Coronary Artery Disease and Acute Coronary Syndrome (CAD & ACS) Flashcards
What is a risk factor for CAD and ACS?
Hypertension. They are all connected
What is Coronary Artery Disease?
- Type of blood vessel disorder in the category of atherosclerosis
- Atherosclerosis is the main cause of CAD
What are the 3 stages of atherosclerosis?
- fatty streak
- fibrous plaque
- complicated lesion
What are factors contributing to atherosclerosis?
Endothelial injury and inflammation
What can cause damage to endothelial lining?
Tobacco use
HTN
Hyperlipidemia
Diabetes
High homocysteine level
Infection
What are markers for inflammation made by the liver?
C-reactive proteins
- CRP levels rise when there is systemic inflammation
- CRP levels are increased in CAD patients
What is collateral circulation?
the body’s compensatory mechanism that creates new connections for blood vessels. (angiogenesis)
What 2 factors contribute to the growth and extent of collateral circulation?
- inherited predisposition to develop new blood vessels (angiogenesis)
- presence of chronic ischemia (poor blood flow)
Why does collateral circulation increase?
Increases when plaque in coronary artery causes an obstruction and blockage leading to ischemia
What are the nonmodifiable risk factors of CAD?
o Age
o Genetics
o Biological sex
o Ethnicity
What are the modifiable risk factors of CAD?
o Tobacco use
o Alcohol use
o Serum lipid level
o Obesity
o Stress
o Sedentary lifestyle
o Diet
o Diabetes (NIDDM)
What is chronic stable angina?
o Chronic and progressive disease
o May be symptomatic and then develop chronic stable chest pain
o Angina = chest pain
o Myocardial ischemia = demand for myocardial O2 exceeds the ability of the coronary arteries to supply
Where does most angina pain occur and for how long?
- occurs substernally (important to ask pt. location of pain)
May radiate to jaw, shoulders, neck, arms
Usually only lasts a few minutes and subsides at rest
Treated with nitroglycerin- dilates peripheral blood vessels, coronary arteries, and collateral vessels
How does Acute Coronary Syndrome develop?
When ischemia is prolonged and not immediately reversible
What can occur/develop with ACS?
Non-ST elevation and unstable angina
What is unstable angina (UA)?
chest pain that is new in onset, and has a worsening pattern from pt.’s chronic stable angina pattern
Unpredictable and must be treated immediately
Nursing care and management includes:
Rapid dxg to preserve cardiac fxn is important
Nursing management for patients with UA/STEMI
Cardiac catheterization with possible PCI (percutaneous intervention) (balloon angioplasty/stent) is considered once angina is controlled or if angina returns or increases in severity
Nursing management for patients with STEMI
- Reperfusion therapy
- Cardiac catheterization is used to find the blockage
- PCI performed after to open the artery to limit infarction size
Thrombolytic therapy aims to limit infarction size by dissolving the thrombus in the coronary artery to re-perfuse the heart muscle
What is atherosclerosis?
hardening of the arteries, fatty deposits in the artery leading to narrowing of the arteries which results in CAD
What kind of a diet will a patient with CAD/ACS have?
Diet that limits saturated fats and cholesterol, emphasize complex carbs
(Ex. of complex carbs = Whole grains, fruits, fiber, vegetables)
What does nursing care and management of a patient with CAD/ACS include?
a. Controlling and changing the effects of modifiable risk factors
b. Regular physical activity program
c. Complete lipid profile recommended every 5 years beginning at age 20
What is the criteria for a patient to receive statin therapy?
i. Patients with known CVD
ii. Patients with primary elevations of LDL cholesterol levels > or = to 190 mg/dl
iii. Patients between 40-75 with diabetes and cholesterol levels between 70-189 mg/dl
iv. ^^ and/or risk for CVD at 7.5%
What is the most widely used drug therapy for CAD/ACS?
Statins
What drug therapy is recommended for people at risk for CAD?
Antiplatelet therapy with low dose aspirin
What medication is considered if patient has contraindications for aspirin?
Plavix
What are the gerontologic considerations for CAD/ACS?
i. Aggressive treatment of HTN and hyperlipidemia helps stabilize plaques in the coronary arteries of older adults
ii. Quitting smoking helps decrease risk
iii. Physical activity program should be encouraged
What type of angina is associated with CAD and STEMI?
Chronic stable angina
What is a STEMI?
ST Elevated Myocardial Infarction
What type angina is associated with ACS and NSTEMI?
Unstable angina
What is a NSTEMI
Non-ST elevated Myocardial Infarction
What is the difference between NSTEMI and STEMI?
STEMI is caused by a FULL OCCLUSION in the artery.
NSTEMI is caused by a PARTIAL OCCLUSION.
What causes increased troponin levels?
MI. During MI, cardiac cells release troponin in response to injury.
What does NSTEMI look like on ECG?
ST depression or T wave inversion
What is the timeframe that one who experiences an NSTEMI should go to the cath lab?
12-72 hours
What are the s/sx of a STEMI?
Chest pain
Pallor, cool, diaphoretic
SNS stimulation
N/V
Fever
SOB
What is the initial tx for a MI?
MONA:
Morphine
Oxygen
Nitro
Aspirin
How often do you monitor vitals for a patient that survived MI?
Every hour for the first few hours
How does morphine treat MI?
Vasodilator and pain med
