Coronary artery disease (CAD)/Stable angina FINAL

Question 1

-Episodic pain lasting 5-15 min
-Provoked by exertion
-Relieved by rest or nitro

Answer 1

chronic stable angina

Question 2

-occurs primarily at rest
-triggered by smoking and increased levels of some substances (histamine, epinephrine)
-may occur n presence or absence of CAD

Answer 2

Prinzmetal’s angina

Question 3

-more common in women
-triggered by activities of daily living
-treatment may include nitro

Answer 3

microvascular angina

Question 4

-new onset angina
-chronic stable angina that increases in frequency, duration, and severity
-occurs at rest or w/ minimal exertion
-pain refractory w/ nitro

Answer 4

unstable angina

Question 5

Usually occurs at points of turbulence (i.e. vessel bifurcations). As plaque increases, arterial lumen progressively narrows→ decreased blood flow to myocardium→ischemia

Answer 5

Atherosclerosis

Question 6

Sx of angina pectoris (chest pain)

Answer 6

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

Question 7

What is the #1 modifiable risk factor for CAD?

Answer 7

smoking

Question 8

What are the 6 P’s for the neurovascular assessment?

Answer 8

Pain
Pulse
Paralysis
Pallor
Paresthesia
Pressure

Question 9

Cardiac cath pre-procedure considerations

Answer 9

• 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

Question 10

Cardiac cath post-procedure considerations

Answer 10

• Sheath Removal – Bedrest, keep extremity straight
• Complications
  o Contrast-induced renal dysfunction, Hematoma/Bleeding, & Restenosis
• Patient Education re: discharge meds

Question 11

Medications for CAD

Answer 11

Nitrates, beta blockers, & calcium channel blockers

Question 12

Beta blockers can cause rebound hypertension. Advise patients that they should never

Answer 12

stop the medication abruptly

Question 13

With transdermal nitroglycerin (patch):

Answer 13

-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

Question 14

Beta blockers decrease in HR and cardiac output. Do not administer if

Answer 14

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

Question 15

Calcium channel blockers cause orthostatic hypotension which places patients at an increased risk for

Answer 15

falls esp. elderly pts

Question 16

Statins reduce cholesterol synthesis in the liver and increase clearance of LDL-C from the blood. Statins are contraindicated for pts w/

Answer 16

liver disease

Question 17

Reminders for statins

Answer 17

Pregnant women should not take
Take a night
Avoid grapefruit juice
Risk for rhabdo

Question 18

Prevention of CAD - Patient self-management

Answer 18

Smoking cessation, healthy diet, lower LDL-C, physical activity, manage DM, lower BP, and lose weight if obese