LEC 3: Coronary Artery Disease (CAD) Flashcards
What are non-modifiable risk factors for CAD?
- Age
- Gender
- Ethnicity
- Genetic predisposition/ family history
What are contributing risk factors to CAD?
- Metabolic syndrome
- Diabetes
- Psychological states/ stress levels
What are major risk factors to CAD that are modifiable?
- Elevated serum lipids
- Increased LDL cholesterol
- Deaceased ADL cholesterol - Hypertension
- Cigarette smoking
- Obesity
- Abdominal obesity - Physical inactivity
Coronary Artery Disease
Coronary Artery Disease leads to:
1a. Chronic stable angina (eventually leads to acute coronary syndrome)
2a. Acute coronary syndrome
Acute Coronary Syndrome leads to:
2a. Unstable angina and non-ST-segment elevation MI
2b. ST-segment elevation MI (total occlusion)
Chronic Stable Angina
Chest Pain (Last 3 to 4 minutes)
- Occurs intermittently- long time period
- Sam onset, duration, and intensity of symptoms
- “Pressure” or “ache” in chest
- Complaints of indigestion or burning
- Pain brief- subsides when precipitating factor gone
- Predictable
- Reversible myocardial ischemia (occlusion is reversible)
- Responsive to nitroglycerin
Acute Coronary Syndrome (ACS)
- Ishemia prolonged, not immediately reversible
- Deterioration of plaque that was once stable
- Thrombus can partially or completely occlude coronary artery
Unstable Angina
Chest pain
- New in onset, occurs at rest, or worsening
- Unpredictable
- Increasing frequency, provoked by minimal or no exertion- even at sleep or rest
- No elevated serum cardiac markers and no electrocardiogram (EXG) changes
What is the cause of unstable angina?
Thrombis partially or intermittently occludes the coronary artery
NSTEMI: Non-ST- Segment Elevated Myocardial Infraction
Clinical Manifestations
- Chest pain longer then 20 minutes- severe, unrelieved by rest, position change, or nitroglycerin
- Diaphoresis, cool, clammy skin
- Blood pressure and heart rate increased initially
- Elevated serum cardiac markers (but ST depression on the ECG)
What is the cause of non-ST- segment elevated myocardial infraction (NSTEMI)?
Thrombis partially or intermittently occludes the coronary artery
STEMI: ST Segment Elevated Myocardial Infraction
Clinical Manifestations:
- Chest pain that does not go away- severe, unrelieved by rest, position change, or nitroglycerine
- Diaphoresis, cool, clammy skin
- Blood pressure and heart rate increased initially
- Elevated serum cardiac makers and ST elevation on the ECG
- Heart cells start to die, enzymes will be released
- If blood flow not restored the patient will die
What is the cause of ST segment elevated myocardial infraction (STEMI)?
Thrombus fully occludes the coronary artery which leads to irreversible tissue damage/ death. Blockage has to be surgically removed
What are the assessments for stable angina and acute coronary syndrome (ACS)?
- Chest pain: PQRSTU assessment
- Other symptoms
- Weakness or numbness in arms, wrists, hands
- SOB
- Diaphoresis
- Pallor, ashen, clammy, cool to touch
- Dizziness
- Dysrhythmias
- Heartburn, nausea, vomiting
- Fever - Special Condierations
- Diabetes mellitus (DM)
- Gender
- Will do an ECG and diagnostic tests to differentiate
- Woman may not experience chest pain, more vague and harder to diagnose
- Diabetics may not experience any pain or shortness of breath
Nursing Interventions for Stable Angina and Acute Coronary Syndrome (ACS)
Patient is having chest pain, what do you do?
- Assessments
- Vital signs
- PQRSTU
- Past history
- Skin assessment - Administer
- Can administer medication if doctors orders
- Can administer nitrogen glyceride is there is a doctors order; 1 every 5 minutes 3x; take BP and ask about chest pains - Position
- Psychosocial
- Notify Dr.
* Need to react quickly
What are the diagnostic test needed?
- Electrocardiogram (ECG)
- Serum cardia markers
- CKMB and troponin level - Chest X-ray (CXR)
- How is the L ventricle ? - Echocardiogram (echo)
- How heart is effective; pump and heart vessesl - Angiography
- Inject die into blood stream and see where blockage is in coronary arteries
What are the overall care goals?
- Relief of pain
- Preservation of myocardium
- Immediate and appropriate treatment
- Effective coping with illness-associated anxiety
- Reduction of risk factors
- Participation in a rehabilitation plan
- Client teaching
- Physical exercise
- Resumption of sexual activity (two flights of stairs without chest pain) - Cardia rehabilitation program in Saskatoon
What is the treatment for chronic stable angina?
- Deceased O2 demand or increase O2 supply
- Health teaching
- Drug therapy
- Antiplatelets agents (aspirin, clopidogrel, ticagrelor) - Blood pressure lowering agents (beta blockers, Ca channel blockers, ACE inhibitors/ ARBs)
- Cholesterol lowering agents (statins)
- Nitrate therapy (nitroglycerin)
What is the treatment for unstable angina and ACS?
- Decrease O2 demand or increase O2 supply
- Re-establish blood flow
- Oxygen
- Nitroglycerin
- Antiplatelets agents (aspirin, clopidogrel, ticagrelor)
- Blood pressure lowering agents (beta blockers, Ca channel blockers, ACE inhibitors/ ARBs)
- Cholesterol lowering agents (statins)
- Analgesics
- Fibrinolytic agents
What are the medical interventions for patients who have total occlusion?
- Percutaneous transluminal angioplasty (PCTA)
- Cardiac Cstherization
- Percutaneous coronary intervention (PIC)
- Stenting - Coronary artery bypass graft surgery (CABG)
Key Points on Coronary Artery Disease (CAD)
- Most common cause of CAD is coronary atherosclerosis
- There are many non-modifiable and modifiable risk factors
- Health promotion is key in preventing cardiac disease
- There are different professions of coronary artery disease that can result from temporary occlusion to cardiac muscle death
- Overall goal is preservation of myocardium by eliminating occlusion
