Week 3 - Coronary Artery Disease Flashcards
what is CAD
- type of blood vessel disorders included in the general category of atherosclerosis
= blockage of blood flow to heart muscle - causing reduced flow of O2 and nutrients to the myocardium
what is the major cause of CAD`
- atherosclerosis
what type of disease is CAD
- progressive –> takes years to develop
what causes atherosclerosis
- complex interactions between the components of the blood and elements hat form the vascular wall
- inflammation and endothelial injury play big role
what can cause damage to the endothelial lining (5)
- tobacco use
- hyperlipidemia
- HTN
- DM
- infection
what is a nonspecific marker of inflammation? how is this impacted during CAD
CRP
- increased in pts with CAD
what are 2 categories of risk factors for CAD
- modifiable
2 nonmodifiable
what are examples of modificable factors of CAD (9)
- elevated serum lipid lvls (cholestrol, triglyceride, LDL)
- HTN
- tobacco & substance use
- physical inactivity
- obesity
- DM
- metabolic syndrome
- psychological states (depression, stress, anger)
- elevated homocysteine lvl
what are examples of nonmodifable factors of CAD (5)
- age
- sex (men > women until 65 years of age)
- ethnicity (more common in white)
- genetic predisposition
- FHx of heart disease
what is homocysteine
- produced by the breakdown of an amino acid found in dietary protein
what is imp to prevent, modify, or slow down the progression of CAD
- appropriate management of risk factors in CAD
describe health promotion r/t CAD
- individuals w risk factors should be encouraged to make changes in their lifestyle tp reduce the risk of heart disease
what can be done to reduce the risk factor HTN for CAD (6)
- regular BP checkups
- take prescribed BP meds
- reduce salt
- stop/never smoking
- control or reduce weight
- exercise regularly
what can be done to reduce the risk factor elevated serum lipids for CAD (5)
- reduce total fat intake
- reduce animal (sat) fat intake
- adjust caloric intake to maintain ideal body weight
- exercise
- increase amt of vegetable proteins and complex carbs in diet
what can be done to reduce the risk factor of smoking for CAD (4)
- enroll in programs to stop
- change daily routines associated w smoking to reduce desire to smoke
- substitute other activities for smoking
- ask family members for support to quit
what can be done to reduce the risk factor of physical inactivity for CAD (3)
- develop & maintain routine for physical activity
- exercise 3-4 x/week
- increase actviites to a lvl compatible w physical fitness
what can be done to reduce the risk factor of a stressful lifestyle for CAD (8)
- increase awareness of behaviors detrimental to health
- alter pattern that cause stress & rushing (ex. get up 30 min earlier)
- set realistic goals for self
- reassess priorities in view of health needs
- learn effective coping strategies
- avoid excessive & prolonged stress
- meditate 20min /day
- plan time for sleep and rest
what can be done to reduce the risk factor of obesity for CAD (5)
- change eating patterns and habits
- reduce caloric intake
- exercise regularly to increase calorie expenditure
- avoid fad and crash diets
- avoid large, heavy meals
what can be done to reduce the risk factor of DM for CAD (4)
- follow recommended diet
- reduce weight
- control diet
- monitor BG regularly
what nutritional therapy is used for CAD (6)
- decrease sat fat, most fats from monounsat fats
- reduce/eliminate alcohol
- omega 3 FA
- high fibre
- decrease cholestrol
- increase complex carbs
what are examples of complex carbs (3)
- whole grains
- fruit
- veggies
what are main sources of sat fats (3)
- red meats
- eggs
- whole milk
what is a good source of omega3 fatty acids
- fatty fish 2x/week
what is included in treatment of CAD (4)
- treat HTN & DM
- lifestyle changes (diet, exercise, no tobacco)
- primary care: yearly appt for physical and diagnostic tests
- meds
what kind of meds are used in treatment of CAD (2)
- drugs that restrict lipoprotein production
- antiplatelet therapy
what does treatment of high cholestrol begin w (6)
- smoking cessation
- dietary caloric restriction
- decreased dietary fat
- decreased cholestrol intake
- increased phys. activity
- stress management
at what point are meds used to lower cholestrol
- cholestrol lvls reassessed 6 mo. after diet therapy
- if remain elevated, then drug therapy may be started
what are the most widely used drugs to lower lipids
statins
what do statins do
- inhibit synthesis of cholestrol
what are s/e of statins (3)
- liver damage
- myopathy
- rhabdomyolysis
what should be monitored for a pt on statins (3)
- liver enzymes
- creatinine kinase
- jaundice
what can CAD lead to ?
- if atherosclerosis ruptures –> blood clot can form = blockage of coronary artery = MI
describe symptoms of CAD (3)
- often asymptomatic for years
- may develop chronic but stable chest pain
- if the demand for myocardial O2 exceeds the ability of the coronary arteries to supply the heart w O2, get myocardial ischemia = angina
what is angina
- chest pain
- the clinical manifestation of reversible myocardial ischemia
what can lead to myocardial ischemia
- increased demand for O2
- decreased supply of O2
what is the primary reason for insufficient blood flow
- narrow of the coronary arteries r/t atherosclerosis
how long does it take for the myocardium to become hypoxix
- 10 seconds
with total occlusion of the coronary arteries, how long does it take for contractility of the heart to stop
- several minutes
what does chronic, stable chest pain refer to
- chest pain that occurs intermittently over a long period of time with the same pattern of onset & intensity of symptoms
what does chronic stable angina feel like (6)
- pressure/ache in chest
- constrictive
- squeezing
- heavy
- choking
- suffocating sensation
NOT a sharp or stabbing pain
how does angina change w position or breathing
- it doesnt
what other symptoms might be experienced w chronic stable angina (2)
- indigestion
- burning sensation in epigastric region
where might angina radiate to (5)
- neck
- jaw
- shoulders
- arms
- between shoulder bladers
describe onset of chronic stable angina (3)
- brief (3-5 min)
- subsides when precipiating factor is relieved
- pain rare at rest
what can decreased O2 supply (11)
- anemia
- hypoxemia
- pneumonia
- asthma
- COPD
- low blood vol
- coronary artery spasm
- coronary artery thrombosis
- dysrhythmias
- HF
- valve disorders
what can caused increased O2 demand or consumption (10)
- anxiety
- cocaine use
- HTN
- hyperthermia
- hyperthyroidism
- physical exertion
- aortic stenosis
- cardiomyopathy
- dysrthytmias
- tachycardia
what does an ECG usually reveal during chronic stable angina
- transient ST segment depression = indicative of ischemia
= NSTEMI
what is important in assessment of angina (6)
- Onset
- Precipitating factor
- Quality of pain
- Radiation of pain
- Severity of pain
- Timing
how is chronic stable angina controlled on an outpt basis
- with meds
describe med regime for a pt with chronic stable angina
- bc episodes of chronic stable angina are predictable, meds can be timed to provide peak effects during the time of day when angina is likely
what is the treatment of chronic stable angina aimed at (3)
- decreasing O2 demand
- increasing O2 supplu
- or both
what is used to treat chronic stable angina (8)
- O2
- reduce CAD risk factors
- antiplatelet and cholestrol-lowering meds
- short-acting nitrate therapy *first line tx)
- long-acting nitrates
- beta blockers
- calcium channel blockers
- ACE-I
what is drug therapy for chronic stable angina aimed at
- prevent MI/death
- reduce Sx
how do nitrates produce their principal effects
- dilate peripheral blood vessels
- dilate coronary arteries and collateral veins
what does dilating peripheral blood vessels cause
- decreased SVR
- venous pooling
- decreased venous blood return to heart
= reduced cardiac workload = myocardial demand decreased
what does dilating coronary arteries and collateral vessels cause
- increased blood flow to ischemic area of heart
what is a type of short-acting nitrate used for treatment of chronic stable angina
- nitroglycerin
how can nitro be adminstered (2)
- sublingual
- translingual spray
how quickly does nitro relieve angina? how long is its duration
- in 3 min
- duration = 30-60 min
what is the recommended dosage of nitro
- 1 tablet sublingual
- or 1 metered spray
describe how nitro is taken
- take 1 dose (should last 30-60 min)
- if symptoms unchanged or worse after 5 min, take another dose
- if still not changed, take 3rd dose and call 911
no more than 3 doses in one episode
what is important pt education regarding nitro (6)
- place under tongue and let dissolve
- spray under tongue
- should cause a tingling sensation
- store in dark glass bottle to protect from degradation
- s/e: increased HR, headache, dizzy, flushing
- caution against quickly standing d/t orthostatic hypotension
- new supply every 6 mo. (lose potency once open)
- take tylenol w nitrate for HA
- nitrate holiday
what are long acting nitrates used for
- used to reduce incidence of anginal attacks
what is the predominant s/e of nitrates
- headache r/t dilation of cerebral blood vessels
what is a nitrate holiday? what is the importance of this?
- pts can become tolerate to nitro-induced vasodilation
- pts should schedule an 8-hr nitrate free period (usually at night) to avoid
what are the preferrred drugs for management of chronic stable angina
- beta blockers
what is an example of a beta blockers used for management of chronic stable angina
- metaprolol
what effect do beta blockers have for management of chronic stable angina
- decrease in myocardial contractility
- decreased HR, SVR, BP
= reduced myocardial O2 demand
what are some s/e of beta blockers (7)
- bradycardia
- hypotension
- wheezing
- GI complaints
- weight gain
- depression
- sexual dysfnxn
who should beta blockers be avoided in (2)
pts with
- asthma
- diabetes (mask signs of hypoglycemia)
when are calcium channel blockers used
- if use of beta blockers are contraindicated, poorly tolerated, or not controlling anginal symptoms
what is an example of a calcium channel blocker
- amlopdipine
what do calcium channel blockers do (4)
- systemic vasodilation w decreased SVR
- decreased myocardial contractility
- coronary vasodilation
- cause sm. muscle relaxation and vasodilation of coronary and systemic arteries = increased blood flow
what med do calcium channel blockers impact? how?
- potentiate the action of digoxin by increasing serum digoxin lvls
- monitor serum digoxin lvls during first week of therapy
what should you teach pts on calcium channel blockers and digoxin
- S&S of digoxin toxicity
who are ACE-I useful for in treatment of chronic stable angina (3)
- pts with DM, significant CAD, previous history of MI
what is used to diagnose CAD (10)
- history
- physical exam
- chest xray
- 12-lead ECG
- lipid profile
- echo
- holyer monitoring
- exercise stress testing
- coronary angiography
- pharmacological nuclear imaging
what are the major elements of tx of chronic stable angina (6)
Antiplatelet, antianginal, ACE-I Beta blockers, BP Cig smoking, cholestrol Diet, diabetes Education, exercise Flu vaccine
what should you teach a pt with chronic stable angina (6)
- identify and avoid precipiating factors of angina
- decrease modifiable risk factors
- low sodium, low sat fat diet
- maintain ideal body weight
- regular exercise (brisk walk on flat surface at least 30 min/day, 5x/week)
- proper use of nitro
if a nurse is present during an anginal attack, what measures should they institute? (6)
- O2
- VS
- 12-lead ECG
- prompt pain relief (nitro then morphine if necessary)
- auscultate heart sounds
- comfortable positioning for pt
describe pain assessment during an anginal attack
- OPQRST
- ask to rate pain before and after treatment
what is silent ischemia
- ishcemia that occurs without subjective symptoms
what type of pts have an increased incidence of silent ischemia
- pts w diabetes d/t neuropathy
what is nocturnal angina
- angina that occurs only at night , but not necessarily when the pt is in the recumbent position or asleep
what is angina decubitus
- chest pain that occurs only when laying down
- relived by standing or sitting
what is prinzmeal’s angina
- angina at rest that usually occurs in response to spasms of a major coronary artery
what is important teaching for a pt on beta blockers
- do not stop arubtly, can cause severe angina
- do not miss doses
