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