Chapter 37: Coronary Artery Disease and Acute Coronary Syndrome 2 Flashcards
1
Q
men or women: report more disability after heart event
A
women
2
Q
symptoms occur within one hour: angina, palpitations, dizziness, or lightheadedness
A
sudden cardiac death (SCD)
3
Q
___________ protects women in younger ages from CAD
A
estrogen
4
Q
cardiac catheterization and PCI: assess catheter insertion site for these three things every ___ minutes for first hour, then agency policy
A
hematoma, bleeding, bruit
15
5
Q
type of ischemia associated with diabetic neuropathy
A
silent ischemia
6
Q
this form of angina is more common in women and occurs upon physical exertion
A
microvascular angina
7
Q
absolute or relative contraindication: recent ischemic stroke within past 3 months
A
absolute
8
Q
regular physical activity helps with these three things
A
decreased weight
decreased systolic BP
increased HDL cholesterol
9
Q
after CABG surgery, monitor for this type of dysrhythmia
A
atrial fibrillation
10
Q
arterial anastomoses within coronary circulation
A
collateral circulation
11
Q
these changes on 12-lead ECG indicate ischemia
A
ST segment depression or T wave inversion
12
Q
CABG is an option in these three conditions
A
diabetes, LV dysfunction, chronic kidney disease
13
Q
men or women: mortality rates from CAD have decreased more rapidly for this gender
A
men
14
Q
men or women: develop more collateral circulation
A
men
15
Q
sudden cardiac death (SCD) occurs with these two conditions
A
prior MI (most common)
acute MI
16
Q
two conditions that increase risk of CAD
A
diabetes mellitus, chronic kidney disease
17
Q
stents/PCI require therapy with these medications afterward (also known as dual antiplatelet therapy or DAPT)
A
aspirin, clopidogrel or ticagrelor
18
Q
men or women: first heart event is more often UA than MI
A
women
19
Q
absolute or relative contraindication: current use of oral anticoagulants
A
relative
20
Q
men or women: report more typical signs and symptoms of angina and MI
A
men
21
Q
condition in which dysrhythmia causes disruption on cardiac function, resulting in loss of cardiac output and cerebral blood flow
A
sudden cardiac death (SCD)
22
Q
absolute or relative contraindication: significant closed-head or facial trauma within past 3 months
A
absolute
23
Q
men or women: those who have an MI are more likely to have a fatal heart event within 5 years than other gender
A
women
24
Q
chest pain often occurs in early morning and greater than 20 minutes
A
myocardial infarction
25
grafts in traditional CABG surgery may involve any of these three vessels
internal mammary (thoracic) artery (IMA, ITA)*
saphenous vein*
radial artery
(*most common)
26
II, III, aVF leads
inferior leads (right ventricle)
27
these two MI complications are characterized by a new, loud systolic murmur and require emergency repair
ventricular septal wall rupture and left ventricular free wall rupture
28
the substances _________ and ___________ result in coronary artery spasm resulting in chest pain and MI
cocaine, methamphetamine
29
high-dose aspirin is treatment of choice for these two complications of MI
pericarditis, Dressler syndrome
30
normal HDL
men: >45 mg/dL
women: >55 mg/dL
31
treatment to lower LDLs may slow the process of forming ___________
fatty streaks
32
this MI complication causes acute and massive mitral valve regurgitation and a new systolic murmur
papillary muscle dysfunction or rupture
33
when to reassess patient after starting statin therapy
after 6 weeks
34
decreased urine output, crackles, JV distention, hepatic engorgement, peripheral edema are examples of manifestations of this
cardiovascular manifestations of MI
35
three things to look for in a chest X-ray for a patient with chronic stable angina
cardiac enlargement, pulmonary congestion, aortic calcification
36
decreased pumping power after an MI can cause this complication
heart failure
37
normal total cholesterol
<200 mg/dL
38
lipid profile screening begins at age ___ and continues every ___ years until age ___, when screening continues every ___ years
20, 5, 50, 1-2
39
nutritional therapy to prevent CAD involves reducing these five things
saturated fats, cholesterol, red meat, egg yolks, whole milk
40
intermittent chest pain that occurs over a long period with similar pattern of onset, duration, and intensity of symptoms
chronic stable angina
41
men or women: in early age have higher HDL and lower LDL levels
women
42
scar tissue is still weak ____________ after MI
10-14 days
43
nicotine use increases LDL, decreases HDL, and increases oxygen radicals, causing vessel _____________ and ____________
inflammation, thrombosis
44
second-hand smoke increases CAD risk by _____%
25-30
45
men or women: are undertreated with guideline-based recommendations, leading to worse outcomes and increased rates of readmission, reinfarction, and death in first year after MI
women
46
abnormal heart sounds that can occur with an MI
S3, S4, new holosystolic murmur
47
after CABG surgery, patients usually go to the cardiac ICU for ________ hours
24-36
48
absolute or relative contraindication: traumatic or prolonged (>10 min) cardiopulmonary resuscitation
relative
49
obesity includes a waist circumference of >___ in men and >___ in women
40, 35
50
absolute or relative contraindication: known structural or vascular abnormality
absolute
51
absolute or relative contraindication: suspected aortic dissection
absolute
52
Gender and ethnicity group at highest risk for CAD
white men
53
two dysrhythmias that are the most common causes of death in prehospitalization period of an MI
ventricular tachycardia (VT)
ventricular fibrillation (VF)
54
acute care/nursing management for chronic stable angina (7)
1. position upright, apply oxygen
2. assess VS, pain, heart/breath sounds
3. continuous ECG; 12-lead ECG
4. pain relief: NTG, IV opioid
5. cardiac biomarkers
6. chest X-ray
7. provide support; reduce anxiety
55
balloon angioplasty is also known as
percutaneous coronary intervention (PCI)
56
lipids accumulate and migrate into smooth muscle cells
fatty streak
57
Which personality type has a higher risk of CAD, Type A or B?
Type A
58
men or women: receive more evidence-based therapies when acutely ill from CAD
men
59
gold standard intervention to identify and localize CAD
cardiac catheterization
60
complication of MI that is associated with a high death rate
cardiogenic shock
61
normal fasting triglycerides
40-160 mg/dL men
35-135 mg/dL women
62
two inclusion criteria for thrombolytic therapy
1. chest pain less than 12 hours and 12 lead shows STEMI
2. no absolute contraindications
63
absolute or relative contraindication: noncompressible vascular punctures
relative
64
what to do when ECG shows ST elevation
send to cath lab for PCI
thrombolytic therapy if cath lab not immediately available
65
men or women: have larger diameter coronary arteries; vessel diameter is inversely related to risk for restenosis after interventions
men
66
this MI complication is characterized by inflammation of visceral and/or parietal pericardium
pericarditis
67
LDL high risk for CAD
>160 mg/dL
68
what to do when ECG shows ST depression or T-wave inversion
send patient to critical care or telemetry unit
69
two ways hypertension serves as risk factor for CAD
causes endothelial injury
decreases elasticity of vessels
70
men or women: fewer have "classic" signs and symptoms of angina or MI
women
71
homocysteine levels increase with increased breakdown of the essential amino acid __________
methionine
72
blood vessel disorder that involves soft deposits of fat that harden with age
atherosclerosis
73
five postop complications after cardiopulmonary bypass used with CABG surgery
systemic inflammation, bleeding, anemia, infection, hypothermia
74
pathogenesis of atherosclerosis (4)
1. chronic endothelial injury
2. fatty streak
3. fibrous plaque
4. complicated lesion
75
normal LDL
<130 mg/dL
76
severe chest pain not relieved by rest, position change, or nitrate administration characterized by heaviness, pressure, tightness, burning, constriction, or crushing
myocardial infarction
77
nicotine increases ____________ levels, reducing oxygen-carrying capacity of Hgb
carbon monoxide
78
MI healing process after fourth day (three things)
1. catecholamine-mediated lipolysis and glycogenolysis result in increased glucose
2. necrotic zone identifiable by ECG changes
3. collagen matrix laid down- scar tissue
79
common locations of MI pain
substernal, epigastric that may radiate to neck, lower jaw, arms, back
80
three causes of dysrhythmias in MI patients
ischemia, electrolyte imbalances, SNS stimulation
81
LDL moderate risk for CAD
130-159 mg/dL
82
diagnostic study specific to sudden cardiac death
electrophysiology study (EPS)
83
absolute or relative contraindication: active internal bleeding
absolute
84
cardiac catheterization/PCI within ______________ for NSTEMI
12-72 hours
85
type of contraction that typically proceeds VT or VF
premature ventricular contractions (PVCs)
86
three medications given during PCI
unfractionated heparin or low-molecular weight heparin
direct thrombin inhibitor
glycoprotein IIb/IIIa inhibitor
87
men or women: higher mortality rate and more complications after coronary artery bypass graft surgery
women
88
six complications of PCI
dissection or rupture of artery
abrupt closure
acute stent thrombosis
failure to cross blockage
extended infarct
in stent restenosis
89
HDL high risk for CAD
<40 mg/dL
90
ischemia that occurs in absence of any subjective symptoms
silent ischemia
91
scar tissue has replaced necrotic tissue _____________ after MI; said to be healed
6 weeks
92
FITT formula: FITT stands for
Frequency, Intensity, Type, and Time
93
three ways increased homocysteine levels affect blood vessels
damage endothelium
promote plaque buildup
enhance clotting
94
acute care for ACS upon admission to ICU/telemetry unit
1. monitor VS, pulse ox
2. continuous ECG
3. serial 12-lead ECGs
4. serial cardiac biomarkers
5. bed rest/limit activity for 12-24 hours; increase gradually
95
when can sexual activity be resumed after ACS/MI
7-10 days afterward or when patient can climb 2 flights of stairs or brisk walking
96
two main goals of treatment for chronic stable angina
reduce oxygen demand and/or increase oxygen supply
97
V1-V4 leads
anteroseptal leads (left ventricle)
98
cardiopulmonary bypass (CPB) is associated with these complications
neurological dysfunction
renal problems
systemic inflammatory response
99
collateral circulation allows adequate blood and oxygen to heart except with _____________
increased workload (exercise)
100
women take __________ time than men to accumulate comorbidities
longer
101
men or women: seek medical care later in CAD process, most likely because of lack of recognition of atypical symptoms
women
102
absolute or relative contraindication: prior ischemic stroke over 3 months ago
relative
103
three examples of Omega-3 fatty acid sources
tuna, salmon, mackerel
104
absolute or relative contraindication: pregnancy
relative
105
restenosis may occur ________ after cardiac catheterization and PCI
3-6 months to a year
106
absolute or relative contraindication: significant hypertension on presentation (SBP >180 or DBP >110)
relative
107
absolute or relative contraindication: active peptic ulcer disease
relative
108
total occlusion of coronary artery indicates this condition
STEMI
109
two contributing factors to collateral circulation
1. inherited predisposition for angiogenesis
2. presence of chronic ischemia
110
V5, V6 leads
lateral leads (toward apex)
111
oxygen demand greater than oxygen supply results in ________________
myocardial ischemia
112
MI healing process within 24 hours
inflammatory process: leukocytes infiltrate area of cell death; enzymes released
113
non-ST elevation acute coronary syndrome can indicate one of these two conditions
unstable angina
non-ST segment elevation myocardial infarction (NSTEMI)
114
how many IV lines are required for thrombolytic therapy
2-3
115
thrombolytic therapy within ______________ for STEMI for hospitals without access to cath lab
30 minutes
116
absolute or relative contraindication: known intracranial cancer
absolute
117
after sudden cardiac death (SCD) episode, implantable cardioverter-defibrillator (ICD) implant is placed with left ventricular dysfunction with ejection fraction <__%
30
118
partial occlusion of coronary artery indicates one of these two conditions
unstable angina, NSTEMI
119
statin therapy is recommended for these four patients***
1. patients with known CVD
2. LDL cholesterol > 190 mg/dL
3. Age 40-75 with diabetes and LDL 70-189 mg/dL
4. Age 40-75 with LDL 70-189 mg/dL and 10-year risk for CVD at least 7.5%
120
plaque ruptures, platelets accumulate, thrombus forms, and vessel further narrows or totally occludes
complicated lesion
121
I, aVL leads
lateral leads (toward base)
122
which type of biomarkers are the best indicators of MI
cardiac-specific troponins
123
absolute or relative contraindication: history of intracranial hemorrhage
absolute
124
four advantages of off-pump coronary artery bypass (OPCAB)
less blood loss
less renal dysfunction
less postop AFib
fewer neurological complications
125
absolute or relative contraindication: dementia
relative
126
emergency care for acute coronary syndrome (6)
1. Oxygen and upright position
2. 12-lead ECG
3. IV access
4. Drugs: nitroglycerine (SL), ASA (chewable), morphine, statin
5. treat dysrhythmias per agency protocol
6. monitor serum biomarkers
127
three ways in which diabetes increases risk of CAD
increased endothelial dysfunction
altered lipid metabolism
increased cholesterol and triglycerides
128
how long are heart cells viable after hypoxia occurs
20 minutes
129
CAD negatively affects cardiac ________, decreasing ___________ and __________
function, cardiac output (CO), perfusion
130
most common complication that presents in 80-90% of MI patients
dysrhythmias
131
(Women, Men) are more likely to survive a cardiovascular event
Men
132
absolute or relative contraindication: severe uncontrolled hypertension
absolute
133
men or women: standard screening for risk for sudden cardiac death is more predictive
men
134
after total coronary occlusion, heart muscle becomes hypoxic within ____________, after which __________ metabolism begins and increases _______________ levels
10 seconds, anaerobic metabolism, lactic acid
135
absolute or relative contraindication: intracranial or intraspinal surgery within 2 months
absolute
136
this diagnostic study can show hypokinesis or akinesis of necrotic areas of heart
echocardiogram
137
coronary artery bypass graft (CABG) surgery recommended in these four situations
1. medical treatment failed
2. disease involves left main coronary artery or three vessels
3. PCI cannot be done
4. failed PCI or chest pain continues
138
cardiac biomarkers are important in absence of ST elevation because they distinguish against _____________, which is negative, and _______________, which is positive
unstable angina, NSTEMI
139
men or women: have more "silent" MIs
women
140
after age ____, the incidence of MI in men and women equalizes
55
141
cardiac-specific troponin I is increased ______ after onset of MI, peaks at ______, and returns to baseline over ______
4-6 hours, 10-24 hours, 10-14 days
142
this MI complication is characterized by thin myocardial wall that bulges out during contraction
left ventricular aneurysm
143
nutritional therapy to prevent CAD involves increasing these three things
complex carbohydrates, fiber, Omega-3 fatty acids
144
two dysrhythmias that may occur after an MI, especially if sinus or AV nodes were involved
bradycardia, heart block
145
incidence of CAD is ____ times greater among people who have diabetes
2-4
146
manifestations include mild to severe chest pain, pericardial friction rub, fever, decreased BP, ECG changes (diffuse ST elevation)
pericarditis
147
MONA acronym for nursing care for angina and MI
Morphine for pain
Oxygen
Nitroglycerine
Aspirin
148
cardiac catheterization/PCI within _____________ for STEMI
90 minutes
149
absolute or relative contraindication: recent internal bleeding within 2-4 weeks
relative
150
pain lasts more than 10 minutes with this type of angina
unstable angina
151
men or women: fatigue is often first symptom of ACS
women
152
four risk factors of CAD related to metabolic syndrome
central obesity
hypertension
abnormal serum lipids
high fasting BG
153
collagen covers fatty streak, narrowing vessel lumen and reducing blood flow
fibrous plaque
154
manifestations include chest pain, fever, malaise, pericardial friction rub, arthralgia, increased WBC and sedimentation rate
Dressler syndrome
155
five causes of cardiogenic shock
decreased oxygen and nutrients related to:
severe LV failure, papillary muscle rupture, ventricular septal rupture, LV free wall rupture, right ventricular infarction
156
absolute or relative contraindication: history of chronic, severe, poorly uncontrolled hypertension
relative
157
fasting triglycerides risk for CAD
>150 mg/dL
158
why is serum glucose high after an MI
it is required to rebuild myocardium
159
cardiac catheterization and PCI: how often to perform neurovascular assessment for first hour afterward
every 15 minutes
160
Which has a higher risk of obesity, an apple or pear figure?
apple figure
161
absolute or relative contraindication: major surgery within past 3 weeks
relative
162
angina occurs when one or more arteries are blocked ___% or more by atherosclerotic plaque or left main coronary artery is blocked by ___% or more
70, 50
163
absolute or relative contraindication: for streptokinase, prior treatment within past 6 months
absolute
164
initially in an MI, HR and BP are ____________, then BP ______________ secondary to decreased ____
increased, decreases, cardiac output
165
heart sound that could be present with chronic stable angina
transient S3 murmur
166
rare form of angina that occurs at rest with or without CAD involving a spasm of a major coronary artery from increased intracellular calcium
Prinzmetal's angina
167
two things that can increase catecholamine levels
nicotine
SNS stimulation
168
types of intracoronary stents
bare metal stent (BMS)
drug-eluting stent (DES)
169
causes of chronic endothelial injury (7)
hypertension, tobacco use, hyperlipidemia, hyperhomocysteinemia, diabetes, infections, toxins
170
high risk for CAD is considered ___ or more risk factors with ____% chance in next 10 years of having heart attack
2, 10-20
171
men or women: experience onset of heart disease about 10 years later than the other gender
women
172
three examples of onset of chronic stable angina
physical exertion
stress
emotional upset
173
new-onset chest pain that occurs at rest or with increase in frequency, duration, or with less effort than chronic stable pattern
unstable angina
174
a wearable cardioverter-defibrillator
amiodarone
175
two types of anesthesia given during cardiac catheterization and PCI
dissociative and local
176
this MI complication is characterized by pericarditis and fever that develop 1-8 weeks after an MI
Dressler syndrome
177
sudden cardiac death (SCD) is most commonly caused by these three things
CAD
structural heart disease
conduction disturbances
178
endothelial injury leads to _____________ and _____________
left ventricular hypertrophy, reduced stroke volume
179
after starting a lipid-lowering drug, if lipids are still high after initial reassessment, do this
change to alternate drug
180
men or women: first heart event is more often MI than angina
men
181
process by which normal myocardium will hypertrophy and dilate in an attempt to compensate for infarcted muscle
ventricular remodeling
182
chest pain in the absence of significant CAD and in the absence of a coronary spasm of a major coronary artery
microvascular angina
183
men or women: in later age LDL levels and risk for MI increase
women
184
MI healing process by fourth day
proteolytic enzymes of neutrophils and macrophages begin to remove necrotic tissue resulting in thin wall
