Coronary Artery Disease (CAD)

Question 1

What are the three different possible “names” for CAD?

Answer 1

coronary heart disease
ischemic heart disease
coronary artery disease (all interchangeable)

Question 2

what is responsible for almost all cases of CHD?

Answer 2

atherosclerosis

Question 3

non-modifiable risk factors for CHD

Answer 3

Age (increases with age)
Gender (males at greater risk)
Family History (particularly younger individuals with a family history or premature disease)

Question 4

modifiable risk factors of CHD

Answer 4

1. elevated serum lipids
2. HTN
3. Tobacco use
4. Lack of physical activity
5. obesity (apple shape higher risk of CHD, pear shape)
6. DM
7. Depression and stress

Question 5

patient teaching of how to reduce risk factors of CHD

Answer 5

check lipids regularly, and use statin meds if indicated
check BP regularly, use antihypertensive meds if indicated
stop smoking, don’t start smoking
start exercising at least 40 min 3-4 times per week
avoid fad diets, restrict saturated fats, sweets, cholesterol foods
monitor glucose levels
use stress reduction activities

Question 6

chronic stable angina

Answer 6

occurs with moderate to prolonged exertion in a pattern familiar to patient.
frequency, duration, intensity remain the same over several months
results in slight limitation in activity
relieved by rest
managed with drug therapy
rarely requires aggressive therapy.

Question 7

diagnostic testing for stable ischemic heart diesase

Answer 7

thorough physical exam with complete history
EKG/ECG
stress test (exercise or pharmacological)
echocardiogram and/or TEE

Question 8

if stress tests determines low and moderate risk

Answer 8

symptoms can be managed without intervention

Question 9

if stress test determines high risk patients

Answer 9

Coronary angiography (cardiac cath) and revascularization with either percutaneous coronary interventions n ( PCI) or Coronary artery bypass graft (CABG)

Question 10

what is the goal of collaborative care of chronic stable angina?

Answer 10

decreased oxygen demand and increased oxygen supply
reduce risk factors
medications (antiplatelet, lipid lowering agents)

Question 11

medications used for chronic stable angina

Answer 11

beta blockers (prevents re-infarction and improves survival for MI patients)
calcium channel blockers ( given in conjunction with BB)
nitrates ( SL first, teach pt how to take properly)
ranolazine (sodium current inhibitor)

Question 12

how do you teach a patient to take nitrates?

Answer 12

take 1 tab SL, if chest pain not relieved in 5 min call 911, take another tablet. DO NOT exceed 3 tablets

Question 13

if angina is NEW onset what do you teach the patient?

Answer 13

to chew 325 mg aspirin IMMEDIATLEY

antiplatelet effect begins within 1 hour and lasts several days

Question 14

types of rapid acting nitro

Answer 14

nitrostat (SL)
nitro spray ( translingual)
Trildil ( IV)

Question 15

types of short acting nitro

Answer 15

transderm-nitro (skin patch)

Nitro-bid (ointment)

Question 16

types of long acting nitro

Answer 16

isosorbide (SL or oral)

Question 17

what is important for nurses to know about nitro?

Answer 17

wear gloves when administering ointments or patches
do not discharge a defibrillator over a patch
DO NOT use nitro with meds for erectile dysfunction
IV form comes in a glass bottle and requires special tubing

Question 18

What do patients need to know about SL nitro?

Answer 18

it works in less than 3 minutes
keep accessible at all times!
protect from light
let dissolve DO NOT CHEW
should tingle under the tongue
call 911 if 1st dose ineffective

Question 19

what are the side effects of nitro?

Answer 19

Bounding HA, dizziness and flushing

risk for postural hypotension

Question 20

Patient teaching for nitro

Answer 20

use prophylactically PRN
only use when needed to reduce risk of building a tolerance
replace bottle every 6 months