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N232 > Coronary Artery Disease > Flashcards

Coronary Artery Disease Flashcards

1
Q

what are 4 actions of atherosclerotic heart disease (ASHD)?

A
  1. narrows the lumen of the vessel
  2. reduces elasticity
  3. increases risk of plaque rupture and subsequent plaques
  4. increases vasospasm
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2
Q

what happens with narrowing the lumen?

A

reduces blood flow to the area supplied by the artery

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3
Q

what is the result of reduced elasticity?

A

makes it less resilient in the face of volume of pressure changes, and increases the risk of vasospasm

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4
Q

what is the result of increased risk of plaque rupture?

A

clot formation

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5
Q

what are some non-modifiable atherosclerosis risk factors?

A
  • family Hx
  • sex
  • race
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6
Q

what are some medically alterable risk factors of athero?

A
  • hypertension
  • hyperlipidemia
  • diabetes mellitus
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7
Q

why is diabetes a risk factor for athero?

A

damage vessel walls, gets plaque formation

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8
Q

what are some modifiable risk factors of athero?

A
  • smoking
  • stress
  • central obesity
  • sedentary lifestyle
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9
Q

what are neurological symptoms of an MI?

A
  • dizzy
  • restless
  • lightheaded
  • anxiety
  • pain
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10
Q

what are some cardiovascular symptoms of an MI?

A
  • chest pain
  • jugular vein distention (JVD)
  • inc., dec., or abnormal HR
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11
Q

what are GI symptoms of an MI?

A
  • nausea
  • vomiting
  • burping
  • heartburn
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12
Q

what are respiratory symptoms of an MI?

A
  • SOB
  • dyspnea
  • crackles (in HF)
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13
Q

what are some integumentary symptoms of an MI?

A
  • cool
  • clammy
  • diaphoretic (sweating)
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14
Q

what is a psychological symptom of an MI?

A
  • feeling of impending doom or denial that anything is wrong
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15
Q

what is an ECG?

A

measures the electrical activity of the heart, NOT the mechanical

  • look at the rhythm of the heart
  • can give info on the area of the heart damaged
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16
Q

what is an ECG used to help diagnose?

A

acute coronary syndrome (ACS)

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17
Q

what is an angiogram?

A

allows x-ray visualization of the coronary arteries following the injection of contrast medium
- can see blockage

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18
Q

what is an echocardiogram?

A

sound waves create an image of the heart in motion

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19
Q

what does an echo show?

A

how much damage has been done to the heart

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20
Q

what can an echo evaluate? (6)

A
  • heart wall motion
  • ventricular function
  • valvular disease
  • heart under stress
  • pericardial fluid
  • ejection fraction
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21
Q

what is the equation for the ejection fracture?

A

amount of blood pumped out of the ventricle / total amount of blood in the ventricle

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22
Q

what does the lipid profile consist of?

A
  • total cholesterol
  • high-density lipoprotein cholesterol (HDL-C)
  • low-density lipoprotein cholesterol (LDL-C)
  • triglycerides
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23
Q

what is total cholesterol?

A

this test measures all the cholesterol in the lipoprotein particles

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24
Q

what is high-density lipoprotein cholesterol (HDL-C)?

A

measures the cholesterol in HDL particles, often called the “good cholesterol” because it removes excess cholesterol and carries it to the liver for removal

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25
Q

what is low-density lipoprotein cholesterol (LDL-C)?

A

calculates the cholesterol in LDL particles, often called the “bad cholesterol” because it deposits excess cholesterol in the walls of BVs, which can contribute to atherosclerosis

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26
Q

what are triglycerides?

A

measures all triglycerides in all the lipoprotein particles, most is in the very low-density proteins

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27
Q

what does the amount of damage in an MI depend on?

A
  • the degree of obstruction
  • the duration
  • collateral circulation
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28
Q

what reduces blood flow/oxygen to to myocardium?

A
  • the atherosclerotic process

- the development of a clot around a ruptured atherosclerotic plaque causes a sudden occlusion

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29
Q

when do symptoms of an MI appear?

A

when the coronary artery blood flow is reduced by at least 75%

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30
Q

is increased workload on the heart in the face of a fixed supply supply or demand?

A

demand

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31
Q

is reduced blood supply to the heart supply or demand?

A

supply

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32
Q

is reduced oxygen carrying capacity of coronary arteries supply or demand?

A

supply

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33
Q

what can increased workload on the heart be caused by? (3)

A
  • HTN
  • aortic stenosis
  • increased metabolic demand
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34
Q

what is reduced blood supply to the heart caused by? (3)

A
  • atherosclerosis
  • coronary artery vasospasm
  • thrombus/embolus
35
Q

what is reduced oxygen carrying capacity of coronary arteries caused by? (3)

A
  • anemia
  • hemodilution
  • acute blood loss
36
Q

what is the nursing care for reduced O2 demand d/t MI?

A
  • rest
  • nitrates
  • morphine
  • beta blockers
  • Ca channel blockers
  • ACE inhibitors (ARB)
37
Q

what is the nursing care for inc. O2 supply d/t MI?

A
  • oxygen when indicated (only when <90%)
  • aspirin 160-325 mg chewed
  • thrombolytic
  • PCI (percutaneous coronary interventions)
  • coronary artery bypass
38
Q

what are medications used for MIs?

A
  • heparins

- antiplatelets

39
Q

what is the management for ischemia?

A
  • oxygen
  • nitrates
  • activity/asprin
  • morphine
  • beta blocker
40
Q

what do nitrates do?

A

relax vascular SM in arteries, particularly in veins, reducing preload and consequently reducing cardiac workload

41
Q

what is the worst thing that could happen to someone on nitrates?

A

vessels dilate too much and blood pools in periphery –> reducing CO

42
Q

what do you do if someone has a nirto patch and their BP is tanking?

A

REMOVE THE PATCH

43
Q

what routes does nitro come in?

A
  • sublingual tablets
  • spray (fastest onset)
  • patches
  • IV
44
Q

what is a common side effect of nitro?

A

headaches

45
Q

what are pre/post assessments of nitro?

A

BP and pain

46
Q

what does morphine do?

A
  • reduces pain and anxiety which reduces SNS activity
  • relaxes vascular SM
  • reduces cardiac workload
  • relaxes bronchial to enhance oxygenation
47
Q

what does morphine slow?

A

the administration of the anti-platelet med being given

48
Q

what is the worst that can happen with morphine?

A
  • resp depression/arrest

- hypotension

49
Q

what does aspirin do?

A
  • treats inflammation

- inhibits coagulation

50
Q

how much does aspirin reduce mortality by?

A

23%

51
Q

what is the worst thing that could happen with aspirin?

A

allergic reaction

52
Q

what do beta blockers do?

A

reduce CO by blocking beta receptors (beta 1)

53
Q

what is the worst that could happen with beta blockers?

A
  • bradycardia
  • inadequate CO
  • bronchospasm
54
Q

what are some examples of beta blockers?

A
  • atenolol
  • metoprolol
  • propranolol
  • doxazosin
  • terazosin
55
Q

what do calcium channel blockers do?

A

relaxation of the vessel walls through blocking of calcium

- reduce after-load and cardiac workload

56
Q

what is the worst that could happen with calcium channel blockers?

A
  • bradycardia

- inadequate CO

57
Q

what can someone not have on calcium channel blockers?

A

GRAPEFRUIT JUICE!!!

58
Q

what are some examples of calcium channel blockers?

A

norvasc, renidil, diltiazem, verapamil

59
Q

what do ACE inhibitors do?

A

inhibit the conversion of angiotensin 1 to angiotensin 2

- reduces afterload and dec. workload of heart

60
Q

what is the worst that can happen with ACE Inhibitors?

A
  • inadequate CO

- cough (angioedema) form action on vasodilator bradykinins

61
Q

what are some examples of ACE inhibitors?

A

enalapril, captopril, ramipril, quinapril

62
Q

what do fibrinolytics do?

A

dissolves body’s fresh fibrin clots (all of them)

63
Q

when are fibrinolytics used?

A

within 6 hours of the first symptoms of a STEMI and percutaneous coronary intervention is not available within 90 mins of first medical contact

64
Q

how much can fibrinolytics reduce mortality by?

A

47-75% if delivered in first hour on onset of symptoms

65
Q

what does heparin do?

A
  • lengthen clotting time
  • prevents thrombus formation/growth
  • inhibits certain clotting
66
Q

how long is the onset for IV heparin?

A

immediate

67
Q

how long is the onset for SC heparin?

A

up to 1 hour

68
Q

what is the half life for heparin?

A

1.5 hours

69
Q

what lab value do you need to monitor closely when administering heparin?

A

PTT

70
Q

what does heparin put you at risk for?

A

GI bleeding

71
Q

what is the antidote for warfarin?

A

vitamin K

72
Q

what do anti-platelet drugs do?

A

reduce platelet aggregation

73
Q

when should you hold anti-platelet drugs?

A

when the platelet count 50 or lower

74
Q

when are thienopyridines indicated?

A

especially after stents

75
Q

when should glycoprotein be given?

A

when patient is going home eg. atrial fib

  • do not require follow up blood work
  • more stable then on warfarin
76
Q

does glycoprotein have an antidote?

A

NO

77
Q

what do statins do?

A

inhibit cholesterol production

- 20-40% reduction in LDL, raise HDL, and lower triglycerides

78
Q

what is the worst that can happen with statins?

A

liver dysfunction, LFT test needs to be done prior/ 3 months past

79
Q

what is important about muscles when administering statins?

A

they become tender and weak

- check CPK (creatinine phosphokinase)

80
Q

what are some adverse effects of statins?

A
  • heartburn
  • abdominal cramping/diarrhea
  • memory loss
81
Q

when should you give statins?

A

with meal in evening

82
Q

why can statins cause early dementia?

A

brain needs fat in order to function, therefore memory is decreasing when you use statins to get rid of fats including those in the brain

83
Q

what is an example of a statin?

A

atorovastatin

N232 (9 decks)

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