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303 Med Surg > Coronary Artery Disease and Acute Coronary Syndrome (CAD & ACS) > Flashcards

Coronary Artery Disease and Acute Coronary Syndrome (CAD & ACS) Flashcards

1
Q

What is a risk factor for CAD and ACS?

A

Hypertension. They are all connected

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2
Q

What is Coronary Artery Disease?

A
  • Type of blood vessel disorder in the category of atherosclerosis
  • Atherosclerosis is the main cause of CAD
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3
Q

What are the 3 stages of atherosclerosis?

A
  1. fatty streak
  2. fibrous plaque
  3. complicated lesion
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4
Q

What are factors contributing to atherosclerosis?

A

Endothelial injury and inflammation

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5
Q

What can cause damage to endothelial lining?

A

 Tobacco use
 HTN
 Hyperlipidemia
 Diabetes
 High homocysteine level
 Infection

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6
Q

What are markers for inflammation made by the liver?

A

C-reactive proteins
- CRP levels rise when there is systemic inflammation
- CRP levels are increased in CAD patients

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7
Q

What is collateral circulation?

A

the body’s compensatory mechanism that creates new connections for blood vessels. (angiogenesis)

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8
Q

What 2 factors contribute to the growth and extent of collateral circulation?

A
  1. inherited predisposition to develop new blood vessels (angiogenesis)
  2. presence of chronic ischemia (poor blood flow)
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9
Q

Why does collateral circulation increase?

A

Increases when plaque in coronary artery causes an obstruction and blockage leading to ischemia

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10
Q

What are the nonmodifiable risk factors of CAD?

A

o Age
o Genetics
o Biological sex
o Ethnicity

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11
Q

What are the modifiable risk factors of CAD?

A

o Tobacco use
o Alcohol use
o Serum lipid level
o Obesity
o Stress
o Sedentary lifestyle
o Diet
o Diabetes (NIDDM)

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12
Q

What is chronic stable angina?

A

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

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13
Q

Where does most angina pain occur and for how long?

A
  • 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
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14
Q

How does Acute Coronary Syndrome develop?

A

When ischemia is prolonged and not immediately reversible

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15
Q

What can occur/develop with ACS?

A

Non-ST elevation and unstable angina

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16
Q

What is unstable angina (UA)?

A

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

17
Q

Nursing care and management includes:

A

Rapid dxg to preserve cardiac fxn is important

18
Q

Nursing management for patients with UA/STEMI

A

Cardiac catheterization with possible PCI (percutaneous intervention) (balloon angioplasty/stent) is considered once angina is controlled or if angina returns or increases in severity

19
Q

Nursing management for patients with STEMI

A
  • 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
20
Q

What is atherosclerosis?

A

hardening of the arteries, fatty deposits in the artery leading to narrowing of the arteries which results in CAD

21
Q

What kind of a diet will a patient with CAD/ACS have?

A

Diet that limits saturated fats and cholesterol, emphasize complex carbs
(Ex. of complex carbs = Whole grains, fruits, fiber, vegetables)

22
Q

What does nursing care and management of a patient with CAD/ACS include?

A

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

23
Q

What is the criteria for a patient to receive statin therapy?

A

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%

24
Q

What is the most widely used drug therapy for CAD/ACS?

A

Statins

25
Q

What drug therapy is recommended for people at risk for CAD?

A

Antiplatelet therapy with low dose aspirin

26
Q

What medication is considered if patient has contraindications for aspirin?

A

Plavix

27
Q

What are the gerontologic considerations for CAD/ACS?

A

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

28
Q

What type of angina is associated with CAD and STEMI?

A

Chronic stable angina

29
Q

What is a STEMI?

A

ST Elevated Myocardial Infarction

30
Q

What type angina is associated with ACS and NSTEMI?

A

Unstable angina

31
Q

What is a NSTEMI

A

Non-ST elevated Myocardial Infarction

32
Q

What is the difference between NSTEMI and STEMI?

A

STEMI is caused by a FULL OCCLUSION in the artery.
NSTEMI is caused by a PARTIAL OCCLUSION.

33
Q

What causes increased troponin levels?

A

MI. During MI, cardiac cells release troponin in response to injury.

34
Q

What does NSTEMI look like on ECG?

A

ST depression or T wave inversion

35
Q

What is the timeframe that one who experiences an NSTEMI should go to the cath lab?

A

12-72 hours

36
Q

What are the s/sx of a STEMI?

A

Chest pain
Pallor, cool, diaphoretic
SNS stimulation
N/V
Fever
SOB

37
Q

What is the initial tx for a MI?

A

MONA:
Morphine
Oxygen
Nitro
Aspirin

38
Q

How often do you monitor vitals for a patient that survived MI?

A

Every hour for the first few hours

39
Q

How does morphine treat MI?

A

Vasodilator and pain med

303 Med Surg (5 decks)

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