coronary alterations management Focus Flashcards
where is the left anterior descending coronary arteries
anterior and lateral wall of LV
where is the circumflex artery
posterior and lateral wall of LV
where is the Right coronary artery
SA and AV node
what helps in development of atherosclerosis
Endothelial injury and inflammation
what are some non modifiable risks for CAD
over 65, male, obese women, african amercian, 1st degree family history, genetics
what are some modifiable risks for CAD
HDL, LDL, cholesterol over 200, triglycerides over 150, hypertension, smoking, decreased physical activity, obese BMI over 30, drug use, pernicious anemia
what defines metabolic syndrome - insulin resistance
central obesity, hypertension, abnormal serum lipids, elevated fasting BG
what could be some contributing factors to CAD
DM, metabolic syndrome, psychological status, homocysteine level (pernicious anemia), substance abuse
what does the med atrovastain do
decreases lipids by inhibiting cholesterol synthesis= increasing HDL and decreasing LDL
what should you monitor for atrovastain
liver damage and myopathy
what changes should be made for the diet for CAD
decrease saturated fats, cholesterol, red meat, egg yolks, and whole milk
increase complex carbs, fiber, omega 3 fatty acids
what is ischemia cause
angina
what is ischemia
the demand for myocardial oxygen exceeds what the coronary arteries can give
what could be some cause of unstable angina
acute coronary syndrome (MI),
what are the 2 options for acute coronary syndrome (MI) and what are there differences
NSTEMI (no ST elevation )
STEMI (ST elevation)
what are the 2 procedures you can do for angina stable or unstable
Percutaneous coronary intervention or coronary artery bypass graft
how does nitroglycerin work
Dilates the peripheral and coronary blood vessels
what are some long acting nitrates
lsordill, limdur, nitroglycerin ointment, transdermal controlled release nitrglycerin
what is the main complication for nitrates and what is the intervention for that
orthostatic hypotension - monitor BP after initial dose, advise patient to change positions slowly
what med should not be taken with nitrates and why
erectile dysfunction (viagra) because it can cause severe hypotension
what are the meds used for stable angina
ACE (lisinopril), ARBs (losartan), beta blockers
what are some interventions for stable angina
upright position, supplemental O2, VS, ECG, assess lungs, nitroglycerin, tropnin lap values
what are troponin lap values normally for stable angina
negative
what is unstable angina
deterioration of plaque blockage, which then ruptures, platelets go to fix it causing a bigger blockage and stops blood flow = irreversible myocardial cell death
what does a chest X ray show for CAD
heart enlargement, aortic calcifications, pulmonary congestion
what would a chest X ray rule out
aortic distension
what are you looking at on an 12 lead ECG for CAD
changes in baseline and ST elevation
what is normal troponin
0 - 0.04
what is normal high sensitivity troponin
less then 14
what does a coronary computed tomography angiography do
detects calcified/ non calcified plaques in the artery
what diagnostic test could you do for CAD
chest xray, ECG, labs (troponin), echocardiogram, exercise stress test, thallium scans
what should you do if someone has IV contrast allergy but needs to go to cath lab
pre-medicate with corticosteroids and still go to cath lab and use contrast
what is the treatment of choice for STEMI
emergent percutaneous coronary intervention
what are the 2 different stents for percutaneous coronary intervention and whats the difference
Bare metal (1mt-1yr dual anti-platelet therapy), drug-eluting stent (minimum of one year of anti-platelet therapy)
what does dual anti-platelet consist of
Aspirin + clopidogrel (plavix)
what are some alternatives for plavix
ticagrelor or prasugrel
what is the management after coronary revascularization
monitor for recurrent angina, VS, cardiac rhythmic/dysrhythmia, insertion site, neurovascular assessment (peripheral pulses), bed rest per policy
who gets thrombolytic therapy
STEMI who cant get to the lab so give within 30minutes of arrival
what interventions do you need to do for thrombolytic therapy
draw blood from 2-3 IV sites, do invasive procedures first, monitor for bleeding, neuro status,
what is the best sign after thrombolytic therapy
ST returning to baseline
how do you prevent reocclusion for thrombolytic therapy
heparin
what are the ss of acute thrombolytic syndrome
increased HR and BP first then a drop in BP, crackles, jugular vein distention, new murmur, diaphoresis, nv, fever (100 degrees in first 24-48 hours)
why would someone need coronary surgical revascularization with coronary artery bypass grafting
failed medical management, multivessel disease, non a candidate for percutaneous coronary intervention (because blockage too long or difficult to access), multiple comorbidities
what is part of the process for coronary surgical revascularization with coronary artery bypass grafting
sternotomy and cardiopulmonary bypass
what are some complications of coronary surgical revascularization with coronary artery bypass grafting
bleeding (anemia from RBC damage), fluid and electrolyte imbalances, hypothermia (bc blood is cooled when gone through bypass machine), infection
what should you monitor for coronary surgical revascularization with coronary artery bypass grafting
hemodynamic status, fluid status, monitor for afib (very common so restart beta blockers ASAP)
what is the most common complication of acute coronary artery syndrome (MI)
Dysrhythmias
what is the most common cause of death prehospitalisation
VT and VF
how does HF happening because of acute coronary artery syndrome (MI)
pumping power of the heart is diminished because of scaring
what is cardiogenic shock
heart is not working effectively leaving the body poorly perfused
what are the ss of acute pericarditis
mild-severe chest pain made worse with inspiration/coughing/movement of upper chest, relieved when sitting forward
what are the 2 med used for acute pericarditis
aspirin or colchicine
what will happen next if someone has ventricular wall rupture and papillary muscle rupture
new loud systolic murmur, HF, and cardiogenic shock will ensue
what is left ventricular aneurysm
myocardial wall becomes thinned and bulges out during contraction
what is usually recommended for someone who has LV aneurysm
anticoagulants unless contraindicated
