Coronary Artery Disease

Question 1

Ischemia

Answer 1

portion of body that is deprived from sufficient oxygen

Question 2

Atherosclerosis

define, prognosis, risk factors

Answer 2

build up of plaque along artery walls, narrowing and constricting bloodflow

Prognosis: good with early detetion + treatment

Risk factors:
1. diabetes
2. obesity
3. sedentary lifestyle
4. elevated blood homocystine
5. fibrinogen levels

Caution: 2 or more of the preceding risk factors increase risk of CAD

Question 3

4 CAD characteristics

Answer 3

1. involves a spectrum of clinical entites ranging from angina to infarction to sudden cardiac death
2. an imbalance of myocardial oxygen supply and demand resulting in ichemic chest pains
3. subacute occlusion may produce no symptoms
4. symptoms present when lumen is at least 70% occluded

Question 4

Angina pectoris
Description, symptoms, duration

Answer 4

1. precursor to heart attack
2. symptoms: mild to mod. substernal chest pain/ discomfort, pressure or dull ache in chest + L arm, but maybe felt anywehere in UB, including neck,jaw, back, arm, epigastric area
3. lasts less than 20 mins.
4. increased demand on heart

chest pain inc. in severity, freq, duration=inc. of myocardial infart

or sudden death

Question 5

stable angina

Answer 5

angina occuring during exercises or activity; relieved with rest and/or sublingual nitroglycerin (meds for angina pectoral is, a vasodilator)

Question 6

unstable angina

Answer 6

1. coronary insufficiency at rest without any precipitating factors or exertion
2. pain is difficult to control

Question 7

Variant angina (Prinzmetal’s angina)

Answer 7

1. Caused by vasospsm of coronary arteries in the absence of occulsive disease.
2. Responds will to nitroglycerin or calcium channel blocker long term

(vasospastic angina or variant angina) is a known clinical condition characterized by chest discomfort or pain at rest with transient electrocardiographic changes in the ST segment, and with a prompt response to nitrates. These symptoms occur due to abnormal coronary artery spasm.

Question 8

Myocardial infarction (MI)

Answer 8

1. Prolonged ischemia injury
2. Death of an area of the myocardium caused by occlusion of one or more of the coronary arteries
3. Results in necrosis of heart tissue

Question 9

S&S of MI

Answer 9

1. Severe substernal pain of more than 20 minutes duration which may radiate to neck, jaw, arm, and/or epigastric area.
2. Dyspnea, rapid respiration, SOB
3. Indigestion, nausea, and vomiting
4. Pain unrelieved by rest and/or sublingual nitroglycerin

CAUTION: Pain may be misinterpreted as indigestion

Question 10

Heart Failure (HF)

Answer 10

1. A clinical syndrome in which the heart is unable to maintain adequate circulation of the blood to meet the metabolic needs of the body.
2. Caused by CAD, valvlar disease, congenital heart disease, hypertension, infections

Question 11

Left-sided HF (CHF)

Type of Heart Failure

Answer 11

1. blood is not adequately pumped into systemic circulation
2. Characterized by pulmonary congestion, edema, and low cardia output due to backup of blood from left ventrical (LV) to left atrium (LA) and lungs
3. D/T excessive workload of heart; cardia arrhythmias; or heart damage

Question 12

Right heart failure

Type of Heart Failure

Answer 12

1. blood is not adequately returned from the systemic circulation to the heart
2. Characterized by increased pressure load on the right ventricle (RV) with higher pulmonary vasuclar pressures
3. D/T LV failure, mitral valve disease of chronic lung disease; produces hallmark signs of jugluar vein distension and peripheral edema

Type of Heart Failure

Question 13

Biventricular failure

Type of Heart Failure

Answer 13

Severe LV pathology producing backup into the lungs, increased PA pressure, and RV signs of HF

Question 14

Symptoms of Biventricular Failure

Type of Heart Failure

Answer 14

1. Muscle wasting
2. Myopathies
3. Osteoporosis

Question 15

Medical Management

Answer 15

1. diagnostic procedures (x-ray, ECG, echocardiogram/ultrasound, cardiac stress test and catherterization, pulmary function test)
2. Dietary and lifestyle interventions (exercise, low salt/low cholesterol diets, weight reduction, smoking cessation)
3. pharmaceutical interventions

Question 16

Angiopasty

(PTCA- percutaneous transluminal coronary angioplasty)

Answer 16

1. catheter is inserted into femoral artery, a balloon is then inflated at the site of the lesion and push the plaque against arterial wall, inserting a cardiac ” stent” - to keep coronary a. open.
2. improves coronary blood flow, and left ventricular function, anginal relief

Surgical management

Question 17

Coronary artery bypass grafts (CABG)

Answer 17

1. Diseased sections of the coronary arteries are bypassed with use of healthy vessels to create new circular pathways in coronary artery.
2. graft improves coronary blood flow, and left ventricular function, anginal relief

Surgical management

Question 18

Other surgical management

Answer 18

1. Intravascular stents: wire mesh implant postanginoplasty to prevent restenosis and occulusion in coronary or peripheral arteries
2. Transplantation: used in end-stage myocardial disease (cardiomyopathy, ischemic heart disease, valvular heart disease)
3. Ventricular assistive devices (VADs): implanted device (pump) that improves tissue perfusion and maintain cardiogenic circulation (for severe pts)
4. Thrombolytic therapy for acute MI: medication administered to activate body’s fibrinolytic system, dissolve clot, and restore coronary BF (streptokinase, tissue plasminogen /TPA, urokinase)

Question 19

When evaluating a client in a skilled nursing facility, the OTR® notes that the client’s skin has a yellowish cast, the fingernail beds are bluish in color, and the client has noticeable edema in both lower extremities. What condition would MOST likely cause these symptoms?

Right-sided congestive heart failure
Left-sided congestive heart failure
Aortic stenosis
Aortic insufficiency

Answer 19

Solution: The correct answer is A.

When the right side of the heart fails, blood flows back into the venous system. Symptoms of right-sided heart failure include cyanotic nail beds, jaundice, and lower-extremity edema.

B: When the left side of the heart fails, blood flows back into the lungs, causing difficulty breathing, anxiety, and cerebral hypoxia.

C, D: Aortic stenosis and aortic insufficiency have symptoms similar to those of left-sided heart failure.