Coronary Artery Disease

Question 1

What is CAD?

Answer 1

coronary arteries that deliver a constant blood supply to heart muscle start to develop fatty plaques which leads to restriction of blood flow to the heart

these fatty plaques are caused a by a condition called atherosclerosis, which creates fatty plaques in the artery walls. This happens overtime, and limits blood supply to the heart muscle, and if it gets worse, it can lead to blockage.
These plaques can also rupture and lead to thrombus formation
(hence causing a Myocardial infarction)
Atherosclerosis can also lead to hypertension, chest pain, and heart failure.

Question 2

this condition creates fatty plaques in the artery walls

Answer 2

atherosclerosis

Question 3

what is the danger with atherosclerosis ?

Answer 3

It limits blood supply to the heart especially and can eventually lead to total blockage. The plaques that build up on the artery walls can rupture and lead to thrombus formation, which can lead to a myocardial infarction.

Question 4

The left coronary artery branches off to

Answer 4

Left circumflex artery

Left anterior descending artery

Question 5

provides blood to left atrium & lateral and posterior walls of the left ventricle

Answer 5

left circumflex artery

Question 6

provides blood to the front and bottom of the left ventricle and front of the septum

Answer 6

left anterior descending artery

Question 7

_____________ artery provides blood to the right atrium and ventricle and to the bottom part of the left ventricle and back of the septum and branches off to:

Answer 7

Right coronary artery;

–Right marginal artery

-Posterior descending artery

Question 8

Factors that increase the risk of atherosclerosis

Answer 8

Smoking
Unhealthy: obese or overweight
High cholesterol
Sedentary lifestyle
Diabetes
Family history

Question 9

Patho of Atherosclerosis Simplified:

LDL adhesion, asymptomatic, stable angina, activity

Answer 9

Blood flows through the artery which contains the red blood cells and lipids (LDL). LDL (low-density lipoproteins…the bad cholesterol) starts to adhere to the artery wall and grows overtime (risks factors can increase the rate at which it grows).

As it grows the patient is usually asymptomatic until the plaque becomes so big the artery starts to become narrow and blood flow to the heart becomes restricted. The patient can experience stable angina when the artery is blocked enough to slightly impede blood flow (however, blood is still able to get to the heart muscle), but the patient only has the chest pain during ACTIVITY. The activity increases the heart rate and puts strain on the heart which already has compromised blood flow, but when the activity STOPS the pain STOPS too.

Question 10

_______________ can develop if chronic ischemia is experienced. This is where more than one artery forms to re-route blood to the heart muscle to make up for the decreased blood flow due to the blockage.

Answer 10

Collateral circulation

Question 11

Patients with fatty plaque buildup in the arteries are at risk for the plaques to___________, which can lead to ___________.

Answer 11

rupture. coronary thrombosis

This can lead to coronary thrombosis where clotting material aggregates at the site of rupture and this leads to a significant or complete blockage of the coronary artery. Patients will have acute coronary syndrome with unstable angina or experience a myocardial infraction. This is a medical emergency.

Question 12

S/S of Coronary Artery Disease

Many patients are ___________during the early phases of CAD development.

Answer 12

asymptomatic;

chest pain during activity (stable angina…not a medical emergency but patients need to let their doctor know about this chest pain so diagnostic testing can be performed). The pain may feel like heaviness on chest….can progress to unstable angina where the patient will have pain at rest and it is more intense…may not be relieved by Nitroglycerin.

Shortness of breath: easily gets short of breath during activity because the blood supply is impeded to the heart muscle.

Very tired, feeling run down especially with activity

Question 13

stable angina is characterized by

Answer 13

chest pain with activity that is relieved at rest. It is NOT a medical emergency

Question 14

stable angina can progress to _______, which is characterized by

Answer 14

unstable angina; pain at rest and upon exertion, more intense pain, may not be relieved by nitroglycerin

Question 15

three symptoms to remember with coronary artery disease

Answer 15

chest pain, short of breath, tired more easily especially with activity

Question 16

How is Coronary artery disease diagnosed ?

Answer 16

Blood tests: Lipoprotein profile: total cholesterol, LDL, HDL, triglycerides

EKG

Stress test

Heart Cath

Question 17

How can an EKG help to diagnosed CAD?

Answer 17

assesses if there are any changes in the ST segments or t-waves (shows if there is a heart attack in the progress, previous heart attack, or compromised blood flow)
A 24 or 48 hour Holter monitor may be ordered to watch the heart rhythm during the patient’s regular activities of daily living.
ekg st depression and elevation

ST segment depression: demonstrates ischemia that is reversible
ST segment elevation: infarction where there is injury to the heart muscle

Question 18

ST segment depression in CAD demonstrates …………

Answer 18

ischemia that is reversible

Question 19

ST segment elevation in CAD demonstrates ……

Answer 19

infarction where there is injury to the heart muscle

Question 20

How does a stress test help to diagnose CAD ?

Answer 20

It monitors the heart rate and rhythm during exercise and see if there are any EKG changes

During activity, if blood flow is reduced ST segment depression will occur and patient may have chest pain and then as activity stops the ST segment will return back to normal. A patient will probably then be ordered a heart cath to assess where the potential blockage is located.

Also, a nuclear stress test may be ordered. This is where a tracer is injected and pictures of the heart are taken to assess blood flow of the heart muscle during activity.

Question 21

What is a nuclear stress test ?

Answer 21

where a tracer is injected and pictures of the heart are taken to assess blood flow of the heart muscle during activity.

Question 22

How can a heart catheter help to diagnose CAD ?

Answer 22

special catheter is inserted into the femoral or radial artery to assess for blockages in the artery. Dye is injected into the coronary arteries to assess if they are blocked (coronary angiography)…moderate sedation is used and the patient breathes on their own.

Question 23

What is the decision to be made following heart catheterization ?

Answer 23

Cardiac doctor makes the decision if the artery needs:

PCI (also called angioplasty): Percutaneous Coronary Intervention
Balloon angioplasty: inflates a balloon in the blocked artery to compress the plaque against the artery wall and a stent is placed to allow blood to flow back through the artery.

Atherectomy: removal of plaque from the artery
Sometimes, arteries cannot be stented and the patient will have to have surgery known as coronary artery bypass graft.

Question 24

Atherectomy

Answer 24

removal of plaque from the artery

Sometimes, arteries cannot be stented and the patient will have to have surgery known as coronary artery bypass graft.

Question 25

PCI

Answer 25

Percutaneous Coronary Intervention
Balloon angioplasty: inflates a balloon in the blocked artery to compress the plaque against the artery wall and a stent is placed to allow blood to flow back through the artery.

Question 26

Patients with stable angina will complete a ____________ test to assess the need for a heart cath.

Answer 26

stress

The most non-invasive testing is performed first to assess the need of more invasive procedures.

Question 27

Nursing interventions for CAD? What is the goal ?

Answer 27

prevent further progression of CAD

by Educating patient about treatment, preventive measure, medications, and management

Question 28

Modifying lifestyle education points for CAD

Answer 28

How to manage with diet (low fat, low calorie)
Exercise program
Smoking cessation and why it is important
Weight loss

Question 29

Education points for CAD

Answer 29

Educate the patient about the significance and complications of CAD (discussed in part 1 of this series)

Modifying lifestyle:
How to manage with diet (low fat, low calorie)
Exercise program
Smoking cessation and why it is important
Weight loss

Monitoring heart rate and blood pressure

Signs and symptoms and when to seek help

Education about procedures: EKG, stress test, heart cath, lipid profile blood test

Question 30

Antiplatelet meds: prevent clots from forming or growing which decrease the chances of _______________

Answer 30

ischemia

Question 31

With Aspirin, we need to watch out for ………..

Answer 31

GI bleeding

Question 32

Plavix for CAD would be used in patients who can’t tolerate ____________ or just had a __________ placed

Answer 32

Aspirin; stent

Question 33

For patients taking Plavix, what should we monitor for?

Answer 33

Monitor for:
Thrombotic Thrombocytopenic Purpura (TTP): clotting disorder where clots form in blood vessels in the body which causes decreased blood flow to vital organs…low platelet count, neuro changes, bruising, anemia, renal failure, fever

**will need to discontinue medication for 5-7 days before a planned surgical procedure because of the increase chance of hemorrhage while taking this drug. Patients need to let their surgeon know they are taking Plavix because they will be switched to another blood thinner prior to the surgery. Plavix takes a while to clear in the body’s system.
Nitrates:

Question 34

a potentially fatal condition characterized by thrombocytopenia, hemolytic anemia, neurologic symptoms, renal dysfunction, and fever

Answer 34

Thrombotic Thrombocytopenic Purpura

Question 35

What to remember about Nitrates, specifically Nitroglycerin

Answer 35

Nitroglycerin: dilates vessels to allow more blood to get the heart muscle
Educate about how to take: sublingual (underneath the tongue)

Take right when having chest pain
Place one tab or one spray under the tongue

Patient may feel dizzy or hot flushing after taking Nitro.

As the nurse, you will need to monitor their blood pressure because Nitro causes hypotension

If not relieved in 5 minutes take another dose of Nitro a 2nd dose and

If not relieved in 5 minutes take another one for a 3rd dose. The patient is NOT to take more than 3 total doses. If not relieved with the 3rd dose of Nitro the patient needs to call 911.

Question 36

What to remember about cholesterol lowering medications: what should be monitored

Answer 36

Statins “Lipitor, Crestor, Zocor” (goal: LDL less than 100 mg/dL) helps lower LDL, total cholesterol, lower triglycerides, and increase HDL.

Educate not to replace diet and exercise

Notify doctor if they develop muscle pain or tenderness

Monitor CPK (creatine kinase) levels…. which if elevated it can cause muscle problems

Monitor liver function because statins act on the liver to block it from producing too much cholesterol.

Question 37

What to remember about beta blockers for CAD

they should not be taken with ____________

Answer 37

end in “lol” Propranolol, Metoprolol
lowers heart rate and blood pressure which reduces work load on the heart. This will help decrease episodes of chest pain
side effects: mask hypoglycemia signs and symptoms like sweating and tachycardia in diabetics, bradycardia, breathing problems in patients with COPD or asthma, don’t take with grapefruit juice

Question 38

what to remember about ACE inhibitors for CAD

Answer 38

end in “pril” Lisinopril
blocks the conversion of angiotensin I to angiotensin II which caused vasodilation….lowers blood pressure…this decreases the workload on the heart.
Side effect: nagging dry cough