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NRSG 327 > Week Week 3: Acute Coronary Syndrome > Flashcards

Week Week 3: Acute Coronary Syndrome Flashcards

1
Q

Coronary artery disease

A

A type of blood vessel disorder that is included in the general category of atheroscleoriosis (affects hearts arteries and produces various pathological effects especially reduced flor of oxygen and nutrients to the myocardium)

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2
Q

What specifically does coronary artery disease do in the body?

A

starts as soft deposits of fat that harden with age “the hardening of the arteries”

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3
Q

What is the major cause of CAD?

A

atherosclerosis

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4
Q

What lab test is often elevated in patients with CAD?

A

C reactive protein (produced by the liver, nonspecific marker of inflammation)

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5
Q

How does CAD develop?

A

over many years
when it is symptomatic usually it is well advanced

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6
Q

What are the developmental stages of CAD?

A

Fatty streak
Fibrous plaque
Complicated lesion

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7
Q

What occurs in stage 1: Fatty streak?

A

characterized by lipid filled smooth muscle cells
yellow tinge appears as fat fills
can be seen by age 15

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8
Q

What can reverse the fatty streak stage?

A

treatment that lowers LDL cholesterol may reverse this process

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9
Q

What occurs in stage 2: Fibrous plaque?

A

LDL’s and platelet growth factors stimulate smooth muscle proliferation and thicken arterial wall
collagen covers the fatty streak and forms a plaque

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10
Q

What occurs in stage 3: Complicated lesion?

A

fibrous plaque continues to grow and continued inflammation can result in the plaques instability, ulceration and rupture
Can lead to a thrombus
most dangerous

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11
Q

Angiogenesis

A

the inherited predisposition to develop new blood vessels

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12
Q

What is collateral circulation

A

alternate routes formed by the arteries to supply oxygen and nutrients to the myocardium despite a CAD block

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13
Q

What are modifiable risk factors for CAD?

A

Age
Sex
Ethnicity

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14
Q

What are the 5 major modifiable risk factors in CAD?

A

Elevate serum lipid levels
HTN
Tobacco Use
Physical inactivity
Obesity

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15
Q

What are modifiable contributing risk factors to CAD?

A

DM
Metabolic syndrome
Psychological states
Homocysteine
Substance use

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16
Q

What is metabolic syndrome

A

A cluster of risk factors for CAD who’s underlying pathophysiology may be due to insulin resistance

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17
Q

Who is at high risk for CAD?

A

immediate family history of heart disease
Elevated serum lipid levels
HTN
Tobacco use
obesity
physical inactivity
stress
metabolic syndrome
substance use

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18
Q

What medication restricts lipoprotein production?

A

Statin medications

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19
Q

What medication increases lipoprotein removal?

A

cholestyramine

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20
Q

Examples of saturated fats

A

animal fat
butter
cream cheese
sour cream

USE SPARINGLY

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21
Q

examples of monounsaturated fats

A

Fish oil
Avocado
nuts
olives

22
Q

Examples of polyunsaturated fats

A

Fish oil
shellfish
nuts
seeds
magazine
vegetable oils

USE PRIMAIRLY

23
Q

What is angina

A

chest pain that is a clinical manifestation of reversible myocardial ischemia

24
Q

What is the primary reason for angina?

A

atherosclerosis

25
Q

chronic unstable angina?

A

chest pain that occurs intermittently over a long period with the same onset, duration and intensity of symptoms due to myocardial ischemia (usually secondary to CAD)

26
Q

What is referred pain?

A

when there is an injury on one area of the body but feel pain somewhere else

(eg heart is not getting oxygen but sends pain to jaw, shoulders, arms)

27
Q

How is angina often described?

A

crushing choking suffocating squeezing

28
Q

What factors can precipitate angina?

A

physical exertion
temperature extremes
strong emotions
consumption of heavy meal
tobacco use
sexual activity
stimulants
circadian rhythm patterns

29
Q

What is the first line treatment for angina?

A

Nitrates

30
Q

How do nitrates work?

A

dilating peripheral blood vessels
dilating coronary arteries

31
Q

How long does nitroglycerin take to relieve pain

A

3 minutes

32
Q

How long is nitroglycerins duration?

A

Approx 30-60 minutes

33
Q

How much nitroglycerin can be given in a period?

A

one sublingual spray under tongue (do not inhale) if symptoms do not improve repeat every 5 minutes up to three times then contact emergency services

34
Q

What are 2 predominant adverse effect of all nitrates?

A

Headache (caused by the dilation of cerebral blood vessels)
Orthostatic hypotension

35
Q

What 3 MOA’s do calcium channel blockers do?

A
  1. Systemic vasodilation with decreased SVR
  2. decreased myocardial contractility
  3. coronary vasodilation
36
Q

What is an ACS?

A

when myocardial ischemia is prolonged and not immediately reversible (encompasses unstable angina, MI)

37
Q

Explain how ACS occurs

A

deterioration or atherosclerotic plaque that was once stable, the plaque ruptures exposing intimate to blood which stimulates platelets aggregation which means vasoconstriction with thrombus formation (NSTEMI or STEMI)

38
Q

Unstable angina

A

chest pain that is new in onset, occurs at rest, or has a worsening pattern

39
Q

Unstable angina S&S

A

fatigue
shortness of breath
indigestion
anxiety

40
Q

What is a myocardial infarction?

A

occurs as a result of sustained ischemia causing irreversible myocardial death

41
Q

What is the primary cause of an MI?

A

occur secondary due to thrombus formation

42
Q

S&S of MI?

A

pain, SNS stimulation, hypotension, edema, fever, N/V, cool skin

43
Q

What are some complications with an MI that can occur?

A

Dysrhythmias
Heart failure
cariogenic shock
papillary muscle dysfunction
pericarditis
dressers syndrome

44
Q

What are the medication treatments of choice for ACS?

A

IV nitro, ASA, b adrenergic blockers, systemic anticoagulation and heparin ACE inhibitors

45
Q

What is the treatment acronym for an MI?

A

MONA
morphine sulphate
oxygen
nitroglycerin
asa

46
Q

What are nonmodifable risk factors for ACS?

A

Men over 55 or postmenopausal women
1st degree relative at 55 or younger for men and 65 or younger for women

47
Q

What are differences in CV changes in women compared to men?

A

estrogen is thought to be cardioprotective
women’s CV events occur 10 years later than in men
women may present differently

48
Q

What are modifiable factors for ACS?

A

heart healthy diet
statins
activity
HTN management
smoking cessation
DM managrmrtn
Stress management
Drugs/alcohol cessation/limitation

49
Q

What do statins do?

A

block cholesterol synthesis lowers LDL and triglyceride levels

50
Q

What does Niacin do?

A

decrease lipoprotein synthesis lowering LDL and triglyceride levels

51
Q

What do Bile acid sequestrates do?

A

bind to cholesterol in the intestine to increase breakdown and lower LDL levels

NRSG 327 (4 decks)

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