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

if they have high serum lipid levels (3)

If they have high BP (3)

If they use tobacco
(2)

If they are physically inactive
(1)

If they are obese
(3)

If they are DM
(3)

If they are stressed
(1)

Answer 5

check lipids regularly, and use statin meds if indicated, diet control

check BP regularly, use antihypertensive meds if indicated, DASH diet

stop smoking, don’t start smoking (benefits from stopping will be dramatic and almost immediate, changing to lower nicotine or filtered cigarettes isn’t going to reduce risk)

• check with HCP before starting exercise regimen is middle aged and hx of medical problems
• exercise periods should be at least 40 mins long with warm up and cool down periods
• ideally moderate exercise 3-4 x a week
• if they can’t do that – walk daily for 30 minutes at a comfortable pace
• if they can’t do that- walk any distance they can, ex: park car farther away, etc.)

avoid fad diets, restrict saturated fats, sweets, cholesterol foods, increase physical activity

• monitor glucose levels
• monitor glycemic index in foods
• Regular A1c checks

use stress reduction activities

Question 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.

Answer 6

chronic stable angina

Question 7

diagnostic testing for stable ischemic heart diesase (6)

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 = (1)

Answer 8

symptoms can be managed without intervention

Question 9

if stress test determines high risk patients = _____ and ______ with either _____ or ______

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?

• decreased oxygen __________ and increased oxygen ________
• reduce________
• medications (2)

Answer 10

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

Question 11

medications used for chronic stable angina

• To reduce risk factors
  (2)
• To relieve angina
  o _______ – prevents re-infarction and improves survival for MI patients
  o __________ – given with BB
  o _________– SL 1st line treatment for acute angina symptoms, use at onset or prophylactically
  o _________ – long acting sometimes given with BB
  o ________ (sodium current inhibitor)

Answer 11

o Aspirin daily
o Lipid lowering agents

• 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, long acting)
• ranolazine (sodium current inhibitor)

Question 12

how do you teach a patient to take nitrates?
- take____ tab SL
- if chest pain not relieved in __ min = _____
- then what?
- DO NOT exceed __ tablets

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 to take?

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 (3)

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)

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?

wear ______ when administering ______ or ________

do not discharge a defibrillator over a _______

DO NOT use nitro with meds for ___________

____ form comes in a glass bottle and requires special tubing

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?

it works in less than ___ minutes

keep ________ at all times!

protect from _____

let dissolve or chew?

should ______ under the tongue

if __________ and/or_________ = meds are ineffective = call 911

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

1st dose ineffective =  if continued pain and/or no tingling felt under tongue = call 911 

Question 19

what are the side effects of nitro? (3)

which vital should be check before giving?

Answer 19

Bounding HA, dizziness and flushing

take BP before giving!

risk for postural hypotension

Question 20

Patient teaching for nitro

use________ PRN

only use when _______ to reduce risk of building a tolerance

replace bottle every 6 months

Answer 20

use prophylactically PRN

only use when needed to reduce risk of building a tolerance

replace bottle every 6 months