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nurse 251 > week 5 (CAD) > Flashcards

week 5 (CAD) Flashcards

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1
Q

___ % of deaths in Canada are due to cardiac disease

A

29%

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2
Q

What is the major cause of coronary artery disease?

A

atherosclerosis

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3
Q

what is atherosclerosis?

A

hardening of arteries due to plaque

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4
Q

how does atherosclerosis begin?

A

it begins as soft deposits of fat that harden with age

-characterized by deposits of cholesterol and lipids within the intimal wall of the artery

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5
Q

what is plaque formation the result of?

A

plaque formation is the result of complex interactions between the componets of the blood and the elements that form the vascular wall

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6
Q

is CAD a progressive disease?

A

yes, it takes many years to develop

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7
Q

what are the stages of development in atherosclerosis?

A

1) fatty streak
2) fibrosis plaque
3) complete lesion (plaque)

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8
Q

what are the earliest lesions of atherosclerosis characterized by?

A
  • characterized by lipid-filled smooth muscle cells

- blood cells can still get through

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9
Q

what age can fatty streaks be observed in the coronaries?

A

age 15

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10
Q

what can reverse the process of fatty streaks?

A

treatment that lowers LDL cholesterol

-lipitor or crestor

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11
Q

what is LDL?

A

bad cholesterol

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12
Q

what is HDL?

A

good cholesterol

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13
Q

what is the beginning of the progressive changes in the endothelium of the arterial wall called?

A

fibrous plaque

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14
Q

are the changes that are happening in fibrous plaque reversible?

A

no, they are not reversible and will only get worse from this point

  • once endothelial injury has occured, lipoprotiens transport cholesterol and other lipids into the aterial intima
  • the result is narrowing of the vessel luman and a reduciton in blood flow to the distal tissue
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15
Q

what characteristics are present in the final stage, complicated lesion/ complete lesion?

A
  • as the plaque grows, continued inflammation can result in plaque instability, ulceration and rupture
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16
Q

what happens once the integrity of the arteries inner wall is compromised?

A

platlets accumulate in large numbers and form a thrombus
-the thrombus may adhere to the wall of the artery causing further narrowing, or break off and travel to something like th brain- can lead to a heart attack, or total occulsion of the artery

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17
Q

what are some risk factors of coronary artery disease?

A
  • tobacco use
  • elevated blood levels of apolipoprotein B or A1
  • history of hypertension
  • diabetes mellitus
  • abdominal obesity- if measured, can determine if they are at higher risk for CAD
  • lack of fruit or veggie intake
  • alcohol consumption
  • physical inactivity
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18
Q

what are some nonmodifiable risk factors for CAD?

A
  • age, gender, family history, genetic inheritance
  • women tend to manifest CAD 10 years later in life than men (though to be related to the loss of cardioprotective effects of natural estrogen with onset of menopause)
  • in most cases, pts with angina or MI can identity a parent of sibling who has died of CAD
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19
Q

what are some modifiable HIGH RISK factors for CAD?

A

major risk factors: elevated serum lipid levels (high cholesterol), hypertension, tobacco use, physical inactivity, and obesity

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20
Q

what are some modifiable CONTRIBUTING RISK factors for CAD?

A 
diabeties mellitus
metabolic syndrome 
psychological state
homocysteine (clotting factor in blood) 
substance use
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21
Q

what is one of the four most firmly established risk factor for CAD?

A

elevated serum lipid levels

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22
Q

___% of canadians have high cholesterol

A

40%

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23
Q

what do canadian guildlines offer?

A

1) a description of pts whose lipid profile should be screened
2) a classification of metabolic syndrome to evaluate central obesity (waste circumferance PLUS two of the following:
a) plasma triglyceride levels
b) high density lipoprotein (HDL)
c) blood pressure and fasting plasma glucose

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24
Q

what does tx for elevated serum lipid levels include?

A

smoking cessation
diet modification (reduced consumption of both saturated fats and refined sugars)
weight reduction
maintence daily exercise
stress management
and in high risk pts, pharmacological therapy

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25
Q

for ppl who have an elevated serum lipid level, how often should a complete lipid profile be obtained?

A

every 5 years beginning at age 20

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26
Q

a person with a serum cholesterol level exceeding ____mmol/L is at risk for CAD and should be treated

A

5.2 mmol /L

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27
Q

what kind of drugs are most widly used for CAD?

A

statin drugs and lipid lowering drugs

atrovastin and rosuvastatin

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28
Q

what are some serious adverse effects of atrovastin and rosuvastatin

A

-liver damage and myopathy that can progress to rhabdomyolysis (skeletal muscle breakdown) but these are rare

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29
Q

what is important to remember when taking statin?

A

keep hydrated

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30
Q

what is hypertension?

A

Defined as BP pt 140/90 mmhg or higher ( For diabetic pt : 130/ 80 is considered high )

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31
Q

what does the stress of constantly elevated BP increase the rate of?

A

atherosclerotic developement

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32
Q

what can increased workload on that heart case?

A

left ventricular hypertrophy and decreased stroke volume with each contraction

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33
Q

what are some lifestyle factors that contribute to hypertension?

A

obesity, poor dietary habits, high sodium intake, sedentary lifestyle, alcohol and stress

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34
Q

what does nicotine in tobacco cause the release of?

A

catecholamine (epipephrine and norepinaphrine)

-these neurohormones cause an increase in heart rate, peripheral vasocontriction, and increase in bp

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35
Q

what happens to the heart the more a person smoked?

A
  • the more hard the heart has to work

- eventually these changes increaes cardiac workload, necessititating greater myocardial oxygen consumption

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36
Q

what is the minimun amount of time per week of moderate to virgoous excersise it takes to add muscle and bone strengthening?

A

150 min per week

-improves health and reduce cardiac disease risk

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37
Q

what does excersise enhance?

A

enhances fibrinolytic activity (breakdown of platlets) thus reducing the risk of clot formation

38
Q

what is proportional to the degree of obesity?

A

the increased risk for CAD is proportional to obesity

39
Q

what percent of canadians are obese?

A

25%

-waist circumference is now regarded as the factor that indicated the greatest health risk related to obesity

40
Q

what do coronary arteries do?

A

supply the heart with 02

-these arteries lay ontop of the heart

41
Q

what categories of angina are there?

A 
Printzmetals Variant Angina (vasospasm)
Chronic stable angina (fixed stenosis)
unstable angina (thrombus)
42
Q

when does myocardial ischemia occur?

A

Occurs when the demand for myocardial o2 exceeds the ability of the coronary arteries to supply the heart with o2

43
Q

angina or chest pain are the clinical manifestations of reversible…

A

reversible myocardial ishcemia

44
Q

what does chronic stable angina refer to?

A

refers to chest pain that occurs intermittently over a long period with the same pattern of onset, duation, and intesity of symptoms

45
Q

with chronic stable angina, is pain at rest normal or unusual?

A

its unusual

46
Q

how often does pain occur with chronic stable angina?

A

pain usually is brief, lasting 3-5 mins

resolves when 02 returns to heart (rest)

47
Q

where is pain located with chronic stable angina?

A

pain is mostly substernal, but the sensation may occur in the neck or radiate to the jaw, shoulders, and down arms

48
Q

what is indicative of ischemia on ECG?

A

a ST segment depression

49
Q

within what time frame does a pt need an ECG assessment when presenting with chest pain?

A

witihin 5 min

50
Q

what is PQRST?

A 
provoke
quality
Radiation 
Severity 
Timing
51
Q

what is prinzmetals angina?

A
  • spasm of the coronary artery
  • usually happens in young athletes
  • often occurs at rest, usually in response to spasm of teh major coronary artery
  • rare form of angina
  • spasm may occur in the absesne of CAD
52
Q

what are factors that precipitate coronary artery spasm include what?

A

myocardial o2 demands (seen in high intensity workouts, like crossfit

  • when spasms occur, pt experiances angina
  • resolve on own
  • pain may be resolves by moderate excersise of disappear spontaneously
53
Q

what is the goal of tx of angina?

A

decrease o2 demand, increase o2 supply, or both

54
Q

what is sublingual nitroglycerin for?

A
  • is relieves pain of angina in aprox 3 min
  • can be administered sublingually or by reanslingual spray
  • expire after 4-6 months
  • if spray is given and it doesnt work, its not the problem- call EMS (also call if there are no differences in 5 minutes or is worse after 5 min)
55
Q

what will a pt complain of after recieving nitro spray?

A

dizziness and headache

56
Q

what is the recommended dose of nitro of angina?

A

one tablet of one spray under the tongue

57
Q

what are some side effects of sublnigual nitroglycerin?

A

headache, dizziness, and increased heart rate

58
Q

what is the perferred drug for the management of chronic stable angina?

A

beta blocker

59
Q

what do beta blockers do?

A

decrease myocardial contractility (makes is easier for the heart to pump)
-reduces the myocardial 02 demand

60
Q

what are some adverse effects of beta blockers?

A

bradycardia and hypotension

61
Q

what is metroprolol?

A

beta 1 blocker - It is used to treat high blood pressure, chest pain due to poor blood flow to the heart, and a number of conditions involving an abnormally fast heart rate.
- it is normal for these pts to have low bp, even though the medication decreases it further.

62
Q

if beta blockers are contraindicated or do not control angina symtoms, what is used?

A

calcium channel blockers

nifedipine, verapamil, diltiazem

63
Q

what are the effects of a calcium channel blocker?

A

effects are:

a) systemic vasodilatoin with decreased SVR (vasular resistance)
b) decreased myocardial contracility
c) coronary vasodilation
- cardiac muscle and vascular smooth muscle cells are more dependent on extracellular calcium and therefore more sensitive to calcium channel blockers
- causes smooth muscle relaxation and relative vasodilation of coronary arteries, this increasing blood flow

64
Q

what can certain high risk pts with chronic stable angina benefit from?

A

the addition of an angiotensin-converting enzyme inhibitor (ACE) (captopril)
-such patients include those with diabetes, significant CAD, and previous history of MI with left ventricular dysfunction

65
Q

what is under the umbrella of an acute cornonary syndrome?

A

The term acute coronary syndrome (ACS) refers to any group of clinical symptoms compatible with acute myocardial ischemia and includes unstable angina (UA), non—ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI).

66
Q

what is acute coronary syndrome associated with?

A

deterioration of an atherosclerotic plaque that was once stable

  • plaque ruptures and thrombus forms
  • this unstable lesion may be partially occluding a vessle by a thrombus (manifesting as unstable angina or NSTEMI)
  • total occlusion by a thrombus - (STEMI)
  • ACS requires hospitalization
67
Q

what is unstable angina?

A
  • chest pain that is new in onset, occurs at rest or has a worsening pattern
  • stable angina can turn into unstable angina
  • unstable angina may be the first sign of coronary artery disease
  • is unpredictable and an emergancy
68
Q

how does unstable angina affect woman?

A
  • women experiance fatigue, shortness of breath, indigestion and anxiety
  • highly missed in women because it affects them differently
69
Q

what is myocardial infraction?

A
  • aka heart attack
  • occurs as result of sustained ischemia, causing irreversivle myocardial cell dealth
  • when thrombus develops, perfusion to the myocardium distal to the occulsion is halted
  • degree of dysfunction depends on area of the heart involved and the size of the infraction
70
Q

between ___ and ___% of all acute MI’s occur secondary to thrombus formation

A

80 - 90%

71
Q

how long can cardiac cells withstand ischemic conditions before cell death occurs?

A

20 minutes before cell death occurs

72
Q

if ischemia persists, the entire thickness of the heart muscle (myocardial) becomes necrosed in approximately…

A

5-6 hours

73
Q

what are the descriptions of an infraction based on?

A

the location of damage

-the location of the infract correlated with the coronary artery involved

74
Q

what do inferior wall infracts result from?

A

occlusion of the right coronary artery

75
Q

what do anterior wall infractions result from?

A

occlusions in the left anterior descending artery

76
Q

how do ppl present when having an MI?

A

-severe pain, immobilizing pain not relieved by rest
-SNS: diaphoresis, clammy
-Cardiovasular manifestationsL increased HR and BP
-Nausea and vomiting, secondary to pain
-Fever: manifestation of inflammatory process caused by cell death (occurs when pt has waited too long with MI)
Dysrhymias: fast HR (tachycardia) or slow HR (bra)
Cardiogenic shock: inadequate 02 causes severe left ventricular failure (pts who come from far away may have this)
Heart failure: the pumping power of the heart is diminished, initial signs include mild dyspnea, restlessness, or tachycardia. can progress to pulmonary congestion, S3 or S4 heart sound/

77
Q

what is an ECG for the purpose of diagnosis?

A

is the primary tool to rule out or confirm unstable angina or MI. changes in the QRS ST segment. and the T wave caused by ischemia develop quickly. serial ECG’s are obtained every 2 to 4 hours

78
Q

What are serum cardiac markers?

A
  • cardiac enzymes such as troponin and creatine kinase are used to diagnose MI.
  • Trop and CK are present in blood within 3-12 hours after a MI (they are present in blood from cardiac cell death), Therefore a blood test can confirm this is happening.
  • if first test come back negtive, do a second one
  • troponin is normally less than 0.5, any more or climbing is myocardial ischemia occuring or has occured
79
Q

what are coronary angiography?

A

-indicated as a first line tx for confirming MI
-goal is to open affested artery within 90 min.
in percutanous coronary intervention, a drug eluded stent is placed to keep it open

80
Q

what is a cornonary artery bypass graft surgery?

A
  • consists of bypassing the obstructed coronary artery with grafts from the internal mammary artery or saphenous vein
  • high sucess rate
  • the saphenous vein is removed from one or both legs and sections are anastomaosed proximately to the ascening aorta and to a cornonary distal to the blockage
81
Q

what are the overall goals of a pt with Acute cornoary syndrome?

A
  • relieve pain
  • preservation of the myocardium
  • immediate and appropriate tx of ischemia
  • effective coping with illness associated anxiety
  • particiapation in a rehab program
  • reduction of risk factors
82
Q

should 02 be given to a person who is having an MI?

A

NO. it will increase mortality

83
Q

what could a nurse expect of a pt once pain is relieved?

A

denial in pt who interpets the absense of pain and the absense of a cardiac disease

  • nurse needs to tell pt that this doesnt “fix” the problem.
  • pt need to understand recovery takes time
84
Q

what does cardiac rehab do?

A

restores person back to an optimal state of physiologically, psychologically, spiritualy, economically, and vocationally

85
Q

how long is it safe to resume sexual activity after having an MI?

A

it is safe 10 days after an MI

  • when you can walk up and flight of stairs without shortness of breath, it is then safe to return to sexual acitivty
  • is SOB happens during sex, take a break
86
Q

what is a common misconseption that a pt has after an MI?

A

they think they need to “rest” thier heart

  • physical activity is necessary for optimal physiological functioning (make heart stonger) and psychological well being
  • pts should be instructed to stop excersing if angina or dyspnea occurs
  • everyday pt should walk a little more
  • pt should be taugh to check their pulse
87
Q

what is decreased cardiac output related to?

A

related to myocardial injury and is characterized by a decrease in BP, increase in HR, dyspnea, dysrhythmias, and pulmonary edema

88
Q

what is an expected pt outcome?

A

maintains stable signs of effective cardiac perfusion

89
Q

what are nursing interventions for cardiac issues?

A
  • monitor vital signs, monitor dysrhythmias, monitor resp status, monitor fluid balance, and arrange periods of exercise and rest
  • dont give fluid to pts with cardiac issues, it will be harder for their heart to pump
90
Q

what is the greatest risk within the first 24 hours of an evolving MI?

A

ventricular fibrillation

nurse 251 (14 decks)

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