NUR 146 - Week 8 - Coronary Artery Disease Flashcards
Define atherosclerosis
an abnormal accumulation of lipid and fibrous tissue in the lining of arterial blood vessels
What is metabolic syndrome?
Defined as a cluster of metabolic abnormalities
Diagnosis is made if a person has 3 of the following 5 risk factors
1) Enlarged waist circumference >40” in men, >35” in women
2) Elevated triglycerides >175mg/dl
3) Reduced HDL <40mg/dl in males, <50g/dl in females
4) Hypertension
5) Elevated fasting blood glucose
- Metabolic Syndrome is considered a major risk factor for CAD
How can CAD be prevented?
Controlling modifiable risk factors:
- Manage cholesterol via medication, diet, exercise
- Tobacco cessation
- Manage hypertension with meds, diet, exercise
- Manage diabetes with meds, diet, exercise
Discuss Low Density Lipoproteins in regard to CAD
“Bad cholesterol”
Promotes production of atheroma
- Primarily made of cholesterol
Discuss High Density Lipoproteins in regard to CAd
Lipid level recommendations for:
Total
LDL
HDL
Triglycerides
Total: <200 mg/dl
LDL: <100 mg/dl or <70mg/dl if high risk
HDL: > 40mg/dl in males, >50 mg/dl in females
Triglycerides: <150 mg/dl
Hyperlipidemia:
Management
Dietary
- High fiber
- Emphasis on plant-based foods, whole grains
- Fish
- Low intake of red meat
Physical Activity
- weight reduction
- Increased physical activity can increase HDL and lower triglycerides
- Goal is 150 min/week
Hyperlipidemia:
Pharmacologic therapy
Used in conjunction with diet and exercise
6 categories:
- Statins
- Nicotinic Acids
- Bile acid sequestrants
- Cholesterol absorption inhibitors
- Omega-3 Acid Ethyl Ester
Statins
What do they do?
Adverse Effects?
First line medication to treat increased LDL levels; results in lower total cholesterol, LDL and triglyceride AND increase HDL levels
Adverse effects:
Common = Myalgia, Arthralgia (Muscle pain, joint pain)
Serious = Myopathy, rhabdomyolysis (breakdown of muscle)
What should you monitor for a patient on Statins?
LFTS
- Statins are contraindicated in patients with liver disease
What time do you administer statins? Why?
In the evening
- Body produces cholesterol at night
Bile Acid Sequestrants:
How are they used?
Mechanism of action
Nursing Considerations
Side effects
Cholestyramine, colestipol
Used in adjunct therapy with statins; results in decreased LDL, may slightly increase HDL
Mechanism of action: Decreased fat absorption
Nursing considerations:
- Take before meals
- May decrease absorption of meds
Side effects:
- Constipation
- Abdominal pain
- GI bleed
Cholesterol Absorption Inhibitors:
What does it do?
Side effects
Nursing considerations
Ezetimibe
- Inhibits absorption of cholesterol in small intestine = lower LDL levels
Side effects:
- Abdominal pain
- Myalgia, athralgia (muscle pain, joint pain)
Nursing Considerations:
- Contraindicated in liver disease; monitor LFTs
- May cause increased fasting glucose & Hgb A1c
- May cause increased AST, ALT
- May cause hyperkalemia
Risk factors for CAD
Modifiable:
- Hyperlipidemia
- HTN
- smoking
- diabetes
- obesity
- sedentary lifestyle
- metabolic syndrome
Nonmodifiable:
- Male gender
- Family hx
- hx of hypercholesterolemia
- male >45 yo, female >55 yo
- African american
Effects of tobacco use in regards to CAD
Effects of tobacco use:
- HTN
- Coronary vasoconstriction
- Increased LDL oxidation –> damages endothelium, causing thrombus formation
- Smoke inhalation increased CO2 levels = decreased oxygen to myocardium
Describe the relationship of diabetes and CAD
Hyperglycemia accelerates development of CAD
Angina Pectoris:
What is it?
Cause?
Types?
Clinical syndrome characterized by episodes of pain or pressure in anterior chest
Cause: Insufficient coronary blood flow which = decreased oxygen supply in the setting of increased myocardial oxygen demands
Angina:
Pathophysiology
Supply vs. Demand; usually caused by underlying atherosclerotic disease
- Often associated with obstruction of at least one major coronary artery
- When myocardium (cardiac muscle) has increased demands, it must increase blood flow through coronary arteries
Results in ischemia = chest pain
Precipitating Factors of Angina:
The 4 E’s
Explain the patho for each “E”
physical Exertion, cold Exposure, Eating heavy meal, Emotional stress
physical Exertion:
- Increases myocardial oxygen demand
Exposure to cold:
- Vasoconstriction and elevated BP
- Increases oxygen demands
Eating a heavy meal:
- Increases blood flow to GI tract for digestion
- Results in reduced blood flow to heart
Emotional stressors:
- Results in catecholamine (epinephrine, norepinephrine) release
- Results in increased BP, HR and myocardial workload
Angina:
Clinical manifestations
Anginal Pain
Quality: Described as tightness, choking or heavy sensation
Location: Often retrosternal, may radiate to neck, jaw, shoulders
Often associated with anxiety or impending doom
Associated symptoms:
- N/V, dyspnea, SOB, dizziness, diaphoresis
Physical assessment may show as normal
Types of Angina:
Stable
Predictable pattern; “If I do this, I will feel pain”
- Pain occurs on exertion
- Symptoms are similar between episodes
- Pain is relieved by rest and/or nitroglycerin
Types of Angina:
Unstable
Unpredictable pattern
- Pain may occur at rest
- Pain lasts longer than the previous episode
- Seen as high risk of MI
Requires medical intervention!
Types of Angina:
Variant / Prinzmetal’s
What is it
Patho
Cause/Trigger
Chest pain occurring at rest
Patho: Coronary Vasospasm (Blood vessels spasm)
- Pain is caused by decreased blood supply during spasm
- Pain is NOT a result of increased Myocardial oxygen demand
Triggered by autonomic stimulation, smoking, cocaine use
Variant / Prinzmetal’s Angina:
Treatment
- Isosorbide Mononitrate
- Calcium channel blockers
- May also be treated with cardiac stent to decrease spasms
