WK 2: CAD & ACS Flashcards
What is coronary artery disease?
Coronary artery disease (CAD) is a narrowing or blockage of your coronary arteries, which supply oxygen-rich blood to your heart. This happens because, over time, plaque (including cholesterol) buildup in these arteries limits how much blood can reach your heart muscle.
What is the Patho of coronary artery disease?
- Fatty streaks - Start of buildup of lipids in arteries
- Fibrous plaque - Collagen layer overtop of lipids
- Complicated lesion - Plaque starts to rupture and blood clot forms around causing further narrowing.
What are Risk factors of coronary artery disease?
· Nonmodifiable
○ Age
○ Sex (males more prone)
○ Ethnicity
○ *Family history
○ Genetics
· Modifiable
○ Elevated serum lipid levels
○ Elevated blood pressure (BP)
○ Tobacco use
○ Physical inactivity
○ Obesity
○ Diabetes mellitus
○ Elevated fasting bold glucose level
○ Psychosocial risk factors
○ Homocysteine elevation
Substance use
How does Coronary Artery Disease impact the Cardiovascular System?
Narrowed arteries can cause chest pain because they can block blood flow to your heart muscle and the rest of your body. Over time, CAD can weaken the heart muscle. This may lead to heart failure, a serious condition where the heart can’t pump blood the way it should.
What are Managements of CAD?
· lifestyle factors
○ Quit smoking
○ Control BP
○ Manage Cholesterol
○ Eat healthy
○ Limit alcohol
Cholesterol-lowering medications
- statins, fibrates, PCSK9 Inhibitors
- Medications that restrict lipoprotein production
- Medications that increase lipoprotein removal
- Medications that decrease cholesterol absorption
Aspirin
- Prevents platelet activation and reduces incidence of MI and death in patients with CAD
- Dose- 160- 325 mg when diagnosis made- ER then 81-325 mg daily
- Can be taken even if already on NSAIDS
- May need to have proton pump inhibitors- Omeprazole(Prilosec) prescribed
- Prevent binding and clot formation
What is the Pathophysiology of Chronic stable angina?
- The primary reason for insufficient blood flow is narrowing of the coronary arteries by atherosclerosis
- Myocardium becomes hypoxic within 10 seconds of coronary artery occlusion
- With total occlusion contractility ceases after several minutes depriving the myocardial cells of oxygen and glucose for aerobic metabolism
- Anaerobic metabolism begins and lactic acid accumulates
- Lactic acid irritates myocardial nerve fibers and transmits a pain message to the cardiac nerves and the upper thoracic posterior nerve roots – this is the reason for referred cardiac pain to the left shoulder and arm
Clinical presentation of Chronic stable angina?
- Chest pain that occurs intermittently over a long period with the same pattern of onset, duration, and intensity of symptoms
- Patients may deny feeling pain
- May experience indigestion or a burning sensation in the epigastric region
- Presence places patient at higher risk for adverse outcomes and death
- Predictable signs and symptoms
Long-acting nitrates for Chronic stable angina?
Isosorbide dinitrate and isosorbide mononitrate, Transdermal controlled-release nitrates
Indication: Used to reduce the incidence of anginal attacks
Side effect: headaches due to dilation of cerebral blood vessels
Complication: Orthostatic hypotension is a complication of all nitrates – BP should be monitored
Nursing Consideration: Tolerance to nitrates can develop – patients should have an 8-hour nitrate-free period every day (usually at night)
Beta-blockers for Chronic stable angina
Decrease HR, SVR, and BP which reduces myocardial oxygen demand
CCBs for Chronic stable angina
Cause systemic vasodilation with decreased SVR, decreased myocardial contractility, and coronary vasodilation
ACE inhibitors for Chronic stable angina
Used in certain high-risk patients such as those with diabetes, significant CAD or previous MI
What types of Diagnostic tests are used to evaluate chronic stable angina?
- History and physical
- Electrocardiogram (ECG), chest radiograph
- *Exercise stress test - usually how it is diagnosed
- Echocardiogram
- Computed tomography (CT), positron emission tomography (PET)
- Coronary angiography
- Lab studies
What is Acute Coronary Syndrome
- Chest pain that is new in onset, occurs at rest, or has a worsening pattern
- Unstable angina is unpredictable and represents an emergency.
- Always an emergency
STEMI – may see pathological Q wave
NSTEMI or UA – usually no Q wave
What are clinical presentation of Acute Coronary Syndrome
· Pain
○ Deep aching pain not relieved by Nitro
○ Severe immobilizing chest pain not relieve by rest, position change or nitrate administration, may describe as feeling of heaviness, tightness, burning, constriction or crushing
· Sympathetic nervous system stimulation
○ Short of breath,
○ HR elevated
· Cardiovascular manifestations
○ Cool extremities
○ Fever
○ clammy
○ Nausea and vomiting
○ Fever
○ Common locations are substernal, retrosternal or epigastric areas, may radiate to the back, jaw, neck or arms
○ Usually lasts for 20 minutes or more and is described as more severe that usual anginal pain
Shortness of breath, confusion, dizziness, skin that may be ashen, clammy, cool to touch, nausea and vomiting, fever
