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NURS 232 > Coronary Artery Disease > Flashcards

Coronary Artery Disease Flashcards

1
Q

Races that are at greater risk of CAD and stroke

A

(because of risk of HTN and diabetes)
- South Asian
- African
- Caribbean

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2
Q

Define CAD

A

A type of BV disorder that is included in the general category of atherosclerosis

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3
Q

Synonyms for CAD

A

ASHD - arteriosclerotic heart disease
CVHD - cardiovascular heart disease
IHD - ischemic heart disease
CHD - coronary heart disease

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4
Q

Primary clinical manifestation of oxygen deprivation to tissues

A

Pain (informed through pain receptors)

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5
Q

Primary clinical manifestation of poor coronary circulation

A

Chest pain or angina

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6
Q

Atherosclerosis

A
  • begins as soft deposits of cholesterol and lipids that harden with age in the intimal wall of an artery
  • referred to as “hardening of arteries”
  • atheromas (fatty deposits) have a preference for the coronary arteries
  • major cause of CAD
  • endothelial lining is altered as a result of inflammation and injury
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7
Q

3 Stages of Atherosclerosis

A
  1. Fatty streaks (potentially reversible)
  2. Fibrous plaque (covered by plaque forming collagen)
  3. Complicated lesion (can result in plaque instability, ulceration, and rupture)
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8
Q

Define collateral circulation

A
  • arterial anastomoses (connections) exist within the coronary circulation
  • body grows new BS to provide alternative routes to deliver BS
  • only in chronic cases of ischemia, there is no time to develop collateral circulation in acute cases
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9
Q

Non-modifiable Risk Factors of CAD

A
  • Aging
  • Men > Women until 65 years of age
  • Ethnicity
  • Family Hx (familial hypercholesterolemia - autosomal dominant disorder)
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10
Q

Modifiable Risk Factors of CAD

A
  • metabolic syndrome
  • smoking
  • physical inactivity
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11
Q

4 Categories of Health Promotion for CAD

A
  1. Physical fitness
  2. Nutritional therapy
  3. Cholesterol-lowering drug therapy (Statin drugs)
  4. Anticoagulant therapy (aspirin/heparin)
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12
Q

Describe Chronic Stable Angina

A

When O2 demand > O2 supply, chest pain occurs intermittently over a long period with the same pattern of onset, duration, and intensity of symptoms. Pain is often “heavy” rather than “sharp” and never occurs during rest

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13
Q

Treatment of Chronic Stable Angina

A
  • Nitro spray
  • Rest
  • Relieve pain
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14
Q

Precipitating factors of Chronic Stable Angina

A

Things that increase O2 demand:
- physical exertion
- temp extremes
- increase of SNS (strong emotions, sexual activity)
- smoking
- heavy metals
- circadian rhythm patterns

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15
Q

ABCDEFs of Chronic Stable Angina Management

A

A - antiplatelets & antianginals & ACE inhibitors
B - beta blockers & BP
C - cessation of smoking & cholesterol
D - diet & diabetes
E - education & exercise
F - flu vaccinations (catching a flu would increase O2 demand)

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16
Q

Silent Ischemia

A

Ischemia that is asymptomatic to chest pain, but indicates itself through diaphoresis (sweating), dizziness, nausea, and R shoulder pain. Associated with DM due to autonomic neuropathy of the CVS.

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17
Q

Prinzmetal’s (variant) angina

A

Occurs at rest in response to a SPASM of a coronary artery. Seen in clients with a Hx of migraines and Raynaud’s phenomenon. RELIEVED by exercise.

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18
Q

Describe ACS

A

Acute Coronary Syndrome:
Deterioration of plaque already formed in coronary arteries that once was stable, but is now either ruptured and/or a thrombus has formed a blockage. When myocardial ISCHEMIA is prolonged and not immediately reversible.

(umbrella term for: unstable angina, NSTEMI, STEMI)

19
Q

Describe UA

A

Unstable Angina:
Chest pain resulting from myocardial ischemia that is new, occurs at rest, worsening, but not constant.

This is NOT a heart attack

20
Q

Describe NSTEMI

A

Non-ST Elevated MI:
Partial thickness blockage heart attacks. Has less dramatic clinical manifestations.

21
Q

What 3 things are required to identify a heart attack:

A
  1. ECG changes
  2. Positive cardiac markers
  3. Presence of cardiac blockages (cardiac cell death)
22
Q

Time it takes before cellular death starts in a NSTEMI

A

20 mins

23
Q

Time it takes before the entire thickness of the heart muscle becomes necrosed in a NSTEMI

A

5-6 hours

24
Q

Can dead cardiac muscle rejuvenate?

A

No

25
Q

What is ST?

A

Part of the electrocardiogram - the region between the end of ventricular depolarization (contraction) and beginning of ventricular REpolarization (RElaxing).

2 boxes above the line to be clinically significant.

Electrical conduction always precedes mechanical contraction of the heart.

26
Q

What indicates interruption in electrical conduction in the AV node & bundle of His?

A

Ischemia in the right coronary arteries

27
Q

What is troponin?

A

Type of protein found in myocardium and not normally in the blood, but when myocardium is damaged, it is sent into the BS. Troponin isn’t normally found in the blood.

28
Q

Describe STEMI

A

ST-elevated Myocardial Infarction:
Total full thickness blockage of a cardiac artery. More rapid onset and progression of NSTEMI symptoms.

29
Q

Goal of a STEMI

A

“Door to balloon (angioplasty) time of 90 minutes”

30
Q

Clinical Manifestations of CAD

A

Midsternal pain radiating to L shoulder, L jaw, and down L arm. Substernal radiating to intrascapular. “someone sitting on my chest”, “heaviness”, “tightness”

Women may present more with nausea, SOB, substernal pressure, more R should or bilateral shoulder pain

31
Q

Assessment of Angina

A

PQRST + Stat ECG (goal 10 mins) + Vitals

P - precipitating events
Q - quality of pain
R - radiating pain
S - severity of pain
T - timing (come and go or present? have you had it before?)

32
Q

Goals of care for all CAD pts

A
  1. Decrease the demand for O2 (rest, help anxiety)
  2. Increase O2 supply (O2 therapy, give nitroglycerin for vasodilation only once determining pt is not on Sildenafil (Viagra) and has had an ECG rule out an inferior MI which could critically response to the low BP effects of nitro)
33
Q

Diagnostic Studies for ACS

A
  1. 12-lead ECG
  2. Lab studies: serial troponins (3 hours apart initially and if it is elevated, another one in 6 hours)
    - additionally: CBC, CP7 (blood chemistry panel), fasting lipids and glucose, LFTs (liver), BNP (brain natriuretic peptide), and TSH (thyroid)
  3. Chest x-ray
  4. Echocardiogram (sees valves and chest wall mov.)

Then only for NSTEMI or unstable angina:
5. Exercise stress test (when no abnormal ECG changes and normal serial troponins). ECG leads used while on a treadmill. Sent for a non-urgent angiogram if ECG changes are seen)

34
Q

The three meds STEMI Pts get on transit to a cath lab:

A
  1. Aspirin (80mg)
  2. Ticagrelor (antiplatelet)
  3. Heparin (reversible)

*no long-acting enoxaparin or long-acting Q meds

35
Q

6 Medications for CAD

A
  1. Nitrates - vasodilators that resolve chest pain
  2. Beta adrenergic blockers - reduce HR, workload, BP
  3. Calcium channel blockers - vasodilators
  4. Angiotensin-converting enzyme (ACE) inhibitors - vasodilators
  5. Opioids - reduce pain
  6. ASA - antiplatelet agent
36
Q

Describe Angioplasty

A

(or PCI: Percutaneous coronary intervention)
Invasive reopening of narrow BVs to restore BF with a balloon catheter.

Often combined with the placement of a stent surrounding the balloon.

37
Q

Describe CABG

A

Coronary Artery Bypass Grafting
- when other interventions don’t work (vessels are too rigid), surgery is done on the heart to make other body vessels into coronary vessels as collateral circulation
- palliative tx, not a cure
- often pts are obese or smokers

38
Q

When do you do another ECG?

A

If chest pain is the same or worse after 30mins

39
Q

What are the majority of MIs secondary to?

A

Thrombus formation

40
Q

ECG readings in a STEMI are:

A

ST elevation in two contigious leads

41
Q

What is Fribrinolysis?

A

TNKase - powerful at breaking down clots, used as a backup if 90 mins can’t be met

42
Q

Describe Angiogram

A
  • part of cardiac catheterization
  • a procedure that uses a wire, contrast dye, and fluoroscopy to examine blockages in coronary arteries
43
Q

Describe Metabolic Syndrome

A

Collection of risk factors for CVD and DM

“DIDOH”

  1. Dyslipidemia - abnormal serum lipids
  2. Insulin Resistance
  3. Dysglycemia - abnormal fasting blood glucose
  4. Obesity
  5. HTN

NURS 232 (11 decks)

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