part 7

Question 1

What is the angina treatment goal?

Answer 1

decrease oxygen demand by: 
-decreasing contractility
-decreasing preload 
-decreasing after load 
-keep HR low 
and/or 
-increase oxygen supply

Question 2

What is the management of chronic stable angina?

Answer 2

• education (lifestyle mods to balance demand and supply)
• cholesterol lowering agents
• antiplatelet
• additional drug therapy: short and long acting nitrates, B-adrenergic blockers, calcium channel blockers, ACE inhibitors

Question 3

What are the diagnostic studies for CAD and CSA?

Answer 3

• chest x-ray: cardiac enlargement and calcifications, pulmonary congestion
• 12 lead ECG
• Labs: lipids, cardiac enzymes (c-reactive protein for stress)
• holter monitoring
• echocardiogram (ultrasound of heart)
• nuclear imaging: stress test, coronary calcification study
• cardiac cath
• cardiac angiogram: dye injected
• coronary revascularization: balloon angio and stent placement

Question 4

What is the RN’s responsibility post cardiac cath?

Answer 4

bleeding 
BP 
HR control 
no thinners 
keep flat (for femoral keep flat for 4 hours)

Question 5

What is acute coronary syndrome?

Answer 5

• unstable angina
• prolonged not immediately reversible ischemia
• angina to MI
• NSTEMI and STEMI
• symptoms are due to an imbalance between myocardial O2 supply and demand

Question 6

What is the warning sign for NSTEMI and STEMI?

Answer 6

unstable angina

Question 7

• chest pain that is new onset or worsening pattern
• plaque has ruptured is unstable and clots can form
• represents an emergency

Answer 7

ACS: unstable angina

Question 8

What are the symptoms of ACS unstable angina?

Answer 8

• angina increased frequency
• easily provoked
• does not go away with rest
• fatigue
• SOB
• indigestion
• anxiety
• it is much worse then the chronic stable angina pattern

Question 9

What are the manifestations of MI?

Answer 9

• asymptomatic
• pain (squeezing, crushing, radiating)
• sympathetic nervous system activation: diaphoresis, peripheral vasoconstriction, clammy/cool skin, dyspnea, sense of doom and anxiety
• cardiovascular: dizzy, initial HR and BP increase then decrease with decreased CO
• nausea and vomit with little warning
• confused look
• women: atypical pain, SOB, fatigue
• older people: ALOC, pulmonary edema, dysrhythmia

Question 10

What are the signs and symptoms of prolonged low cardiac output?

Answer 10

• decreased kidney perfusion
• fever 100.4
• left ventricular dysfunction: crackles from fluid backing up
• right ventricular dysfunction: JVD and peripheral edema
• heart sounds might change: distant S3 and S4 murmur