Coronary Vascular Disease Flashcards
Progression of Coronary Artery Disease
atherosclerosis -> angina -> ACS -> MI
Risk factors for CAD
- family hx
- gender (onset earlier in males)
- age (> 45 m; > 55 f)
- race (greater risk in African Americans)
- high cholesterol
- hyperlipidemia
- elevated TGs
- smoking/tobacco use
- HTN
- DM
- obesity
- physical inactivity
- metabolic syndrome
stable angina
pain associated myocardial ischemia
atherosclerosis
abnormal accumulation of lipid deposits and fibrous tissue within arterial walls and lumen
What determines symptoms of atherosclerosis?
vessel location and amount of narrowing in the vessel
How often should people with atherosclerosis receive routine follow-up labs?
every 6 months
What are the modifiable risk factors of atherosclerosis?
- cholesterol/TG levels
- tobacco use
- hypertension
- DM
- activity
- weight
syndrome brought on by an imbalance of oxygen supply to the demand of oxygen need in the myocardium
angina pectoris
What are the main causes of angina pectoris?
- atherosclerosis
- myocardial ischemia
- any reduction in blood flow to the heart (HOTN)
predictable and consistent pain that occurs on exertion and is relieved by rest and/or nitro
stable angina
symptoms increase in frequency and severity; pain not usually relived with rest or nitro
unstable angina
objective evidence of ischemia, but pt reports no pain
silent ischemia
Common exacerbating factors of stable angina
- exercise
- extreme cold
- high stress situation
- substances (tobacco, caffeine, some illicit drugs)
What is the big deal about unstable angina?
it is a health emergency as it is often an indicator of an impending MI
S/S angina pectoris
- pain like indigestion, gripping, pressure, restlessness, anxiety, feeling of impending doom
- chest/neck/jaw/shoulder pain
- BP fluctuation, N/V, pallor, tachycardia, vasoconstriction
older adults will vary as will the symptoms vary in men and women
atypical chest pain symptoms in women
- chest pain, discomfort, pressure
- unusual upper body pain
- cold sweat
- lightheadedness
- nausea
- fatigue
- shortness of breath
angina pectoris medications
- NTG/Imdur
- beta-blockers
- CCBs
- supplemental oxygen
- aspirin, plavix, effient, heparin to prevent larger blockage
emergent situation caused by the onset of myocardial ischemia
acute coronary syndrome
occlusion of the coronary artery that leads to ischemia then to necrosis/death of the myocardium
myocardial infaraction
acute coronary syndrome S/S
same as angina, but onset is faster and they are relieved by rest and medication
ACS diagnostics
- 12 lead EKG
- cardiac enzymes/biomarkers
- echocardiogram
- stress test
- cardiac catheterization
Left Heart Catheterization
radial or femoral artery to insert a catheter, catheter is guided to coronary arteries and contrast is injected
MD can see where vessels are narrowed or blocked
How often should vitals be assessed post-cardiac cath?
usually q15 minutes for the first hour
Post-cardiac cath nursing considerations
- assess vitals, insertion site
- maintain hydration
- maintain bedrest for 4-6 hours (per MD order)
expected ECG changes with ischemia
- ST segment elevation
- ST depression
- T wave inversion
- Pathologic Q wave
pt is symptomatic, but dx are negative for acute ischemia
unstable angina
pt asymptomatic, but dx shows evidence of cardiac ischemia
silent MI
abnormal biomarkers, but no ECG changes
NSTEMI
abnormal biomarkers and ST changes in at least 2 leads
STEMI
What are the two types of STEMIs?
LAD and RCA
widow-maker, anterior wall MI
LAD occlusion
most common, inferior wall MI
RCA occlusion
goals of care for USA and MI
- reestablish blood flow
- decrease damage
- balance supply and demand of oxygen
meds for USA and MI
- NTG/Imdur
- beta-blockers
- CCBs
- supplemental oxygen
- aspirin, plavix, effient, heparin to prevent larger blockage
- ACE-inhibitors
- statins
Procedures for USA and MI
- PCI (angioplasty and stent placement)
- Surgery (CABG)
USA and MI nursing interventions
- position client safely, implement bedrest
- administer MONA if indicated
- call for help from charge nurse
- page provider asap
- call for stat EKG per protocol/MD order
- call for stat labs per protocol/MD order
MONA
- morphine (reduction of workload, pain, and anxiety)
- oxygen (increases oxygen supply)
- nitroglycerin (increases bloodflow to myocardium)
- aspirin (prevention of platelet aggregation)
How fast does reperfusion need to occur with a STEMI?
within 12 hours
What is the “door to needle” time from STEMI indication to thrombolytic admin?
- 30 minutes for best outcomes
- can be within 6-12 if PCI isn’t indicated
