Coronary Artery Disease

Question 1

Blood vessel disorder included in the general category of atherosclerosis; Progressive

Answer 1

Coronary Artery Disease (CAD)

Question 2

Atherosclerosis

Answer 2

Soft deposits of fat that harden with age; hardening of the arteries; seen often in coronary arteries

Question 3

What is the main problem with atherosclerosis and CAD

Answer 3

Increases afterload = increased BP

Question 4

CAD Epidemiology

Answer 4

Leading cause of sudden death in both men and women
Most common type of heart disease
Increased among: adults >/= 65; lower Educational level, more men than women

Question 5

Stages of development of Atherosclerosis

Answer 5

1. Fatty Streaks - lipids in smooth muscle cells
2. Fibrous plaque - r/t endothelial injury & plaque formation
3. Complicated Lesion - most dangerous; fibrous plaque grows -> platelet accumulation -> thrombus formation

Question 6

Arterial connections that exist in the coronary circulation; AKA “rerouting”

Answer 6

Collateral circulation

Question 7

Factors contributing to the growth of collateral circulation (2)

Answer 7

1. Inherited predisposition

2. Chronic Ischemia (decreased blood flow increases collat. Circ)

Question 8

Non-Modifiable risk factors for CAD

Answer 8

Age
Gender
Ethnicity
Family History

Question 9

Modifiable Risk Factors CAD

Answer 9

Elevated blood lipid levels (>200 = serum cholesterol; >150 triglycerides)
Hypertension
Tobacco Use
Lack of Exercise; Obesity; Diabetes; Stress

Question 10

How does stress contribute to development of CAD?

Answer 10

Increased release of catecholamines = increases HR = increases workload on the heart

Question 11

Primary reason for insufficient blood flow is

Answer 11

Narrowing of the coronary arteries

Question 12

Ischemia is an issue with oxygen

Answer 12

Supply and demand

Question 13

Chronic stable angina characteristics

Answer 13

Intermittent
Predictable pattern of onset
“Pressure” or “ache” in chest that lasts only a few minutes
Stops when precipitating event stops

Question 14

Treatment Goals for Stable Angina (ABCDEF)

Answer 14

Antiplatelets/Antianginals; Beta blockers and BP control
Cholesterol lowering, Cig cessation, Calcium Channel Blockers
Diet and Diabetes mgt; Education and Exercise
Flu Vaccination

Question 15

Silent Ischemia

Answer 15

No Subjective symptoms

Seen in pts w/ diabetes - r/t autonomic neuropathy

Question 16

Angina usually caused by coronary artery spasm that often occurs at rest and relieved by moderate exercise

Answer 16

Prinzmetal’s Angina (Variant Angina)

Question 17

How is Prinzmetal’s treated

Answer 17

Ca channel blockers and/or nitrates

Ex. Amlodopine or diltazem

Question 18

What is Acute Coronary Syndrome an umbrella term for?

Answer 18

Unstable Anginna

Myocardial infarction

Question 19

Unstable angina is

Answer 19

Rupture of athlerosclerotic plaque which results in the heart not getting enough oxygen.
Can lead to MI

Question 20

Symptoms of Unstable Angina

Answer 20

New in onset; Occurs at REST with a worsening pattern;

Chest pain can be aching, burning, pressure, heavy, suffocating, radiates to jaw, shoulders, back, arm

Question 21

Medication to treat Unstable Angina

Answer 21

Nitroglycerin - decrease pain by helping blood flow to area

Question 22

Caused by sustained ischemia which causes irreversible cell death in the cardiac muscle.

Answer 22

Myocardial Infarction

Question 23

Describe the process of ischemia leading to MI

Answer 23

Plaque rupture = clot formation = total blockage of artery = heart cell death as result of sustained ischemia

Question 24

Pain Assessment for Angina (PQRST)

Answer 24

Precipitating Event
Quality of pain
Radiation of pain
Severity of pain; Timing of pain

Question 25

Clinical Manifestations of MI

Answer 25

Pain - sometimes confused with indigestion
SNS stimulation - diaphoresis, cool, clammy, ashen
Cardiovascular symptoms
N/V; Fever

Question 26

What is likely to indicated Left Ventricular dysfunction during MI

Answer 26

Crackles in lungs

Question 27

What is likely to indicate right ventricular dysfunction during MI

Answer 27

Peripheral edema

Question 28

Diagnosis of ACS

Answer 28

History and clinical presentation
ECGs
Elevated Cardiac Markers

Question 29

Multiple ECGs done during a specific time frame is

Answer 29

Serial ECGs

Question 30

No ECG changes

Biomarkers = typically normal

Answer 30

Unstable angina

Question 31

Incomplete Coronary Occlusion
ST depression or T-wave inversion
Increased cardiac Biomarkers

Answer 31

Non-ST Elevation MI (NSTEMI)

Question 32

Complete Coronary Occlusion
ST Elevation
Pathological Q-Wave (long)
Ventricular depolarization is affected

Answer 32

ST-Elevation MI (STEMI)

Question 33

Serum Cardiac Marker Levels for MI

Answer 33

CK-MB: Rise 3-6 hrs after MI, peak 12-24hrs normalize 12-48 hrs
Troponin (most specific): rise 4-6 hours after onset MI, peak 10-24 hours, normalized 10-14 days

Question 34

Nursing Care: ACS

Answer 34

1. Oxygenation: 2-4L; 2. 12-Lead ECG
2. Pain Relief; 4. Monitor the patient
3. Relieve anxiety/Provide rest; 6. Admin antiplatelet therapy
4. Monitor Anticoagulant therapy; 8. Prepare for reperfusion therapy

Question 35

What is Emergent Percutaneous Coronary Intervention (PCI)

Answer 35

Balloon angioplasty/stent placement to open artery

Question 36

Goal of PCI

Answer 36

Perform w/in 90 minutes of ER Arrival