Ischemic Heart Disease

Question 1

Coronary heart disease non-modifiable risk factors

Answer 1

age
family history
gender (males younger, after menopause, women catch up with males because they lose the protective power of estrogen)
ethnicity (blacks, hispanics, indigenous ppl)
genetics

Question 2

Coronary heart disease modifiable risk factors

Answer 2

HTN
Smoking
Diabetes
Diet
Obesity/Inactivity (abdominal obesity)
Hyperlipidemia
Depression/Stress

Question 3

Endothelial dysfunction

Answer 3

vessels aren’t necessarily blocked but become narrowed when are supposed to dilate→thought to be result of inappropriate hormones and smoking

Causes: DM, HTN, HPL, smoking

Question 4

Main symptom of CAD

Answer 4

Angina

Question 5

CAD may also be asymptomatic

Other S/Sxs

Answer 5

Dizziness
Chest pain
Heartburn
Irregular heart rate
Weakness
Anxiety
Nausea
Cold Sweat
Burning sensation (stomach, throat/chest, left shoulder)

Question 6

Stable Angina

Answer 6

Caused by atherosclerosis of the coronary arteries and presents as:
Episodic
Occurs on exertion, relieved by rest
Lasts 2-5 minutes
If occurs, need to sit down/rest

Question 7

Unstable Angina

Answer 7

Severe and new onset
Crescendo pattern
Occurs at rest
Lasts > 10 minutes

Question 8

Atypical angina in women

Answer 8

Discomfort→→hot or burning, tenderness

Location→→ not always the chest

Other S/Sxs
Indigestion
heart burn
nausea
fatigue/weakness
lightheadedness
dyspnea

Question 9

Angina pectoris and pain with MI

Answer 9

Pain not brought on by exertion
Pain may radiate to other areas
Pain not relieved in 2-5 minutes
Often accompanied by N/V, SOA, diaphoresis
Risk for MI ↑

Question 10

Nursing implications with stable angina

Answer 10

Education→ remember rest and relaxation; stop what you’re doing and sit down

Nitrates

Prevent/treat further atherosclerosis→→Treat HTN, HLP, DM, smoking cessation

Teach about MIs→increased risk for MIs; pain doesn’t stop within 5 minutes, call 911

Question 11

mechanism of pain relief for stable angina

Nitrates

Answer 11

dilates veins, which decreases preload

Question 12

mechanism of pain relief for stable angina

beta blockers

Answer 12

decrease heart rate and contractility

Question 13

mechanism of pain relief for stable angina

calcium channel blockers

Answer 13

dilate arterioles, which decreases afterload

decreases heart rate and contractility

Question 14

mechanism of pain relief for stable angina

ranolazine

Answer 14

helps the myocardium generate energy more efficiently

Question 15

nitroglycerin

AE

Answer 15

related to vasodilation
HA, hypotension, reflex tachycardia
Tolerance

Question 16

nursing implications for nitrates

Answer 16

Monitor for HA–give mild analgesic, usually subside within 20 minutes (duration of action is short)

apply patches in morning, remove in evening (hairless sites and rotate)

develop tolerance, only take as many as needed

if pain doesn’t subside in 5 minutes, call 911 but take another SL tab, and one more if needed (up to 3)

long-acting forms–taper when d/c to prevent vasospasm

Question 17

Interactions with nitrates

Answer 17

severe hypotension when taken with:
sindenafil/Viagra
antihypertensives
ETOH

Question 18

ranolazine

Answer 18

newest class of anti-anginals

Moa not clear, possibly helps myocardium use energy more efficiently

Question 19

ranolazine

ae

Answer 19

HA, dizziness, N/C

WARNING: prolongs QT interval, acute renal failure, liver cirrhosis

CYP inhibitor–avoid grapefruit juice and other meds that are inhibitors