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218: Patho Part II > Week 2 Coronary heart disease > Flashcards

Week 2 Coronary heart disease Flashcards

1
Q

What is coronary artery disease?

What is myocardial infarction?

A

Coronary after disease is a disease of the arteries in which they narrow and thicken over time, increasing vascular resistance, thus, increasing the likeliness of developing complications, such as heart failure, heart attack, stroke, embolus, or thrombus from occurring.

A myocardial infarction occurs when blood flow decreases or stops to a part of the heart, causing damage to the heart muscle

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2
Q

What is acute coronary syndrome?

A

A group of clinical symptoms where the blood supplied to the heart muscle is suddenly blocked such as heart attack or unstable angina.

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3
Q

What change in the body occur that cause coronary artery disease?

Think about the disease itself and what happens in the arteries.

A

Coronary heart disease is a disease in which a waxy substance called plaque builds up inside the coronary arteries. These arteries supply oxygen-rich blood to your heart muscle. When plaque builds up in the arteries, the condition is called atherosclerosis. The buildup of plaque occurs over many years.

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4
Q

What is atherosclerosis?

A

Atherosclerosis is a reduction or obstruction of blood flow in the coronary vessels to the myocardial tissues from fat deposits

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5
Q

Atherosclerosis begins by damage to the cardiovascular (CV) endothelial tissue vessel walls. What risk factors cause these changes?5

A 
hypertension
tobacco use
hyperlipidemia 
immune reactions
infections
diabetes
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6
Q

What causes abnormal growth of the damaged vessel walls in atherosclerosis?

A

When someone has atheroscelorsis, the damaged cells interact with platelets. The damaged vessels cause the platelets to activate and release a growth factor that stimulates smooth muscle proliferation. This causes the smooth muscles to grow and entraps lipid material. Platelets adhere to calcified fatty deposits and aggregate (compact mass). Clotting factors are released at these deposits and blood clots can occur

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7
Q

What are the three phases of coronary artery disease?

A
  1. fatty streak
  2. raised fibrous plaque
  3. complicated lesion
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8
Q

What is the fatty streak stage of coronary artery disease?

A

Fatty streak is the first stage of CAD and is identifiable as a layer of fatty smooth muscle growth filled with lipids in the damaged endothelial tissue.

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9
Q

As fatty streaks grow, it begins to damage the epithelium. When this happens, what occurs?

A

Cholesterol and lipids are shuttled into the tunica intima, forming fatty deposits. The release of platelet aggregations cause the formation of a fibrous, collagen layer. This fibrous plaque causes inflammation to its surrounding tissue.

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10
Q

What is complicated lesion?

A

Complicated leison is the third phase of the development of CAD. The inflammation in the tissue surrounding the fibrous plaque deposits cause the deposits to become unstable, it can ulcerate and rupture. Platelets adhere to the ruptures tissue and a thrombus (blood clot) is formed. this can cause further restriction or total occlusion of blood flow.

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11
Q

What is collateral circulation?

A

Collateral circulation is a network of several smaller blood vessels that form on the side of the plaque deposit to create a bypass system that reroutes blood flow, reducing CAD symptoms

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12
Q

What are the primary risk factors of CAD?

A

The primary risk factors for CAD are:

  1. smoking
  2. hypertension
  3. abdominal obesity
  4. inactivity
  5. alcohol consumption
  6. malnutrition (fruits and vegetables)
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13
Q

Which fats are major contributors to plaque formation?

What are the most significant modifiable risk factors?

A

LDL’s ( low-density lipoproteins) and serum-triglycerides, including saturated, monounsaturated and polyunsaturated fats are major contributors to plaque formation

Evaluated serum lipid levels
hypertension
tobacco use
physical inacvitiy
obesity
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14
Q

How does hypertension affect blood vessels?

A

Hypertension affects the blood vessel walls by exhibiting shearing forces on the endothelium, which damages the blood vessel and decreases the function of the vessel causing a build up of atherosclerotic plaque buildup, reducing blood flow

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15
Q

How can tobacco use affect blood pressure and CAD?

A

Tobacco use raises blood pressure and nicotine can cause platelet adhesion in the blood leading to the formation of an embolus circulating clots

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16
Q

How does diabetes mellitus affect CAD?

A

DM affects CAD because diabetics typically have elevated serum-lipid levels (hyperlipidemia) which contribute to plaque buildup.

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17
Q

What are some preventative measures for CAD?

A
  • physical activity
  • nutriton
  • drug therapy
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18
Q

At what levels would one considered treatment for high levels of serum-cholesterol?

What types of drugs are used to restrict lipoprotein production?

A

> 5.2mmol/L OR
100 mg/dL

Anything less than 100mg/dL is GOOD cholesterol levels

Statins. Statins are used to reduce cholesterol by preventing the liver from synthesizing it. Statins also increase the ability of the liver to filter LDL’s out of the blood

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19
Q

What is chronic stable angina and what is it caused by?

A

Chronic stable angina is one type of CAD that is characterized by chest pain that occurs intermediately over time, with the same onset, duration and intensity.

It is caused by myocardial ischemia (inadequate blood supply to the heart) that causes hypoxia of the heart.

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20
Q

How would someone describe their chest if they were experiencing chronic stable angina and how long does it last for??

A
  • pain; pressure; ache
  • rarely sharp or stabbing
  • it lasts for 3-5 minutes
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21
Q

What is nocturnal angina?

A

Nocturnal angina occurs at night but not necessarily when the individual is lying down or sleeping

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22
Q

What is angina decubitus?

A

Angina decubitus occurs when the person is lying down, it is usually relieved by standing or sitting.

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23
Q

The treatment of chronic stable angina involves decreasing the tissue oxygen demand or increasing available oxygen. In terms of pharmacotherapy, what classification of drugs would be used to treat chronic stable angina?

A
  • Nitrates
  • beta-blockers
  • calcium-channel blockers
  • angiotensin converting enzyme ACE inhibitors
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24
Q

What is the action of nitrates in terms of treating CSA (chronic stable angina)?

How does the heart benefit from nitrates?

A

nitrates act as vasodilators in both the coronary and peripheral vessels. Vasodilation of the heart decrease the potential for iscehmia to cause harm.

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25
Q

What is the purpose of dilating the peripheral vessels?

A

The dilation of the peripheral vessels serves to increase the volume of blood in the periphery and lowers the volume that the heart is pumping through; the heart does not have to work as hard.

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26
Q

What is a main side effect of nitrate medications?

A

A main side effect of Nitrates is orthostatic hypertension.

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27
Q

What is the action of beta-blockers in terms of CSA (chronic stable angina)?

What is the ending prefix?

A

Beta-blockers decrease the contractility of the heart by blocking excitatory beta receptors, lowering the oxygen demand

LOL is the ending prefix of beta-blockers

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28
Q

What is the action of calcium-channel blockers in terms of CSA (chronic stable angina)?

A

The action of calcium-channel blockers is to decrease heart contractility and act as a vasodilator.

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29
Q

What is one nursing consideration when administering calcium–channel blockers in terms of serum-digoxin levels?

A

CCB are known to raise digoxin serum levels, thus, someone is taking digoxin, then they need to be closely monitored as

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30
Q

What is the action of ACE inhibitors?

A

ACE inhibitors relax blood vessels and used to treat angina

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31
Q

What is acute coronary syndrome (ACS)?

A

Acute coronary syndrome involves either unstable angina or myocardial infarction, and it is associated with deterioration of a once-stable plaque deposit

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32
Q

What occurs to the stable plaque deposit in acute coronary syndrome?

A

The plaque deposit in acute coronary syndrome ruptures, forming a thrombus, and blood flow is thus restricted or occluded

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33
Q

What are the characteristics of an unstable angina?

A

The characteristics of an unstable angina are:

  • variable onset, duration, intensity
  • new
  • occurs at rest
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34
Q

What is a myocardial infarction and what are they usually caused by?

A

A myocardial infarction occurs when a myocardial ischemia is unrelieved and hypoxic tissues begin to die. They are usually caused by thrombus formations.

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35
Q

What is a thrombus?

A

A thrombus is a blood clot formed in situ within the vascular system of the body and impeding blood flow.

36
Q

This layer of the heart is the first to become necrotic in the event of severe ischemia >20 minutes.

A

subendocardium

37
Q

What are the clinical manifestations of a MI?

A 
pain
SNS stimulation
Cardiovascular manifestations
nausea and vomiting
fever
38
Q

What is the hallmark sign of someone experiencing a MI?

A

Severe, immobilizing chest pain not relieved by rest or nitrates is the hallmark sign of an MI

39
Q

What occurs when the SNS is stimulated during a MI?

A

During an MI, ischemic tissues release catecholamines (epic/norepi) that cause a system stress response.

40
Q

During a heart attack, peripheral vasoconstriction would cause the persons skin to feel?

A

cool

41
Q

This pain is often associated with a heart attack.

A

epigastric pain (heartburn)

42
Q

Why would someone experiencing a heartache have a fever?

A

Someone experience an MI would develop a fever due to myocardial cell death that release contents that cause systemic inflammatory responses that induce a fever.

43
Q

After experiencing an MI, what changes occur to the heart tissue that can cause late heart failure?

A

In an attempt to restore cardiac performance, ventricular remodelling includes hypertrophy and dilation of the heart vessels and tissue, which can lead to late heart failure

44
Q

Dysrhythmia is a complication of myocardial infarction. What is it?

A

Dysrhythmia include tacky-and bradycardia and irregular heartbeats.

45
Q

What is ventricular fibrillation?

A

Ventricular fibrillation is a heart rhythm problem that occurs when the heart beats with rapid, erratic electrical impulses. This causes pumping chambers in your heart (the ventricles) to quiver uselessly, instead of pumping blood

46
Q

In the reduction of cardiac performance, the heart may not be able to produce enough blood flow to meet the body’s metabolic demands. When this occurs, it is known as

A

heart failure

47
Q

What is papillary muscle dysfunction and what causes it?

A

Papillary muscle dysfunction occurs when someone has an MI. This causes damage to the tissues, which reduces AV valve function. These changes in the affected valve cause murmurs and reduces cardiac output.

48
Q

What is a ventricular aneurism?

A

Ventricular aneurism is a complication of MI. The word aneurysm refers to a bulge or ‘pocketing’ of the wall or lining of a vessel commonly occurring in the blood vessels at the base of the septum, or within the aorta.

49
Q

What is pericarditis?

A

Pericarditis is inflammation of the pericardial tissue found in the heart.

50
Q

What is Dressier’s syndrome and what is it caused by?

A

Dressier’s syndrome occurs when pericarditis leaks fluid and is accompanied by a fever. this is caused by an antigen-antibody reaction the dead myocardial cells which can be detected by elevated WBC.

51
Q

What is STEMI?

A

During a heart attack, ECG’s can distinguish where a heart attack took place. If ST is elevated then the infarction spans the full thickness of the myocardium.

52
Q

What is NSTEMI

A

NSTEMI occurs when the infarction was only partial thickness. The ST segment will be inversion scant to moderate

53
Q

What are serum cardiac markers?

A

Serum cardiac markers are certain proteins that are released during an MI from dying myocardial cells that indicate if an MI has occured

54
Q

What can we do as nurses to assist someone who has experienced or is experiencing a MI?

A
  • quick treatment
  • nitroglycerine and aspirin should be administered IMMEDIATELY; chew on the aspirin
  • oxygen supplementation can offset ischemic areas
55
Q

Percutaneous coronary intervention is a medical intervention used to treat someone with who experienced an MI. What is it?

A

Percutaneous coronary intervention involves the insertion of an inflatable ballot via catheter that, when inflated, presses the coronary plaques up against the vascular walls, spreading them out and improving circulation

56
Q

What is coronary artery bypass graft?

A

Coronary artery bypass grafts are able stents (hallow tubes) put into the ischemic vessels that restore luminal diameter and blood flow

57
Q

What is the goal once an MI has been confirmed?

A

The goal is to open the obstructed artery within 90 minutes.

58
Q

What is fibrinolytic therapy?

A

Fibrinolytic therapy is the use of clot-busting medications that can be used to break down and eliminate coronary thrombi.

59
Q

In the first stages of a MI what are the focused nursing interventions?

A

The focused assessment should be on pain management and relief, physiological monitoring with vital stats.

Promote rest and relief of anxiety too.

60
Q

What are a leading cause of sudden cardiac death?

A

Sudden cardiac death is a result of ventricular dysrhythmias

61
Q

Which arteries affect the peripheral arterial disease?

A
  • aortoilliac
  • femoral
  • popliteal
  • tibial
  • peroneal
62
Q

Where do diabetics typically develop peripheral material disease (PAD)?

A

Diabetics typically develop PAD below the knees.

63
Q

What is intermittent claudication?

A

Intermittent claudication is periodic, temporary, ischemic muscle pain, the classic symptom of PAD. The pain is a by-product of lactic acid buildup in the muscles being deprived of oxygen

64
Q

What is peripheral artery disease?

What type of drug is used to treat peripheral arterial disease?

A

Peripheral artery disease (PAD) is a circulatory problem in which narrowed arteries reduce blood flow to your limbs. When you develop peripheral artery disease (PAD), your extremities — usually your legs — don’t receive enough blood flow to keep up with demand.

pentoxifylline; works by altering blood properties (RBC flexibility, fluid viscosity)

65
Q

What are signs of PAD?

A
  • taut, shiny skin
  • loss of hair in affected area
  • diminished or absent peripheral pulses
66
Q

What diagnostic test is used to reveal the existence and severity of PAD?

What does it entail?

A

Ankle-brachial index

It is a number that is calculated by comparing the ratio of systolic blood pressure between the brachial and ankle arteries. A health range is 0.9-1.3

Mild: 0.41-.89
Severe: 0-0.4

67
Q

What internvetions are used to help lower the onset of PAD?

A
  • lowering hypertension
  • quit smoking
  • lower serum-lipid levels
  • tight BG control with diabetic patients
68
Q

This classification of drugs can also help lower the risk of developing PAD.

A

Anti platelet drugs, such as aspirin, ticlopidine and clopidogrel

69
Q

What would some treatment options be for clients with later stage PAD?

A

protection from trauma
wound treatment
infection control

70
Q

What is the least desirable, but most effective treatment of PAD?

A

amputatoin

71
Q

What are characteristics of peripheral arterial disease?

Peripheral pulse?
Cap refill?
Ankle-braichail index?
Edema?
Hair?
Ulcers? Location?
Nails?
Skin temp?
A

Peripheral pulse: decreased or absent

Cap refill: longer

Ankle-brachial index: reduced

Edema: not present

Hair: falls out

Ulcer location: ankles/anywhere on feet

Nails: thickened/brittle

Skin temp: cool, cooler down the legs

72
Q

What are some characteristics of peripheral venous disease?

Edema?
Ulcers? Location?
Nails?
Skin?
Skin temp?
A

Edema: present in lower leg and foot

Ulcer location: mid-ankle

Nails: normal or thickened

Skin texture: thick and hardened

Skin temp: normal

73
Q

What is venous thromboembolism? (VTE)

or deep venous thrombosis

A

Venous thromboembolism is a condition in which blood clots form in the deep veins of the leg (known as deep vein thrombosis, DVT) and can travel in the circulation and lodge in the lungs (known as pulmonary embolism, PE).

74
Q

What are three major factors that affect VTE?

A
  1. venous stasis
  2. damage to endothelium
  3. hyper coagulability of the blood
75
Q

What is an embolism?

A

An embolism is the lodging of an embolus, a blockage-causing piece of material, inside a blood vessel. The embolus may be a blood clot (thrombus), a fat globule (fat embolism), a bubble of air or other gas (gas embolism), or foreign material.

76
Q

What is a crucial role of the endothelial cells to prevent an embolus from being lodged into the pulmonary vessels?

A

Encapsulation

77
Q

What is thrombophelbitis?

A

Thrombophlebitis is swelling and hardening of veins and is caused by venous insufficiency (DVTs or Varicose Veins).

78
Q

What is one non pharmacological treatment for venous insufficiency?

A

Exercise or compression devices!

79
Q

When an iscehmic MI occurs, what changes occur in an EKG?

A

T-wave Inversion, resulting from altered repolarization

80
Q

When an injury occurs in an MI, what changes occur in an EKG?

A

elevated ST segment, resulting from altered depolarization. Consider an elevation greater than 1 mm significant.

81
Q

INFARCTION is a complete lack of blood reaching the cell, causes myocardial cell death (necrosis). What changes occur in an EKG?

A

Pathologic Q wave, resulting from abnormal depolarization or from scar tissue that can’t depolarize.

82
Q

This protein is an important indicator of an MI when released into circulation after an MI.

A

troponin 1

83
Q

What are some clinical manifestations of a myocardial infarction?

A
  • intially high blood pressure, then low blood pressure
  • crackles
  • jugular venous distension, hepatic engorement, peripheral edema
  • abnormal heart sounds
  • nausea and vomiting
  • fever
84
Q

What is the drug of choice for the relief of pain associated with acute MI and how would it be administered?

A

Morphine

Small doses (1-3mg) IV every 5 minutes until complete pain relief

85
Q

What is the acronym used to treat MI?

After you administer this acronym, what would follow?

A

MONA

Morphine
Oxygen
Nitroglycerin
Asa/aspirin

Calcium-channel blockers and beta-blockers would be administered to help slow the heart down due to myocardium injury

218: Patho Part II (8 decks)

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