week 5 (CAD) Flashcards
1
Q
___ % of deaths in Canada are due to cardiac disease
A
29%
2
Q
What is the major cause of coronary artery disease?
A
atherosclerosis
3
Q
what is atherosclerosis?
A
hardening of arteries due to plaque
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
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
6
Q
is CAD a progressive disease?
A
yes, it takes many years to develop
7
Q
what are the stages of development in atherosclerosis?
A
1) fatty streak
2) fibrosis plaque
3) complete lesion (plaque)
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
9
Q
what age can fatty streaks be observed in the coronaries?
A
age 15
10
Q
what can reverse the process of fatty streaks?
A
treatment that lowers LDL cholesterol
-lipitor or crestor
11
Q
what is LDL?
A
bad cholesterol
12
Q
what is HDL?
A
good cholesterol
13
Q
what is the beginning of the progressive changes in the endothelium of the arterial wall called?
A
fibrous plaque
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
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
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
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
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
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
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
21
Q
what is one of the four most firmly established risk factor for CAD?
A
elevated serum lipid levels
22
Q
___% of canadians have high cholesterol
A
40%
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
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
25
for ppl who have an elevated serum lipid level, how often should a complete lipid profile be obtained?
every 5 years beginning at age 20
26
a person with a serum cholesterol level exceeding ____mmol/L is at risk for CAD and should be treated
5.2 mmol /L
27
what kind of drugs are most widly used for CAD?
statin drugs and lipid lowering drugs
| atrovastin and rosuvastatin
28
what are some serious adverse effects of atrovastin and rosuvastatin
-liver damage and myopathy that can progress to rhabdomyolysis (skeletal muscle breakdown) but these are rare
29
what is important to remember when taking statin?
keep hydrated
30
what is hypertension?
Defined as BP pt 140/90 mmhg or higher ( For diabetic pt : 130/ 80 is considered high )
31
what does the stress of constantly elevated BP increase the rate of?
atherosclerotic developement
32
what can increased workload on that heart case?
left ventricular hypertrophy and decreased stroke volume with each contraction
33
what are some lifestyle factors that contribute to hypertension?
obesity, poor dietary habits, high sodium intake, sedentary lifestyle, alcohol and stress
34
what does nicotine in tobacco cause the release of?
catecholamine (epipephrine and norepinaphrine)
| -these neurohormones cause an increase in heart rate, peripheral vasocontriction, and increase in bp
35
what happens to the heart the more a person smoked?
- the more hard the heart has to work
| - eventually these changes increaes cardiac workload, necessititating greater myocardial oxygen consumption
36
what is the minimun amount of time per week of moderate to virgoous excersise it takes to add muscle and bone strengthening?
150 min per week
| -improves health and reduce cardiac disease risk
37
what does excersise enhance?
enhances fibrinolytic activity (breakdown of platlets) thus reducing the risk of clot formation
38
what is proportional to the degree of obesity?
the increased risk for CAD is proportional to obesity
39
what percent of canadians are obese?
25%
| -waist circumference is now regarded as the factor that indicated the greatest health risk related to obesity
40
what do coronary arteries do?
supply the heart with 02
| -these arteries lay ontop of the heart
41
what categories of angina are there?
```
Printzmetals Variant Angina (vasospasm)
Chronic stable angina (fixed stenosis)
unstable angina (thrombus)
```
42
when does myocardial ischemia occur?
Occurs when the demand for myocardial o2 exceeds the ability of the coronary arteries to supply the heart with o2
43
angina or chest pain are the clinical manifestations of reversible...
reversible myocardial ishcemia
44
what does chronic stable angina refer to?
refers to chest pain that occurs intermittently over a long period with the same pattern of onset, duation, and intesity of symptoms
45
with chronic stable angina, is pain at rest normal or unusual?
its unusual
46
how often does pain occur with chronic stable angina?
pain usually is brief, lasting 3-5 mins
| resolves when 02 returns to heart (rest)
47
where is pain located with chronic stable angina?
pain is mostly substernal, but the sensation may occur in the neck or radiate to the jaw, shoulders, and down arms
48
what is indicative of ischemia on ECG?
a ST segment depression
49
within what time frame does a pt need an ECG assessment when presenting with chest pain?
witihin 5 min
50
what is PQRST?
```
provoke
quality
Radiation
Severity
Timing
```
51
what is prinzmetals angina?
- 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
what are factors that precipitate coronary artery spasm include what?
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
what is the goal of tx of angina?
decrease o2 demand, increase o2 supply, or both
54
what is sublingual nitroglycerin for?
- 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
what will a pt complain of after recieving nitro spray?
dizziness and headache
56
what is the recommended dose of nitro of angina?
one tablet of one spray under the tongue
57
what are some side effects of sublnigual nitroglycerin?
headache, dizziness, and increased heart rate
58
what is the perferred drug for the management of chronic stable angina?
beta blocker
59
what do beta blockers do?
decrease myocardial contractility (makes is easier for the heart to pump)
-reduces the myocardial 02 demand
60
what are some adverse effects of beta blockers?
bradycardia and hypotension
61
what is metroprolol?
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
if beta blockers are contraindicated or do not control angina symtoms, what is used?
calcium channel blockers
| nifedipine, verapamil, diltiazem
63
what are the effects of a calcium channel blocker?
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
what can certain high risk pts with chronic stable angina benefit from?
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
what is under the umbrella of an acute cornonary syndrome?
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
what is acute coronary syndrome associated with?
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
what is unstable angina?
- 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
how does unstable angina affect woman?
- women experiance fatigue, shortness of breath, indigestion and anxiety
- highly missed in women because it affects them differently
69
what is myocardial infraction?
- 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
between ___ and ___% of all acute MI's occur secondary to thrombus formation
80 - 90%
71
how long can cardiac cells withstand ischemic conditions before cell death occurs?
20 minutes before cell death occurs
72
if ischemia persists, the entire thickness of the heart muscle (myocardial) becomes necrosed in approximately...
5-6 hours
73
what are the descriptions of an infraction based on?
the location of damage
| -the location of the infract correlated with the coronary artery involved
74
what do inferior wall infracts result from?
occlusion of the right coronary artery
75
what do anterior wall infractions result from?
occlusions in the left anterior descending artery
76
how do ppl present when having an MI?
-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
what is an ECG for the purpose of diagnosis?
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
What are serum cardiac markers?
- 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
what are coronary angiography?
-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
what is a cornonary artery bypass graft surgery?
- 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
what are the overall goals of a pt with Acute cornoary syndrome?
- 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
should 02 be given to a person who is having an MI?
NO. it will increase mortality
83
what could a nurse expect of a pt once pain is relieved?
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
what does cardiac rehab do?
restores person back to an optimal state of physiologically, psychologically, spiritualy, economically, and vocationally
85
how long is it safe to resume sexual activity after having an MI?
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
what is a common misconseption that a pt has after an MI?
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
what is decreased cardiac output related to?
related to myocardial injury and is characterized by a decrease in BP, increase in HR, dyspnea, dysrhythmias, and pulmonary edema
88
what is an expected pt outcome?
maintains stable signs of effective cardiac perfusion
89
what are nursing interventions for cardiac issues?
- 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
what is the greatest risk within the first 24 hours of an evolving MI?
ventricular fibrillation
