Coronary Artery Disease and Coronary Syndrome Flashcards
What are the four developmental stages of CAD?
- Fatty streak
- Fibrous plaque
- Complicated lesion
- Collateral circulation
What is the range for sodium?
135-145
What is the range for potassium?
3.5-5
What is the range for glucose?
3.9-7.8
What is the range for leukocytes?
4.5-11
What is the range for hemoglobin?
female: 120-160
male: 135-180
What are some health promoting behaviours for CAD?
- physical fitness
- nutritional therapy
- cholesterol-lowering drug therapy
- anti platelet therapy
What is angina?
Chest pain that is the clinical manifestation of reversible myocardial ischemia
What are the symptoms of angina?
- tightness, choking, or a heavy sensation
- anxiety
- retrosternal and may radiate to neck, jaw, shoulders, back, or arms (usually left)
-dyspnea or shortness of breath, dizziness, nausea, and vomiting - SUBSIDES WITH REST
What is stable symptoms of angina?
- Usually follows a predictable pattern.
- Pain generally happens at about the same point with exercise or emotional stress.
- Pain is usually relieved with rest or medication.
What are unstable symptoms of angina?
- Unexpected chest pain at rest or without stimulating activity.
- If the chest pain is new, worsening or constant, there is a greater risk of having a heart attack, an irregular heartbeat (arrhythmia), and even sudden death.
- See doctor as soon as possible.
What is chronic stable angina?
Reversible (temporary) myocardial ischemia = angina (chest pain)
- O2 demand > O2 supply
What is the S&S of chronic stable angina?
- Pressure/ache in chest
- Pain usually lasts 3 to 5 minutes.
What are the 5 types of stable angina?
- silent ischemia
- nocturnal angina
- angina decubitus
- prinzmetal’s (variant) angina
- microvascular angina
What is silent ischemia?
- Ischemia that occurs in the absence of any subjective symptoms
- Associated with diabetic neuropathy
- Confirmed by ECG changes
What is nocturnal angina?
Occurs only at night but not necessarily during sleep
What is angina decubitus?
- Chest pain that occurs only while lying down
- Relieved by standing or sitting
What is prinzmetal’s (variant) angina?
- Occurs at rest usually in response to spasm of major coronary artery
- rare
- Calcium channel blockers and/or nitrates are used to control the angina (ie. Verapamil, diltiazem)
What is microvascular angina?
- ** Coronary MVD is a new concept and may be a cause of heart disease in women. **
- May occur in the absence of significant coronary atherosclerosis or coronary spasm
- Pain is related to myocardial ischemia associated with abnormalities of the coronary microcirculation
What is the diagnosis test for stable angina?
- ECG, stress test, echocardiography, EBCT, PET scan, coronary angiography
What is the treatment of stable angina?
- drug therapy
- coronary revascularization: PCI or CABG
What is the drug therapy for chronic stable angina?
- Short-Acting Nitrates: First-line therapy for the treatment of angina. Dilating peripheral blood vessels, coronary arteries, and collateral vessels.
- Long-Acting Nitrates: used to reduce the incidence of anginal attacks.
- β-Adrenergic blockers: Preferred drugs for the management of chronic stable angina
4.Calcium channel blockers: used for prinzmetals angina - Angiotensin-converting enzyme inhibitors: Patients with chronic stable angina who are considered at high risk for a cardiac event.
What is pt teaching for chronic stable angina?
- Lifestyle changes and reduction of risk factors
- Explore, recognize, and adapt behaviours to avoid to reduce the incidence of episodes of ischemia
- Teaching regarding disease process
- Medications (Nitro)
- Returning to activities
- Stress reduction
What is acute coronary syndrome(ACS)?
-Develops when myocardial ischemia is prolonged and not immediately reversible.
- includes unstable angina and myocardial infarction
- part of the myocardium is permanently destroyed
What is the etiology and pathophysiology of acute coronary syndrome(ACS)?
- deterioration of once stable plaque
- rupture
- platelet aggregation
- thrombus
What is unstable angina?
- Chest pain that is new in onset, occurs at rest, or has a worsening pattern.
- Unpredictable and represents a medical emergency
What is myocardial infarction? (MI)
Result of sustained ischemia (>20 minutes), causing irreversible myocardial cell death (necrosis)
- involve the left ventricle
What is the S&S of MI?
- pain
- heaviness, constriction, tightness, burning, pressure, or crushing
-severe, immobilizing chest pain not relieved by rest, position change, or nitrate administration - SOB, crackles, JVD, increased BP, N&V, decreased urine output, cool, clammy skim, anxiety
What is the complications of MI?
- Dysrhythmias
- heart failure
- cardiogenic shock
- papillary muscle dysfunction
- ventricular aneurysm
- pericarditis
- Dressler syndrome
What is the diagnostic studies for Angina and MI?
electrocardiographic findings
- changes in QRS complex, ST segment, and T wave can rule put or confirm UA or MI
What are the three serum cardiac markers for testing for angina and MI?
- CK-MB
- Troponin
- Myoglobin
What is the treatment of acute MI?
MONA
M-morphine
O-oxygen
N-Nitrate
A- Aspirin
What is a percutaneous coronary intervention (PCI)?
- ballon angioplasty
- stent
- Emergent PCI is the first line of treatment for pt confirmed with MI
What is coronary artery bypass graft (CABG)?
- The chest is opened, heart is stopped, blood is rerouted through a lung-heart machine.
- Blood vessel grafts are taken from arteries or veins in the chest wall or other areas of the body and transplanted in front of and beyond the blocked arteries.
- Patients may require one, two, or three grafts depending on the number of coronary arteries that are blocked.
Who is recommended for CABG surgery?
- who do not achieve satisfactory improvement with medical management
- who have left main coronary artery or three-vessel disease
- who are not candidates for PCI (e.g., lesions are long or difficult to access)
- in whom PCI has failed and chest pain is ongoing
What is the complications of CABG?
- Bleeding and anemia from damage to RBCs and platelets
- Fluid and electrolyte imbalances
- Hypothermia as blood is cooled as it passes through the bypass machine
- Infection
What is sudden cardiac death(SCD)?
death due to a cardiovascular cause that occurs within one hour of the onset of symptoms. A sudden cardiac arrest occurs when the heart stops beating or is not beating sufficiently to maintain perfusion and life
What is the 5 H’s of cardiac arrest?
- hypovolemia
- hypoxia
- hydrogen ion (acidosis)
- hyper/hypo-kalemia
- hypothermia
What is the 5 T’s of cardiac arrest?
- toxins
- tamponade
- tension pneumothorax
- thrombosis- coronary
- thrombosis- pulmonary
What lab value do you watch for someone who is having an MI?
troponin, results come faster
- test again in 6 hours
If you are walking a pt with angina and they suddenly get SOB and chest pain. What do you do?
sit them down right where they are
Do female pts experience more typical or atypical symptoms of chest pain? Why?
atypical, they have smaller arteries
Someone has a heart attack, what would you do?
call a code blue
- doctors will eventually put in an angiogram and a stent
What is some post op considerations for someone with an angiogram?
- risk for bleeding, look for pulse below the site
What is ischemia of the heart muscle??
no oxygen to the heart = dying heart muscle
