Coronary Artery Disease and Acute Coronary Syndrome Flashcards
Atherosclerosis
a chronic disease that causes the buildup of plaque in the arteries, which can narrow them and reduce blood flow
Collateral Circulation
alternate or “backup” blood vessels in your body that can take over when another artery or vein becomes blocked or damaged
Cholesterol
> 200 mg/dl
Triglycerides
> 150 mg/dl
HDL
< 40 mg/dl
LDL
> 130 mg/dl
White males
highest mortality from CAD
Native Americans
die earlier than expected
Nutritional Therapy
Decrease saturated fat and cholesterol
Increase complex carbohydrates and
fiber
Increase intake of Omega-3 fatty acids
Limit alcohol use
Limit red meats, full-fat dairy,
processed foods
Activity
Track activity
30 minutes at least 5 days per week
Increase weight training (2 days a
week)
Gerontology Consideration
Assess for readiness for enhanced learning
Symptoms are determined to be a result of CAD not “normal
aging”
Need to modify guidelines for physical activity
Angina
clinical manifestation of
reversible cardiac ischemia
Chronic Stable
Angina
- Chest Pain that occurs
intermittently over long period of
time - Same pattern of onset, duration
and intensity - Pain at rest is unusual
Diagnostic studies
Chest x-ray
12-lead ECG
Laboratory studies
Echocardiogram
Exercise stress test
Coronary CT Angiography
Cardiac Catheterization
Cardiac
Catheterization
Cardiac catheterization
—“gold standard” to
identify and localize CAD
Visualize blockages
(diagnostic)
Open blockages
(interventional)
Percutaneous coronary
intervention (PCI)
Balloon angioplasty
Acute Coronary Syndrome
Unstable angina
ST-segmental elevation MI (non)
Blood flow to the heart muscle is suddenly reduced or blocked
ACS Etiology
Deterioration of once stable plague –>Rupture –> Platelet
aggregation –> Thrombus
Partial
occlusion of
coronary
artery
Unstable
angina or
NSTEMI
Total occlusion
of coronary
artery
STEMI
Clinical Manifestations:
Unstable
Angina
New in onset
Occurs at rest
Increase in frequency, duration, or with
less effort
Pain lasting > 10 minutes
Needs immediate treatment
Symptoms in women often under-
recognized
ECG Changes
Pain
- Severe chest pain not relieved
by rest, position change, or
nitrate administration - Often occurs in early morning
- Atypical in women, elderly
- No pain if cardiac neuropathy
(diabetes)
Sympathetic nervous system
stimulation
- Release of catecholamines
- Diaphoresis
- Increased HR and BP
- Vasoconstriction of peripheral
blood vessels - Skin: ashen, clammy, and/or
cool to touch
Clinical Manifestations: Cardiovascular
Initially, ↑ HR and BP, then ↓
BP (secondary to ↓ in CO)
↓renal perfusion leads to
↓urine output
Crackles
Jugular venous distention
Abnormal heart sounds
* S3 or S4
* New murmur
Clinical Manifestations: Nausea and Vomiting
Reflex stimulation of the
vomiting center by severe
pain
Vasovagal reflex
Clinical Manifestations: Fever
Up to 100.4° F (38° C) in first
24-48 hours
Systemic inflammatory
process caused by heart cell
death
ACS Treatment Priorities
12-lead ECG
Upright position
Oxygen – keep O2 sat > 93%
IV access
Nitroglycerin (SL) and ASA !
(chewable)
Statin
Morphine
Ongoing monitoring
- Treat dysrhythmias
- Frequent vital sign monitoring
- Bed rest/limited activity for
12–24 hours
UA or NSTEMI
- Dual antiplatelet therapy and
heparin - Cardiac catheterization with
PCI once stable
ACS Treatment
EMERGENT PCI
Treatment of choice for
confirmed STEMI
Goal: 90 minutes door to
cath lab
Balloon angioplasty +
stent(s)
Many advantages over CABG
THROMBOLYTIC THERAPY
Only for patients with a
STEMI
Agencies that do not
have cardiac
catheterization resources
Given IV within 30 minutes
of arrival to the ED
Patient selection critical
CABG
24-48 hr ICU
Hemodynamic monitoring
Arterial Line
Chest Tubes
ECG monitoring
Pacing wires
Endotracheal tube
Urinary catheter
Nasogastric tube
CABG Complications
Bleeding, dysrhythmias, pain, DVT
prevention, Inflammation
Nursing Goals
Relief of pain
Preservation of heart muscle
Effective coping with illness-associated anxiety
Resumption of Sexual Activity
Participation in a rehabilitation plan
Health Promotion
UAP
- VS
- I&O’s
- Assist with meals,
toileting - Report complications
LPN
- May handle stable
patient - Cannot administer
thrombolytic
medications
Sudden Cardiac Death (SCD)
Unexpected death
from cardiac
causes
* Occurs within 1 hour of
symptom onset
SCD Symptoms
Dysrhythmia (e.g.,
VT, VF) causes
disruption in
cardiac function,
resulting in loss of
CO and cerebral
blood flow
After SCD
If survive, increased risk of another event due to electrical instability from scarred muscle
“Brush with death”, “Time bomb” mentality, anger, depression
Driving restrictions, change in occupation
Serum Cardiac Biomarkers After MI
Troponin, CK-MB, and myoglobin
ECG Changes
