Coronary artery disease (CAD)/Stable angina Flashcards
Major types of angina
Chronic stable angina
Prinzmetal’s angina
Microvascular angina
Unstable angina
-Episodic pain lasting 5-15 min
-Provoked by exertion
-Relieved by rest or nitro
chronic stable angina
-occurs primarily at rest
-triggered by smoking and increased levels of some substances (histamine, epinephrine)
-may occur n presence or absence of CAD
Prinzmetal’s angina
-more common in women
-triggered by activities of daily living
-treatment may include nitro
microvascular angina
-new onset angina
-chronic stable angina that increases in frequency, duration, and severity
-occurs at rest or w/ minimal exertion
-pain refractory w/ nitro
unstable angina
Usually occurs at points of turbulence (i.e. vessel bifurcations). As plaque increases, arterial lumen progressively narrows→ decreased blood flow to myocardium→ischemia
Atherosclerosis
Angina pectoris
chest pain
Sx of angina pectoris
o Pain symptoms vary - ranges from a vague, barely troublesome ache, bloating, gas to a crushing sensation. Common beneath the sternum, may radiate to L shoulder, down the left arm, straight through to the back, into the throat, jaw, teeth.
o Women may have atypical symptoms such as malaise, SOB, Anxiety & Fatigue
What is the #1 modifiable risk factor for CAD?
smoking
Bad cholesterol
LDL
Good cholesterol
HDL
Troponins indicate
heart tissue death
Lab parameters for CAD
Total cholesterol <200 mg/dL
LDL <100 mg/dL
HDL >40 mg/dL
Triglycerides <150 mg/dL
C-reactive protein <0.175 mg/L (inflammation marker, but not cardiac specific)
Homocysteine <17
Diagnostic tests for CAD
-ECG
-stress tests
-CT or PET scans
Types of stress tests
o Treadmill/Bike - Exercise to stress the heart and look for symptoms of decreased perfusion
o Pharmacologic Stress Test - Same concept, uses dobutamine (increases contractility) or dipyridamole (coronary artery dilator) to stress the heart
Cardiac cath pre-procedure considerations
- look for consent, check for metformin (Glucophage) use, or allergies to iodine or shellfish (contrast medium)
- Assess baseline neurovascular assessment, heart & breath sounds, VS
- Teaching Procedure/Post Procedure:
Conscious sedation – awake during procedure
May feel flushing or warmth when dye is injected
What are the 6 P’s for the neurovascular assessment?
Pain
Pulse
Paralysis
Pallor
Paresthesia
Pressure
Cardiac cath post-procedure considerations
- Sheath Removal – Bedrest, keep extremity straight
- Complications
o Contrast-induced renal dysfunction, Hematoma/Bleeding, & Restenosis - Patient Education re: discharge meds
Medications for CAD
Nitrates, beta blockers, & calcium channel blockers
Beta blockers can cause rebound hypertension. Advise patients that they should never
stop the medication abruptly
With transdermal nitroglycerin (patch):
-apply to a clean, dry, hairless area so medication is better absorbed
-rotate application sites to prevent skin irritation
-remove patch before defibrillation to prevent burns
-remove patch after 12-14 hrs each day to prevent drug intolerance
Beta blockers decrease in HR and cardiac output. Do not administer if
HR is <50-60 bpm or systolic <90-100 mmHg
Watch for signs of HF (cough, edema, SOB, weight gain)
Assess for wheezing & SOB because beta2 blockers causes bronchoconstriction
Calcium channel blockers cause orthostatic hypotension which places patients at an increased risk for
falls
esp. elderly patients
When patients are taking antiplatelets such as aspirin, clopidogrel, & prasugrel what education should be provided?
-bleeding is a side effect
-take w/food to avoid GI upset
-ringing in ears can be a sign of aspirin toxicity
-should not be stopped unless indicated by provider
Statins reduce cholesterol synthesis in the liver and increase clearance of LDL-C from the blood. Statins are contraindicated for pts w/
liver disease
Reminders for statins
Pregnant women should not take
Take a night
Avoid grapefruit juice
Risk for rhabdo
Prevention of CAD - Patient self-management
Smoking cessation, healthy diet, lower LDL-C, physical activity, manage DM, lower BP, and lose weight if obese
