rate
nitrates: reduce myocardial consumption and treats coronary ischemia. dilates the veins. evaluate for hypotension before administering.
beta-blockers: (atenolol/metoprolol) delays onset of ischemia with work or exercise, goal of resting heart rate of 50-60, side effects include depressed mood, fatigue, decreased libido, and dizziness
CCB: decrease SA node automaticity and AV node conduction, decreases HR and strength of myocardial contraction. dilates smooth muscle wall of arterioles. amlodipine and diltiazem most commonly used.
procedural interventions (PCI and CABG) for angina and ACS (indication, patient education, nursing managements, and complications and management of complications)
PCI: may be diagnostic or treatment, balloon angioplasty with intracoronary stent implantation. complications intra-procedure include dissection, perforation, abrupt closure, acute MI. complications post-procedure include abrupt closure of coronary artery, bleeding at insertion site, retroperitoneal bleeding, arteriovenous fistula.
CABG: grafted blood vessel to occluded artery to flow past occlusion. indications include alleviation of uncontrolled angina, left main coronary artery stenosis or multivessel CAD, prevention/tx for MI, arrhythmias, or HF, and tx for complications from unsuccessful PCI. complications include hemorrhage, arrhythmias, pleural effusions, and MI
ECG changes for acute ACS/MI and post ACS/MI ECG changes
ACS ECG changes:
- elevation in the ST segment in two continuous leads is a key diagnostic indicator for MI
- Q wave without ST-segment and T-wave changes indicates an old MI
- NSTEMI by cardiac biomarkers if no persistent ST elevation
