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Nursing 2 Exam 3 > Unit 13 CAD > Flashcards

Unit 13 CAD Flashcards

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1
Q

What are the 3 main coronary arteries?

A

Left anterior descending (LAD)
Circumflex (Circ; Cx)
Right (RCA)

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2
Q

Where do the left anterior descending and circumflex artery supply blood too?

A

Mostly the left side of the heart and the body

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3
Q

Where does the right coronary artery (RCA) supply blood too?

A

Back of the heart

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4
Q

What is angiogenesis in what situation could this take place?

A

creation of new blood vessels,

angiogenesis to compensate for chronic ischemia

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5
Q

What is the pacemaker of the heart?

A

SA node

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6
Q

What is Atherosclerosis?

A

progressive hardening of the arteries

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7
Q

When do the coronary arteries get perfused?

A

during diastole

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8
Q

What are fatty streaks?

A

fat deposits in the lining of the arteries, not a good thing but a natural process

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9
Q

What is a plaque atheroma lesion

A

Blockage within the artery

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10
Q

What are the major modifiable risk factors, contributing, and non-modifiable risk factors for CAD?

A

Elevated serum lipids
HTN
Tobacco use
physical inactivity

Diabetes
Stress
Elevated homocysteine 
substance abuse
metabolic syndrome

Age
Gender
Ethnicity
Genetic predisposition

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11
Q

What are a women’s most common symptoms of CAD/Heart Disease

A

fatigue

flu like symptoms

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12
Q

What is Homocysteine (Hcy) and what is it associated with?

A

Homocysteine is an amino-acid, by-product of protein catabolism, and is associated with an increase risk of CVD

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13
Q

What is C-Reactive Protein (CRP), what does it indicate, and what can it predict?

A

C-Reactive Protein (CRP) is a protein made by the liver and indicates acute inflammation,
-it is a predictive of increased risk for cardiac events in patients with UA and MI

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14
Q

What are the types of serum lipids?

A

Triglycerides (storage)
Cholesterol
Phospholipids

-they circulate as lipoproteins

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15
Q

What are the 2 lipoproteins we focus on and which is “good” and which is “bad”?

A

Low-density lipoproteins (LDLs)
-mostly cholesterol

High-density lipoproteins (HDLs)
-mostly protein

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16
Q

What are the preferred lipid profile levels?

A

Total cholesterol < 200

Triglycerides < 150

LDL < 100
-we want these low

HDL > 60
-we want these high

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17
Q

What kind of physical activity should someone do for CAD risk reduction?

A

10,000 steps

30 min a day

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18
Q

Name the HMG-CoA reductase inhibitors, a side effect, and who shouldn’t use them?

A

HMG-CoA reductase inhibitors (Statins)
 atorvastatin
 simvastatin

Most widely used

Side effects: Leg pain,

PT’s with liver failure should not be given statins

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19
Q

Name the Nicotinic acid derivative and what it should be taken with plus a side effect.

A

-niacin

flushing may occur and should be taken with an NSAID or Aspirin

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20
Q

Name the Fibric acid derivative and what is it most effective for?

A
  • fenofibrate

- most effective for lowering triglycerides and increasing HDL

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21
Q

What do the HMG-CoA reductase inhibitors, Nicotinic acid derivative, and Fibric acid derivative medications essentially do?

A

they restrict lipoprotein production

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22
Q

What does the medication cholestyramine do and what can it interfere with?

A

decreases absorption and can interfere with other medications so administer it separately

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23
Q

What medication is usually given with a statin in combination therapy?

A

ezetimibe

24
Q

Name and describe another lipid regulating medication used when PTs aren’t responding to other therapies.

A

oemga-3 acid ethyl ester

  • can increase live enzymes
  • can interfere with anticoagulants and increase bleeding time
  • adjunct to diet in PT’s with very high cholesterol > 500
25
Q

What are diagnostic tests for CAD?

A 
Chest X-ray
Electrocardiogram
Echocardiogram
Nuclear scans
Cardiac CT scan
Blood tests
- Lipid profile
- Cardiac markers
Cardiac catheterization
26
Q

Describe aspects of Electrocardiogram (ECG or EKG) and what it shows.

A
  • Shows electrical activity of the heart using 12 leads
  • Lead corresponds to location within the heart
  • Helps diagnose injury
  • Can change over time
  • Holter monitoring
  • Exercise stress test
27
Q

If a PT has ischemia what will show on the EKG?

A

ST segment depression and T wave inversion

28
Q

What is general the purpose of a stress test and what are ways it can be performed?

A

-to test how your heart responds to “work”

can be performed treadmill, hand bicycle, and even medication while at rest

29
Q

Describe an echocardiogram.

A

> uses sound waves to evaluate cardiac structures

  • shape
  • size
  • motion

> measures ejection fraction
can also be performed as stress echocardiogram
can be done Transthoracic or
Transesophageal (can see mitral valve disease)

30
Q

What are the purpose of radionuclide scans and what happens with the PTs urine?

A
  • Evaluate coronary artery perfusion
  • Detect areas of myocardial ischemia
  • Assess left ventricle function

PTs urine radioactive for 24 hrs

31
Q

Describe Cardiac Computed Tomography (Cat scan)

A 
 Done with or without
contrast
 Shows anatomy,
coronary circulation,
great vessels
 Coronary CT
angiography
 Calcium-score
screening scan
-Increased coronary
calcium is
predictive of future
cardiac events
32
Q

What are the 4 serum cardiac markers? Describe each.

A

Creatine kinase (CK) non-specific
>CK-MB is specific to heart tissue
- Released with myocardial injury

 Troponin

  • Biomarker of choice for diagnosis of heart damage
  • Detectable within 4 – 6 hours after injury
  • Detectable for 10 – 14 days
  • Level should be less than 0.1

 Myoglobin
-Non-specific and short duration

 Natriuretic Peptide (BNP)
- For diagnosis of heart failure

33
Q

What is angina?

A

pain caused by myocardial ischemia (reversible)

34
Q

When does ischemia occur?

A

When myocardial oxygen demand is greater than myocardial oxygen supply

35
Q

What is angina/ischemia primally caused by and what is usual percentage of obstruction before it occurs?

A

atherosclerosis

> = 75%

36
Q

What is Prinzmetal’s (variant) Angina?

A
  • rare, occurs at rest (supply ischemia)
  • may occur with or without CAD
  • controlled with calcium channel blockers and/or nitrates
37
Q

What is silent ischemia?

A
  • ischemia without subjective symptoms
  • EKG changes will be seen
  • managed the same as angina with symptoms
  • same risk as angina with symptoms
38
Q

Describe stable angina.

A

Transient
Predictable
Same pattern of onset, duration (5-15 min), & intensity
Relieved when cause is stopped or removed
Unusual at rest

*Demand problem

39
Q

How to assess for angina?

A

subjective data:

history
risk factors
symptoms 
pain
O,P,Q,R,S,T

physical data:

signs of adequate perfusion
extra heart sounds
adventitious lung sounds

40
Q

What is the goal for stable angina management?

A

Balance myocardial oxygen supply and demand

41
Q

How is stable angina managed?

A 
>Lifestyle modifications
>Risk factor reduction
       -lipid-lowering agents
>Pharmacological therapy 
      -Nitrates 
      -Beta-blockers
      -Calcium channel blockers
      -Anti-platelets 
>Diagnostic and/or perfusion procedures
42
Q

Describe nitrates, name the two types, and provide information on the use of them.

A

Nitrates are vasodilators (both decreasing venous return and increasing arterial oxygen supply) that relieve angina.

The short acting is sublingual nitroglycerin (NTG)

  • must be kept brown bottle
  • check expiration date
  • up to 3x taken within 5 min. periods
  • check for contraindication like Erectile Dys. Rx

The long acting are:
NTG ointment/patch
Isosorbide dinitrate

43
Q

Describe beta-blockers use for CAD/what they do.

A

They decrease myocardial oxygen demand

  • negative inotrope (decreases work of heart)
  • negative chronotrope
44
Q

Describe calcium channel blockers use for CAD/what they do.

A

Decrease oxygen demand and increase oxygen supply

  • negative inotrope
  • negative chronotrope
  • vasodilator
  • used to treat vasospasm
45
Q

What is the purpose of anti-platelet therapy?

A

to inhibit platelet aggregation/thrombus

46
Q

Name the 3 anti-platelet medications and describe each.

A

aspirin
-inhibits production of thrombus

clopidogrel

  • interacts with PPIs
  • Needs to be activated by an enzyme
  • Plavix test shows if PT has enzyme*

prasugrel
-newer medication
more effective than clopidogrel

47
Q

What is coronary angiography (cardiac catheterization)?

A

-Invasive procedure

-Femoral or radial insertion site
>if inserted radially allan test needs to be performed to assess for adequate perfusion

  • Uses fluoroscopy and contrast media to visualize vessels, valves, chambers
  • Gold standard for diagnosis of CAD*
48
Q

What are two types of precautionary coronary interventions?

A

Balloon angioplasty

Stent placement

49
Q

What are the immediate post procedure priorities?

A 
>Promote safety and comfort 
-Bedrest
       With femoral insertion 
            -keep PT supine
            -affected leg straight
            -HOB <30 degrees
-Pain management

-Meet basic needs
be creative helping PT eat and toileting

-Assess for prodecural complications

50
Q

What are the bleeding complications from cardiac catheterization?

How often would you check vitals?

A

Retroperitoneal bleed (flank and back bleeding, PT might have back pain)

Puncture site bleeding

Psuedoaneurysm (hematoma outside blood vessel)

Checking Neuro every VS check Q4 (frequently)

51
Q

What are two other post procedure complications having to do with lower extremities and the kidneys and what are interventions for each?

A

Lower limp ischemia
-check pulse with doppler

Acute renal failure do to receiving dye

  • assess I&Os (check PT is voiding)
  • check BUN/creatinine
  • provide IV fluids
  • oral fluids
  • antioxidants
52
Q

What is restenosis of a blood vessel and what will be frequently done to check for this complication?

A

Dissection, thrombus, or spasm of the coronary artery

Frequent cardiac assessment

  • telemetry
  • EKG
  • Instruct PT to report symptoms immediately
53
Q

What can be assessed if PT has restenosis?

A
  • Anxious
  • Chest pain present
  • Diaphoretic, cool
  • SOB, hypoxic
  • Extra heart sounds, dysrhythmias
  • Adventitious long sounds
  • VS unstable
54
Q

What are the discharge priorities?

A

Education prior to discharge

  • Medications
  • Lifestyle modifications
  • Cardiac rehabilitation
55
Q

Describe ezetimibe.

A

Decrease cholesterol absorption

Nursing 2 Exam 3 (5 decks)

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