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NURS 2245 Cardiac > Test 2 CAD > Flashcards

Test 2 CAD Flashcards

1
Q

Insufficient oxygen supply to the myocardium….

A

Ischemia

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2
Q

Necrosis when ischemia is prolonged and decreased perfusion causes irreversible damage to tissue….

A

Infarction

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3
Q

Difference in Stable & Unstable angina in regards to what is clogging the artery…

A

Stable Angina: Fixed atherosclerotic plaque

Unstable Angina: Plaque & Platelets

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4
Q

Describe difference in the artery clog with:

Non ST elevation MI

ST elevation MI

A

Non ST elevation MI: Plaque, Platelets, Thrombus blocks vessel part way

ST elevation MI: Plaque, Platelets, Thrombus blocks vessel fully

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5
Q

Formation of Plaque within artery wall
Possibly due to injury

Causes;

Mechanical
Chemical
Physiological
Impaired Na-K pump
Diabetes
Inflammation

A

Atherosclerosis

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6
Q

Cholesterol is needed for body functioning

20 - 40% comes from food.

Where does the rest come from…

A

Produced by the liver

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7
Q

HDL

Optimal
Desirable
Undesirable

A

Optimal >60
Desirable >40
Undesirable <40

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8
Q

Triglycerides

Low
Borderline
High
Very high

A

Low: <150
Borderline 150 - 199
High 200 - 499
Very high >500

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9
Q

Total cholesterol

Desirable
Borderline
High

A

Desirable <200
Borderline 200 - 239
High >240

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10
Q

LDL

Optimal
Near Optimal
Borderline
High
Very high

A

Optimal <100
Near Optimal 100 - 129
Borderline 130 - 159
High 160 - 189
Very high >190

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11
Q

Define:

Moves cholesterol away from the arterial wall

Carries cholesterol to the arterial wall

Transfers triglycerides to cells

A

High density lipoprotein cholesterol
HDL
Moves cholesterol away from the arterial wall

Low Density lipoprotein cholesterol
LDL
Carries cholesterol to the arterial wall

Very low-density lipoprotein
VLDL
Transfers triglycerides to cells

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12
Q

______ is a chronic disease where plaque builds up inside arteries, leading to narrowing and reduced blood flow. It is a leading cause of cardiovascular diseases like coronary artery disease (CAD), stroke, and peripheral artery disease (PAD).

A

Atherosclerosis

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13
Q

Atherosclerosis is a chronic disease where plaque builds up inside arteries, leading to narrowing and reduced blood flow. It is a leading cause of cardiovascular diseases including (3)

A

Coronary artery disease (CAD)
Stroke,
Peripheral artery disease (PAD).

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14
Q

Fatty steak develops in between layers of the artery wall.

_____ engulf the deposited cholesterol & convert to Giant Foam Cells

Formation of Fibrous cap over lipid core

QUESTION….

  1. This plaque can rupture & a thrombus forms at the site causes blockage of oxygen & death to heart muscles THIS IS CALLED…
  2. The plaque stays stable and continues to thicken. This disease process…
A

Macrophages

  1. Acute coronary syndrome
  2. Stenosis
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15
Q

Causes of atherosclerosis (5)

A

Endothelial Damage: Injury to the artery lining due to factors like:

High blood pressure

High cholesterol

Smoking

Diabetes

Lipid Accumulation: LDL (low-density lipoprotein) cholesterol enters the damaged wall and oxidizes.

Inflammation: White blood cells (macrophages) engulf oxidized LDL, forming foam cells.

Plaque Formation: Foam cells accumulate, leading to fatty streaks and plaque formation.

Narrowing of Arteries: Plaques can calcify, harden, or rupture, causing blood clots.

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16
Q

DASH stands for

A

Dietary Approach to Stop Hypertension

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17
Q

____ juice can prevent & reverse atherosclerosis

A

Pomegranate

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18
Q

Teachings for: HMG coA Reductase Inhibitors (Statins)

Teachings (3)

A

Take in evening (When cholesterol synthesis occurs)

Avoid Grapefruit Juice (Increases SE)

Monitor CK levels (Statins can cause muscle damage)

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19
Q

How do statins work…

A

They inhibit the enzyme HMG in the liver which stops the production of cholesterol. They also remove LDL fron the blood

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20
Q

What does Pleiotropic effects of Statins mean….

A

Addition good effects the medication causes.

Anti-inflammatory and plaque-stabilizing properties, further contribute to cardiovascular protection.

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21
Q

Low cholesterol levels will have these problems…

A

Increased risk of viral infection & cancer

Hormonal

Neurological

Vitamin deficiency

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22
Q

Gemfibrozil
Fenofibrate

Examples of which type of medication…
With what effects…

Used alone?

A

Fibric Acid Derivatives

Reduces LDL, VLDL, & Triglycerides. INCREASE HDL levels

Appears beneficial on insulin resistance

Used alone or with Statins

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23
Q

Fibric Acid Derivatives
(Fenofibrate & gemfibrozil)

Lower all bad cholesterol & raise good

Benefical on insulin resistance

Used alone or in conjunction with Statins

Name

SE & TEACHINGS…

A

Muscle pain or weakness (myalgia)
Headache
Nausea or upset stomach
Diarrhea or constipation
Fatigue
Mild elevations in liver enzymes

Serious

Myopathy: Severe muscle pain with elevated creatine kinase (CK).

Rhabdomyolysis: Rare but life-threatening condition causing severe muscle breakdown, leading to kidney damage.

Liver toxicity: Significant liver enzyme elevation or hepatitis.

Teaching:

Avoid ETOH can cause elevated liver enzymes

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24
Q

Nicotinic Acid (Niacin)

Action….

SE….

A

High doses will lower VLDL & Raise HDL

SE:
FLUSHING & Itching
Increased Uric Acid
Increased BS

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25
Q

Ezetimide (Zetia)

Cholesterol Absorption Inhibitors

Prevents Absorption in…..

A

Small intestines

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26
Q

Cholestyramine
Colestipol
Colesevelam

Examples of which type of medication…

A

Bile Acid Resins

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27
Q

Cholestyramine
Colestipol
Colesevelam

(Bile Acid Resins)

Action…

Use….

SE….

A

Action:
Decreases reabsorption of bile acid in small intestine

To create more Bile Acid, Liver must pull LDL from plasma

Use (Off Lable)
Diarrhea

SE:
Constipation
Flatulence
Decreases absorption of other meds

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28
Q

Omega-3 Acid inhibitor
Omega 3 Acid Ethyl Esters (Lovaza)

Action…

SE….

A

Action: Reduces hepatic formation of triglycerides / May increase HDL

SE: Altered taste, belching, dyspepsia (Pain in upper stomach associated with eating), FLU LIKE SYMPTOMS

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29
Q

Problem: Stable angina occurs when the heart’s oxygen demand exceeds supply during physical or emotional stress due to narrowed coronary arteries. It is predictable and relieved by rest or nitroglycerin.

Problem….

A

Stable angina

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30
Q

Monitor: Assess pain (location, intensity, duration, triggers), ECG for ischemic changes.

Interventions:
Administer nitroglycerin for pain relief.

Encourage lifestyle modifications

(healthy diet, regular exercise, smoking cessation).

Educate on recognizing triggers (e.g., exertion, heavy meals, stress).

A

Stable Angina

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31
Q

List meds for stable Angina (5)

A

Medications:
Beta-blockers
calcium channel blockers
nitrates
aspirin
statins.

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32
Q

Problem:
Unpredictable and occurs at rest or with minimal exertion. It is caused by plaque rupture, leading to reduced coronary blood flow and risk of heart attack.

Problem…

A

Unstable Angina

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33
Q

Monitor: Continuous ECG to identify ischemia or arrhythmias; assess cardiac enzymes.

Interventions:

Provide oxygen if SpO₂ <90%.

Administer nitroglycerin for pain and morphine if pain persists.

Prepare for potential coronary angiography or PCI (percutaneous coronary intervention).

Problem…

A

Unstable Angina

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34
Q

Medications for Unstable Angina

A

Medications:
Dual antiplatelet therapy (aspirin and clopidogrel),
anticoagulants (e.g., heparin), beta-blockers,
ACE inhibitors.

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35
Q

Problem: Caused by coronary artery spasms, occurs at rest and is often associated with transient ST-segment elevation. It is unrelated to physical exertion or stress.

A

Variant (Prinzmetal) Angina

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36
Q

Monitor: ECG during episodes to confirm ST-segment elevation that resolves with treatment.

Interventions:

Administer calcium channel blockers (e.g., diltiazem) or nitrates to relieve and prevent spasms.

Avoid beta-blockers, as they can worsen vasospasms.

Problem…

A

Variant (Prinzmetal) Angina

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37
Q

Educate: Avoid triggers such as smoking, cold exposure, and stimulant use (e.g., cocaine).

This problem….

A

Variant (Prinzmetal) Angina

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38
Q

Medications for Prinzmetal Angina

A

Medications:
Calcium channel blockers
nitrates for long-term management.

39
Q

Problem: Occurs due to partial coronary artery occlusion, leading to myocardial injury without complete necrosis…..

A

Non-ST Elevation Myocardial Infarction (NSTEMI)

It is less severe than STEMI but still requires urgent care.

40
Q

Monitor: Continuous ECG, cardiac enzymes (troponin, CK-MB), and hemodynamic status.

Interventions:
Administer MONA (Morphine, Oxygen, Nitroglycerin, Aspirin).

Facilitate coronary angiography if needed.

Problem…

A

Non-ST Elevation Myocardial Infarction (NSTEMI)

41
Q

Medications: For NSTEMI

A

Medications:
Dual antiplatelet therapy, anticoagulants
beta-blockers
ACE inhibitors
statins.

42
Q

Problem: Complete coronary artery occlusion, leading to significant myocardial damage if not treated promptly. It is a medical emergency

A

ST Elevation Myocardial Infarction (STEMI)

43
Q

Monitor: Continuous ECG, monitor for arrhythmias or signs of heart failure.

Interventions:

Administer MONA immediately.(Morphine, Oxygen, Nitroglycerin, Aspirin)

Facilitate reperfusion therapy: PCI within 90 minutes or fibrinolytics if PCI is unavailable.

Provide hemodynamic support as needed.

This problem…

A

STEMI

ST Elevation Myocardial Infarction

44
Q

ST Elevation Myocardial Infarction

Meds (5)

A

Medications:
Dual antiplatelet therapy, anticoagulants
beta-blockers
ACE inhibitors
statins.

45
Q

Is an IV of NTG nitroglycerin ever appropriate…

A

Yes

Ongoing chest discomfort
HTN
Pulmonary congestion

46
Q

Describe action of nitroglycerin…

A

Dilates Coronary Arteries
Peripheral arteries & veins

47
Q

Describe Dosing of nitroglycerin

A

1 tab / spray Sublingual 0.4mg

Q3-5min × 3 until pain relief/ hypotension

48
Q

Type of MI nitroglycerin is Contradicted in…

A

RV MI

49
Q

Nitroglycerin
Contraindicated

SBP…..

HR ….

Type of recent medication…

A

SBP 100 or 90 TEACHER WILL DISCUSS

HR <50 or >100

Phosphodiesterase inhibitor

Sildenfanil
Vardenfamil
Tadafil

50
Q

When to evaluate fir hypotension with nitroglycerin administration….

A

Before & After

51
Q

Types of Reperfusion Therapy (3)

Indications (3)

A

1.Pharmacological Therapy:

Thrombolytics (Clot-Busting Drugs): Medications like alteplase, reteplase, or tenecteplase are used to dissolve blood clots.

Indicated in specific situations like ischemic stroke or STEMI (ST-Elevation Myocardial Infarction).

  1. Mechanical Therapy:

Percutaneous Coronary Intervention (PCI): A procedure where a catheter with a balloon is inserted into a blocked coronary artery to restore blood flow, often followed by stent placement.

Mechanical Thrombectomy: A procedure to remove a clot, commonly performed in patients with acute ischemic stroke.

  1. Coronary Artery Bypass Grafting (CABG):

A surgical method to create a new pathway for blood flow around blocked arteries.

Indications:
Acute Myocardial Infarction (AMI): Especially STEMI.

Acute Ischemic Stroke: When initiated within a specific time window.

Peripheral Arterial Occlusion: To save ischemic limbs.

52
Q

Angina therapies (4)

A

B blocker
Ca channel blocker
Aspirin
Reperfusion therapy

53
Q

Actions:

DECREASES HR WHICH DECREASES O2 DEMAND AND PREVENTS ISCHEMIA

SHORT TERM- Increase EF after 1-3 months of use

Blocks excessive Sympathetic NS stimulation

Prolongs diastole filling time

Prevents remodeling arrhythmias

Medication….

A

Beta-Blockers

OLOL

54
Q

SE in Beta-Blockers (OLOL)
(6)

A

Hypotension
Bradycardia
Fluid retention
Fatigue
Impotence
Masks Hypoglycemia

55
Q

BB & CCB mostly go together for angina problems…

A

False

Caution combining them

56
Q

Verapamil
Diltiazem
Amlodipine

This type of med….

These SE….

A

CCB

Hypotension/ Dizzy
Bradycardia
Constipation

57
Q

Action

Decreased oxygen demand

Vasodilation reduces ventricular wall stress

Decreased HR amd contractility (Increased Oxygen Supply)

Dilate Coronary Arteries

Reverse Vasospasms

A

CCB

Diltiazem
Verapamil
Amlodipine

58
Q

Morphine Sulfate

Action: Binds with Kappa & mu pain receptors to produce analgesia

Dosing….

A

2 - 4 mg

Every 5 - 15 min

up to 8mg can be used

59
Q

How should the ST segment look on an ECG…

What if its not…

A

Flat & even with the baseline

ST segment elevation >1mm in 2 or more continous ECG leads
Large occlusion
Rapid Reperfusion required

60
Q

ST segment elevation >1mm in 2 or more continous ECG leads

This problem…

A

STEMI

ST Elevation Myocardial Infarction

Large occlusion
Rapid Reperfusion required

61
Q

Describe how a NSTEMI will look…

A

ST Depression/ T wave inverted

62
Q

Tissue Perfusion

Timely Reperfusion

Percutaneous Coronary Intervention (PCI)

_____ Minutes first contact
_____ Minutes of EC door

Fibrinolytics

_____ minutes of EC door

A

90 Minutes first contact
[Provided in Class] Minutes of EC door

Fibrinolytics

30 minutes of EC door

63
Q

Alteplase (tPA):
Tenecteplase:
Reteplase:

Which type of medication…

Do what…

For which problems…(3)

A

Fibrinolytics aka thrombolytics

Disolve blood clots by breaking down fibrin

Used for:
ST-Elevation Myocardial Infarction (STEMI)
Pulmonary embolism (PE)
Ischemic stroke

64
Q

Purpose:

Diagnose and evaluate heart conditions (e.g., coronary artery disease, valve function, or heart defects).

Can be used to perform therapeutic interventions, such as angioplasty.

Procedure…

A

Cardiac Catheterization:

65
Q

Purpose:

Reopen narrowed or blocked coronary arteries.

Restore blood flow to the heart muscle.

Procedure:

A balloon-tipped catheter is advanced to the site of the blockage.

The balloon is inflated to compress the plaque against the artery wall.

A

Angioplasty a type of (Percutaneous Coronary Intervention, PCI)

66
Q

Why are anticoagulants held and aspirin given before cardiac Catheterization…

A

Holding anticoagulants reduces bleeding risk during cardiac catheterization, while aspirin is maintained to prevent arterial clot formation, ensuring the safety and success of the procedure.

67
Q

Pre-Procedure Cardiac Catheterization
Nurses responsibilities…

A

Informed Consent: Ensure the patient understands the procedure, risks, and benefits.

Fasting: Ensure the patient has been NPO (nothing by mouth) for 6–8 hours before the procedure.

Medication Review:

Withhold or adjust medications like anticoagulants (e.g., warfarin, DOACs).

Administer prescribed medications such as aspirin or clopidogrel if ordered.

Baseline Assessments:

Vital signs.

Peripheral pulses (especially in the affected limb).

ECG and blood work (e.g., coagulation profile, renal function).

68
Q

Intra-Procedure Care:
Cardiac Catheterization

Monitor Patient Status, how….

A

Continuous ECG monitoring for arrhythmias

69
Q

Activity Restrictions:

Post cardiac Catheterization

A

Activity Restrictions:

For Femoral Access: Keep the leg straight and immobilized for 4–6 hours to prevent bleeding.

For Radial Access: Elevate the wrist slightly, and avoid heavy lifting for 24–48 hours.

70
Q

Inflating a small balloon inside a coronary artery to compress plaque against the artery walls and improve blood flow.

A

Angioplasty

Angioplasty may or may not involve the placement of a stent.

71
Q

Common PCI techniques: (4)

Percutaneous Coronary Intervention (PCI):

A

Balloon Angioplasty: Inflating a balloon to open a blocked artery.

Stent Placement: Inserting a metal mesh device to keep the artery open after angioplasty (most common in modern PCI).

Atherectomy: Removing plaque using specialized devices.

Thrombectomy: Removing blood clots during acute coronary syndromes.

72
Q

Pathway for Cardiac Catheterization

(2)

A

Femoral Access: Femoral artery → iliac artery → abdominal aorta → thoracic aorta.

Radial Access: Radial artery → brachial artery → subclavian artery → aortic arch.

73
Q

Cardiac Catheterization

Fluoroscopy….

Contrast Dye: Injected through the catheter to make the coronary arteries visible on X-ray.

A

Fluoroscopy: Real-time X-ray imaging helps the physician visualize the catheter’s path.

74
Q

rtPA (Activase)
reteplase (Retavase)
tenecteplase (TNKase)

  1. This type of medication…
  2. Absolute & Relative Contraindications (3)
  3. Action….
A
  1. Fibrinolytics
  2. Absolute: Recent Major Bleeding & Preggers

Relative: Hypertension (SBP>180 or DBP > 110

  1. Dissolves thrombi in the coronary arteries to restore blood flow.
75
Q

Class:

Fibrinolytics

Exp.
rtPA(Activase)
reteplase(Retavase)
tenecteplase (TNKase)

Contraindications:
2. Absolute: Recent Major Bleeding & Preggers

Relative: Hypertension (SBP>180 or DBP > 110

Action:
Dissolves thrombi in the coronary arteries to restore blood flow.

Indications/ Treats (1)

Time frame….

A

STEMI

Door to needle 30 minutes

76
Q

P2Y12 aka ADP Inhibitors

Exp.

Clopidogrel (Plavix)
Prasugrel (Effient)
Ticagrelor (Brilinta)
Cangrejos (Kangreal)

Action: Reduces Platelet function

Uses: Decrease sudden cardiac death due to thrombosis

ALERT….

Caution…. (3)

SE…. (2)

A

Alert: Need cardiology approval to stop med

Caution: Age>75
Hx of stroke
Stop 7 days before surgery

SE: Bleeding, stroke

77
Q

ROSC…

A

Return of Spontaneous Circulation

78
Q

Only intervention shown to improve neurological outcome and decrease mortality in Cardiac Arrest patients who dont Regain Consciousness after ROSC….

A

Therapeutic hypothermia

32 - 34 / 89.6 - 93.2

79
Q

Therapeutic hypothermia

32 - 34 C / 89.6 - 93.2 F

Only intervention shown to improve neurological outcome & decrease mortality following patients who Dont Regain Consciousness after ROSC following cardiac arrest.

Adverse SE…. (6)

A

Fluid / electrolyte imbalance
Arrhythmias
Insulin resistance
Shivering
Coagulation
Pain / sedation concerns

80
Q

NSTEMI or UA (Unstable Angina)

Chest Pain
ST Depression _____
T wave _____
Transient (<20 min) ST elevation

Cardiac Markers (Troponin) determines diagnosis

A

ST Depression > 0.5mm

T wave Inversion

81
Q

NSTEMI (Non-ST-Elevation Myocardial Infarction)

Or

UA (Unstable Angina)

Definition Partial blockage of a coronary artery causing myocardial injury with elevated cardiac biomarkers (e.g., troponin).

Partial blockage causing ischemia but without myocardial injury (normal)

ECG Changes May show ST depression or T-wave inversion.

May show similar changes, but often normal.

Symptoms

Chest pain or discomfort, similar to UA but may persist longer and occur at rest.

Chest pain or discomfort, typically at rest or worsening over time. May be new onset or a change in stable angina.

Risk

Higher risk of progressing to a STEMI or further myocardial damage.

Indicates high risk but no myocardial cell death yet.

A

Top = NSTEMI

Bottom = UA

82
Q

NSTEMI Initial treatment: Acute Pain

A

911 / EMS - Call for help

ASA 165 - 325mg, antiplatelet (Clopidogrel)

Nitroglycerin SL

IV if on going

O2, IV, Monitor, Morphine

ECG

H&P

Blood draw cardiac marker

83
Q

Tissue Perfusion Interventions:
Anti-ischemic therapy (6)

A

Bedrest
Oxygen
Nitroglycerin
Beta-Blockers
CCB
ACE/ARB

84
Q

Continous Nitroglycerin

Indications (3)

A

Chest pain (Angina)
Hypertension
Pulmonary Edema

85
Q

Heparin

Bolus IV then continuous infusion to maintain therapeutic level

  1. What is Normal (in regular person)
  2. Low intensity
  3. High intensity
A
  1. 25 - 35 seconds (Someone not recieving Heparin)
  2. Low Intensity 55 - 75 / 60 - 80
  3. High intensity 80 - 100
86
Q

What is a critical Heparin coagulation time.

A

> 120 sec

87
Q

What is a critical Heparin coagulation time.

A

> 120 sec

88
Q

What is a critical Heparin coagulation time.

A

> 120 sec

89
Q

ELISA test is used for…

Describe the health problem it is looking for….

A

HIT

Heprin Induced Thrombocytopenia

HIT is more about clotting risk than bleeding.

Requires immediate action to prevent serious complications like stroke, PE, or limb ischemia.

Future anticoagulation regimens should avoid heparin altogether.

90
Q

Define

Thrombocytopenia/ Thrombocytosis

A

Thrombocytopenia<150,000

Thrombocytosis>450,000

91
Q

Enoxaparin

Class: Low-Molecular-Weight Heparin (LMWH).

Mechanism of Action: Inhibits clotting factors Xa and IIa (thrombin), with a greater effect on factor Xa.

Uses:

Prevention and treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE).

Acute coronary syndromes (e.g., unstable angina, NSTEMI, STEMI).

Labs to monitor…

Route: Subcutaneous (SC) injection.

A

None

However, anti-Xa levels can be monitored in certain cases (e.g., renal impairment).

92
Q

Bivalirudin

Class: Direct Thrombin Inhibitor (DTI).
Mechanism of Action: Binds directly to thrombin (factor IIa), preventing fibrin formation, platelet activation, and clot stabilization.

Uses:

Anticoagulation in patients undergoing percutaneous coronary intervention (PCI).

Alternative to heparin in patients with HIT or at risk for HIT.

Route: Intravenous (IV) infusion.

Monitoring….

A

Monitoring:
Activated clotting time (ACT) or activated partial thromboplastin time (aPTT) may be used for monitoring.

93
Q

Argatroban

Class: Direct Thrombin Inhibitor (DTI).
Mechanism of Action: Inhibits thrombin (factor IIa) directly, preventing clot formation.

Uses:

Anticoagulation in patients with HIT.

Alternative anticoagulant for PCI in patients with HIT.

Route: Intravenous (IV) infusion.

Monitoring…..

Key Notes…

A

aPTT is monitored to maintain therapeutic levels (1.5–3 times baseline).

Key Notes:

Metabolized in the liver; no dose adjustment needed for renal impairment but caution in hepatic dysfunction.

Short half-life (~40–50 minutes).

94
Q

Fondaparinux

Class: Factor Xa Inhibitor (Synthetic Pentasaccharide).

Mechanism of Action: Selectively inhibits factor Xa, interrupting the coagulation cascade.

Uses:

Prevention and treatment of DVT and PE.

Alternative anticoagulant in patients with HIT.

Route: Subcutaneous (SC) injection.

Monitoring….

Key notes…

A

No routine monitoring required, as it has a predictable anticoagulant effect.

Key Notes:

Contraindicated in severe renal impairment (CrCl <30 mL/min).

Long half-life (~17 hours), allowing once-daily dosing.

NURS 2245 Cardiac (8 decks)

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