Unit 9 - CAD Flashcards
coronary artery disease is cause by impaired blood flow to _____
myocardium
chest pain caused by reduced cardiac blood flow
angina pectoris
unstable cardiac ischemia
acute coronary syndrome (ACS)
necrosis/death of myocardial cells
acute myocardial infarction (AMI)
Pathophysiology/etiology of CAD:
- blood flow in coronary arteries regulated by aortic pressure, heart rate, other factors
- large arteries not connected: small arteries joined by _____ channels -> alternate routes for blood flow
collateral
most common cause of reduced coronary blood flow
atherosclerosis
high levels of low-density lipoprotein (LDLs) and toxins lead to arterial endothelial layer damage and plaque formation
atherosclerosis
complex lesions of lipids, fibrous tissue, collagen, calcium, cellular debris, capillaries - develop -> can rupture or ulcerate causing emboli or thrombus
atheromas
where does atherosclerosis develop
where arteries bifurcate or branch
ischemia develops when…
oxygen supply inadequate to meet metabolic needs
acute coronary syndrome
- coronary blood flow _____ but not entirely occluded
- rupture or erosion of _____ plaque (predominant cause)
- coronary artery _____
- progressive vessel _____
- _____ of coronary artery
- _____ myocardial oxygen demand and/or _____ supply
- ECG changes: inversion of T-wave, possible elevation of _____ segment
- coronary blood flow reduced but not entirely occluded
- rupture or erosion of atherosclerotic plaque (predominant cause)
- coronary artery spasm
- progressive vessel obstruction
- inflammation of coronary artery
- increased myocardial oxygen demand and/or decreased supply
- ECG changes: inversion of T-wave, possible elevation of ST segment
acute myocardial infarction (MI) occurs when blood flow to a portion of cardiac muscle is completely _____, resulting in a prolonged tissue _____ by damages area of the heart
blocked
ischemia
MI:
occlusion L anterior descending artery =
anterior MI
MI:
left circumflex artery =
lateral MI
MI can result from acute cocaine _____
toxicity
angina classes:
I
II
III
IV
Angina class:
does not occur with ordinary physical activity
Class I
Angina class:
prolonged walking or stair climbing
Class II
Angina class:
limits normal activities of daily living
Class III
Angina class:
angina with rest or activity
IV
substernal or epigastric chest pain =
acute coronary syndrome
- continuous chest pain
- onset sudden; not precipitated by activity
- accompanied by nausea, vomiting, hypotension, bradycardia
acute myocardial infarction
Diagnostic Tests:
proteins released during a myocardial infarction that are sensitive indicators of _____ _____
myocardial damage
Diagnostic Tests:
not specific to _____ muscle; use is limited
cardiac
Diagnostic Tests:
elevated white blood cell count and erythrocyte sedimentation rate because of _____ _____ _____
myocardial cell inflammation
Diagnostic Tests:
assess blood oxygen and _____-_____ balance
acid-base
Electrocardiogram: changes seen in acute myocardial infarction - T wave \_\_\_\_\_ - ST segment \_\_\_\_\_ - Formation of \_\_\_\_\_ wave
- inversion
- elevation
- Q wave
Echocardiogram:
evaluate cardiac wall motion and _____ _____ function
left ventricular
Radionuclide imaging:
- evaluates myocardial _____
- cannot differentiate between _____ and _____ myocardial infarctions
perfusion
old and new
Conservative management:
- reduce the risk of coronary artery disease (CAD) by _____ regardless of length of time smoking
50%
Conservative management:
Diet
- _____ saturated fat and cholesterol intake
- _____ LDL level
- _____ intake of soluble fiber
- _____ alcohol intake
- overweight or obese: encourage to _____ weight
- reduce saturated fat and cholesterol intake
- Lower LDL level
- increase intake of soluble fiber
- moderate alcohol intake
- overweight or obese: encourage to lose weight
drugs used to lower cholesterol: goal -> achieve LDL level < _____ mg/dL
130
Drug of choice for CAD
nitrate (sublingual nitroglycerin)
nitrate (sublingual nitroglycerin) acts within _____ minutes
1-2
4 side effects of nitrate (sublingual nitroglycerin)
headache
nausea
dizziness
hypotension
first-line drug to treat stable angina
beta-blockres
beta-blockers are contraindicated in clients with _____ or severe _____
asthma
COPD
T/F: beta-blockers may make prinzemtal angina worse
T
Calcium-channel blockers are used for long-term _____
prophylaxis
Calcium-channel blockers are used with caution in clients with _____, _____ _____, _____
dysrythmias, heart failure, hypotension
_____ reduce risk of platelet aggregation and thrombus formation
aspirin
_____ is essential initial treatment for myocardial infarction
aspirin
Fibrinolytics:
- _____ infarct size
- _____ heart damage
- _____ outcomes
limits
reduces
improves
purpose of percutaneous coronary revascularization
restore blood flow to ischemic myocardium by compressing plaque
_____ catheter shaves plaque off vessel walls, removes it
atherectomy
_____ uses section of vein, artery to create connection (bypass) between aorta and coronary artery beyond the obstruction
CABG
CABG
_____ clients -> totally relieves or significantly reduces angina
90%
CABG
heart is stopped during surgery for _____ techniques; newer techniques do not require stoppage and are safer
older
2 approaches to minimally invasive coronary artery surgery:
- port-access coronary artery bypass
- minimally invasive direct coronary artery bypass
laser drills tiny holes in myocardial muscle, provides blood flow to ischemic area
Transmyocardial laser revascularization:
- balloon inflates during diastole, deflates during systole
intra-aortic balloon pump
_____ _____ device
- takes partial or complete control of cardiac function
- risk for infection high
- ventricular assist device
Diagnosis:
CAD
- imbalanced _____: more than body requirements
- ineffective _____ maintenance
nutrition
health
Diagnosis:
Angina
- ineffective _____ perfusion: cardiac
- risk for _____ _____ regimen management
tissue
ineffective therapeutic
Diagnosis: AMI - \_\_\_\_\_ pain - ineffective \_\_\_\_\_ perfusion - \_\_\_\_\_ coping - fear
acute
tissue
ineffective
defined as an alteration in the structure and function of the right ventricle (RV) of the heart caused by a primary disorder of the respiratory system. Pulmonary hypertension is often the common link between lung dysfunction and the heart in _____ _____
cor pulmonale
