Ischemic Heart Disease

Question 1

What happens with sudden cardiac death?

Answer 1

Death within 1 hr of onset of Sx. (20-25% of pts)
Must have CPR & defibrillation within 10 minutes for any chance of survival. (still will likely have cognitive deficit)

Question 2

What is chronic stable angina associated with?

Answer 2

Myocardial O2 demand (HR is the key)

Question 3

What makes it chronic STABLE angina?

Answer 3

Well established level of onset
easily can predict activities that will provoke symptoms
Able to reduce by dec activity or taking NTG.

Question 4

When is angina UNSTABLE?

Answer 4

Positive S/S at rest. Not related to myocardial O2 demand.

Question 5

Clinical cues to presence of unstable angina

Answer 5

Angina at rest, at lower levels of activity
Changes in frequency
Evidence of loss of myocardial reserve (drop in BP, increase HR at previously well tolerated levels of activity)

Question 6

What EKG changes are there with a STEMI?

Answer 6

ST segment elevated. Can have T-wave changes. Electricity not moving through the ventricle like it should indicating dead cells there. (32% all ACS)

Question 7

Complications with STEMI during acute stay

Answer 7

Poor activity tolerance, pt anxiety.

Arrythmias

Question 8

What is distinctive about NSTEMI?

Answer 8

No Q wave changes. Coronaries not completely blocked. Ischemia > 30 min

Question 9

What is infarction?

Answer 9

Immediate loss of ability to perform contractile work. There will be abnormal contraction patterns.

Question 10

Challenges to treating MI

Answer 10

Fear, Activity tolerance, PLOF, Environment PTA, dietary/exercise changes.

Question 11

What do they do with Left Heart Catherization (LHC)

Answer 11

Go thru femoral (or brachial artery) thru aorta find the blockage in the heart, and inflate balloon to push plaque to the side. Place stent. This is more diagnostic.

Question 12

What info is obtained with LHC?

Answer 12

Occlusion, stenosis, restenosis, thrombosis.
Heart chamber size
Heart muscle contraction performance (EF)
Heart and lung BP

Question 13

What are the 2 types of stents used with Percutaneous Coronary Intervention (PCI)

Answer 13

Drug eluding & bare metal

Question 14

How long must you take plavix with the 2 different types of stents?

Answer 14

Drug eluding 1 yr (better at preventing restenosis)

Metal 30 days

Question 15

What ways can they gain access with CABG?

Answer 15

Median sternotomy
Minimally invasive (go tru the ribs, only works with single bypass from LIMA to LAD)

Question 16

What materials can they use for grafting with CABG?

Answer 16

Saphenous vein, radial artery, LIMA

Question 17

What are the standard sternal precautions?

Answer 17

No shoulder flexion > 90
No pushing/pulling with UE
No lifting > 10 lbs
(in general avoid things that stretch the wound)

Question 18

How long are sternal precautions in place for?

Answer 18

6-8 weeks

Question 19

Where is the most common location for dehiscence?

Answer 19

Over the xiphoid process.

Question 20

What will an ischemic disease pt tend to look like demographically?

Answer 20

Overweight, have diabetes/htn/high cholesterol, SMOKER, more men (40-50) than women (50-60)

Question 21

What tests might you be aware of with someone post cardiac surgery?

Answer 21

ECHO, ECG

Labs: cardiac enzymes

Question 22

What will you observe in your eval post op?

Answer 22

HR, BP, UE/LE strenght, activity tolerance, pain, gait, coordination, tone, balance

Question 23

Acute intervention post op

Answer 23

Gait training (stairs, activity tolerance), HR monitoring (shouldn't be > 20 bpm above resting)
EDUCATION (energy conservation, precautions)
LE ROM (keep mobility - if saphenous vein graft)

Question 24

What are common MI warning signs?

Answer 24

• pressure, fullness, - squeezing in center of chest
  pain in throat, neck back, jaw, shoulders, arms
• lightheadedness, dizziness, diaphoresis, pallor
• symptoms unrelieved by NTG, antacids, rest

Question 25

What are uncommon MI warning signs?

Answer 25

• unusual chest pain, stomach or abdominal pain
• continuous midthoracic or interscapular pain
• isolated R biceps pain
• unexplained intense anxiety, weakness, fatigue
  breathlessness