management of coronary artery alterations Flashcards
what is a widow maker
a block in the coronary artery
where is the left anterior descending coronary arteries
anterior and lateral wall of the left ventricle
where is the circumflex coronary artery
posterior and lateral wall of the left ventricle
where is the right coronary artery
SA node and AV node
where there is a block in the right coronary artery what happens
it blocks out the SA node and the AV node
what is atherosclerosis
begins as soft deposits of fat that harden with age over time hardening the arteries
what plays a major role in development if atherosclerosis
endothelial injury and inflammation
why would someone with atherlerscorosis be on antiplatelets
because if that build up of fat explodes all the platelets will go to close it and they pile on eachother blocking blood flow
what are some non-modifiable risks associated with coronary artery disease
over 65 years old, male, women if obese, African Americans, family history (1st degree), genetic predisposition
what are some major modifiable risks for coronary artery disease
HDL, LDL, Cholesterol (>200), triglycerides (>150), hypertension, smoking, low physical activity, obese (BMI>30), drug use, pernicious anemia
what levels do you want for HDL
high >60
what does HDL do
carry lipids away from arteries
what levels do you want for LDL
low levels <160
what does LDL do
carries lipids to arteries
what is an LDL goal for someone who is high risk
<70
what is a DM A1c goal for coronary artery disease
<7%
what are some ss of metabolic syndrome: insulin resistance disorders
central obesity, hypertension, abnormal serum lipids, elevated fasting BG
what are some contributing factors for coronary artery disease
DM, metabolic syndrome, psychological status, homocysteine level (pernicious anemia), substance abuse
what drug can lower lipids
atrovastain - inhibit cholesterol synthesis decreasing LDL and increasing HDL
what should you monitor for atrovastain
liver damage and myopathy
what nutrition therapy for coronary artery disease
decrease saturated fats, cholesterol, red meat, egg yols, whole milk increase complex carbs, fiber, omega 3 fatty acids
what is an antiplatelet therapy used for people over 50
asprin
how long are most CAD asymptomatic
years
what causes symptom angina
ischemia
what is ischemia
demand for myocardial oxygen exceeds what the coronary arteries can supple
what is stable angina
when resting it stops
what is unstable angina
not relieved at rest
what could be some reasons for unstable angina
acute coronary syndrome (myocardial infarction) which would be a Nstemi (non ST elevation myocardial infarction or a STEMI (ST elevation myocardial infarction)
what are some interventions for angina stable and unstable
percutaneous coronary intervention or coronary artery bypass graft
what is collateral cirulation
blockage in the arteries creates tiny branches around the artery to bypass the blockage - increase with chronic ischemia
what are some ss of stable chronic angina
predictable, relieved with rest, rarely requires aggressive treatment
what are some ss of unstable angina
new onset, not relieved with rest, pre-infarction
how is angina usually described
pressure, heaviness, or discomfort in chest
what is a medication that may be used with stable angina
nitroglycerin - 1st line
how does nitroglycerin work
dilates peripheral and coronary blood vessels
how do you take nitroglycerin
sublingually or nasal spray
if after taking nitroglycerin and there is no relief what should you do
call EMS
if some relief after taking nitroglycerin what should you do
take every 5 minutes for max of 3 does
can you take nitroglycerin if before angina happens
yes
what are some long acting nitrates
lsordill, limdur, nitroglycerin ointment, transdermal controlled release nitroglycerin
is ranolazine a 1st line drug
NO
why would you use ranolazine
if other treatments arent working
what is the main side effect for nitrates and how can you relieve it
headaches take Tylenol and keep taking the med
what is the main complication for nitrates and what are the interventions for that
orthostatic hypotension monitor BP after initial dose advise patient to change positions slowly
what can you not take with nitrates and why
erectile dysfunction meds like viagra it can cause severe hypotension
what is the teaching for storage of nitroglycerin
keep away from light and heat, once opened its only good for 6 months
how should a patient take nitroglycerin
place under the tongue pill or spray
can you take sublingual nitroglycerin with long acting nitroglycerin
yes if angina develops while on long acting
how is nitropaste dosed
by the inch
where is nitropaste placed
upper body or arm, over flat muscular area that is free of hair and scars
can you build a nitropaste tolerance
yes so you need to have 10-14 hours in between putting it on
what is the stable angina comobidity treatmennt
ACE (lisinopril) ARBs (losartan), betablocker
what are some acute interventions you can do for chronic stable angina
upright position, supplemental o2, assess vs, ECG, access lungs, nitroglycerin, check troponin lab values (usually negative)
where is S2 heard
second intercostal aortic valve closing
what is happening when S1 is heard
tricuspid valve closing
what is an embolus
moving clot
how does unstable angina happen
deterioration of a plaque blockage, rupture, platelets go to fix it cause a thrombus (non moving clot) which stops blood flow causing irreversible myocardial cell death
what would a chest xray show you for CAD
cardiac enlargement, aortic calcifications, and pulmonary congestion (to rule out aortic distension)
what would be seen on a 12 lead ECG for CAD
changes from baseline and ST elevation
what is the normal troponin 1 levels 0-0.04
0-0.04
what is normal high-sensitivity troponin level
<14
what does a coronary computed tomography angiography detect
calcified and non calcified plaques in the artery in CT scan with IV contrast
What are some diagnostic tests for CAD
chest x ray, ECG, Labs (toponin), echocardiogram, exercise stress test, thallium scans,
what is a cardiac cauterization
looks at coronary arteries in cath lab with IV contrast
when someone is experiencing a STEMI when should you get them to cath lab
within 90 minutes
how could you open arteries with a cardiac cathertization
with more dye you can place a percutaneous coronary intervention or a balloon or stent to keep it open
can some with IV contrast allergy get a cardia cath
yes premeditate with corticosteriods
if someone has renal damage and going to go to cath lab what should you do
pre hydrate and post hydrate because the dye can hurt the kidneys (check creatine levels before)
what is the treatment of choice for a STEMI
Emergent PCI
what is the goal for placement of emergent percutaneous coronary intervention (PCI)
90 minutes from door to cath lab
what is a emergent percutaneous coronary intervention (PCI)
balloon angioplasty + stent
what are the 2 different stents used for emergent percutaneous coronary intervention (PCI)
bare metal stent (BMS) or drug-eluting stent (DES)
what is required for a bare metal stent (BMS)
1month to a year of dual antiplatelet therapy
what is required for drug-eluting stent
minimum of 12 months of dual antiplatelet therapy
what is dual antiplatelet therapy
ASA + clopidogrel (plavix)
if someone cant take clopidogrel (plavix) what can be replaced
ticagrelor or prasugrel
what is the nursing management for coronary revascularization
monitor for reccurent angina, monitor VS/cardiac rhythm/dysrhythmias/ catheter insertion site/ neurovascular assessment (peripheral pulses), bed rest per policy
what is thrombolytic therapy and why would it be used
only for patients with a STEMI who cant get to cath lab give 30 mins after arrival
what is the nursing management for thrombolytic therapy
draw blood and start 2-3 IV sites, do invasive procedures first, monitor for signs of bleeding, monitor neurological status,
what is the best sign for thrombolytic therapy
ST returning to baseline
how can you prevent reocculsion for thrombolytic therapy
heparin
acute coronary syndrome ss
initially increase in HR and BP then drop in BP, crackles, jugular vein distension, new murmur, diaphoresis, nv, fever (up to 100 in first 24-48 hours)
why would someone with unstable angina be given a stool softner
dont want them to bare down
why would someone get a coronary surgical revascularization with coronary artery bypass grafting
failed medical management, multivessel disease, not a candidate for PCI (blockages too long or difficult to access), multiple comorbidities
what is required for coronary surgical revascularization with coronary artery bypass grafting
sternotomy and cardiopulmonary bypass
what is coronary surgical revascularization with coronary artery bypass grafting
taking arteries and veins to graft new ones
what kind of management is done for coronary surgical revascularization with coronary artery bypass grafting
pulmonary artery cath, intraarterial line, pleural/mediastinal chest tubes, ECG, mech vent, urinary cath, NG tube
what are some complications for coronary surgical revascularization with coronary artery bypass grafting
bleeding and anemia from damage to RBCs, fluid and electrolyte imbalances, hypothermia (because the blood is cooled as it passes through bypass machine), infection
what should you monitor for coronary surgical revascularization with coronary artery bypass grafting
hemodynamic status, fluid status, restore temp, monitor for a fib (very common so restart beta blockers ASAP)
what is the teaching involved after a acute coronary syndrome/MI for physical activity
monitor HR, low stress level before discharge, isotonic preferred over isometric
what is isotonic activity
walking, jogging, swimming, bicycling
what is a isometric
lifting, carrying, or pushing heavy stuff
what is the teaching involved after a acute coronary syndrome/MI for sexual activity
can typically resume after 7-10 days or when they can walk up 2 flights of stairs without pain
what is the most common complication of a acute coronary syndrome/MI
dysrhythmias
what is the most common cause of death in pre hospitalization period for a acute coronary syndrome/MI
VT and VF
why would hear failure occur for acute coronary syndrome/MI
pumping power of the heart has diminished because of scar tissue formation
what is cardiogenic shock
when the heart is not working effectively leaving the body poorly perfused -high death rate
what is acute pericarditis
inflammation of the pericardium
what is the ss of acute pericarditis
mild to severe chest pain made worse with inspiration, coughing, movement of upper body relieved by sitting in a forward position
what is the treatment for acute pericarditis
aspirin or colchicine (anti-inflammatory)
what is the ss of ventricular wall rupture and papillary muscle rupture
new loud systolic murmur, HF and cardiogenic shock will ensue, rare and life threatening
what is left ventricular aneurysm
the myocardial wall becomes thinned and bulges out during a contraction
what is recommended for patients with left ventricular aneurysm
anticoagulation if not contraindicated to prevent thrombi
