WK 2: Cardiac Disorders A Flashcards
1
Q
What are the two types of atherosclerosis?
A
Arteriosclerosis and Atherosclerosis
2
Q
What is arteriosclerosis?
A
Thickening and hardening of the walls of the arteries
3
Q
What is atherosclerosis?
A
Occurs when the soft deposits of intra-arterial fat and fibrin along the vessel wall Harden over time
4
Q
Identify 3 risk factors of atherosclerosis
A
Smoking
Hypertension
Diabetes Mellitus
Increased levels low density lipoprotein cholesterol
Decreased levels of high density lipoprotein cholesterol
5
Q
Describe the pathophysiology of atherosclerosis
A
Abnormal accumulation of lipid/fatty substance and fibrous tissues, leading to narrowing of the arterial vessel
6
Q
Identify 3 clinical manifestations of atherosclerosis
A
Chest Pain
Atypical: Nausea, dyspnoea, fatigue, diaphoresis
7
Q
What is hypertension?
A
Diagnosis of systolic BP at 140mmHg or diastolic BP at 90 mmHg at different times repeatedly
8
Q
What are the 4 types of hypertension?
A
Primary hypertension
Secondary hypertension
Hypertensive urgencies
Hypertensive emergencies
9
Q
Define primary hypertension
A
Usually no known cause
10
Q
Define secondary hypertension
A
Cause can usually be identified
11
Q
Define hypertensive urgencies
A
Severe BP elevation 180/110 or above
12
Q
Define hypertensive emergencies
A
Severe BP elevation 220/140 or above
13
Q
Identify 3 risk factors of hypertension
A
Family history
Advancing age
Smoking
Obesity
14
Q
Identify 2 potential complications of hypertension
A
Heart attack
Stroke
15
Q
Describe the pathophysiology of hypertension
A
Complicated combination of genetics and environmental factors that cause neural and hormonal effects e.g. Inflammation = increased BV and PR
16
Q
Identify 3 clinical manifestations of hypertension
A
Usually asymptomatic -
Fatigue
Frequent headaches
Retinal changes
17
Q
What is typically involved in the assessment of hypertension?
A
Blood pressure assessment on several occasions at different times, 24 hour BP monitoring, blood tests, ECG
18
Q
What is angina pectoris?
A
Is the pain or other sensation caused by myocardial ischaemia
19
Q
Define myocardial ischaemia
A
Occurs when the demand for myocardial oxygen exceeds the supply of oxygen from coronary arteries, causing chest pain
20
Q
Identify the two types of angina pectoris
A
Stable angina and unstable angina
21
Q
Define stable angina
A
A brief episode of chest pain that subsides with medication or rest usually associated with physical activity
22
Q
Define unstable angina
A
Presents as either new onset, occurring at rest or increasing. Results from myocardial ischaemia and does not go away with medication or rest
23
Q
Identify 3 risk factors of angina pectoris
A
Coronary artery disease
Increasing age
Smoking
Increased cholesterol
24
Q
Identify 2 complications of angina pectoris
A
AMI
Arrythmia
Death
25
Describe the pathophysiology of angina pectoris
Caused by a reduction of blood flow through the coronary arteries that supply oxygen/nutrients to the myocardium. Either due to a decreased supply or increased demand
26
What must occur for ischaemia to occur?
Arteries must be blocked by 75% for ischaemia to occur
27
Identify 3 clinical manifestations of angina pectoris
Chest pain/discomfort (Stabbing, Crushing, Pressure)
Radiating pain (Arms, Neck, Jaw)
SOB
28
What is Acute Coronary Syndrome
Culmination of atherosclerosis and angina pectoris. Conditions which are caused by a sudden reduction or blockage of blood flow to the heart
29
What are the two types of ACS?
Acute myocardial infarction
| Unstable angina
30
Identify 3 risk factors of acute coronary syndrome
Atherosclerosis
Hypertension
Increasing age
Family history
31
Identify 2 potential complications of ACS
Electrical dysfunction
| Mechanical dysfunction
32
Describe the pathophysiology of ACS; Unstable angina
Usually reversible myocardial ischaemia, signals that the plaque in the arteries has become complicated and is a strong indicator of an AMI
33
Describe the pathophysiology of ACS; Acute myocardial infarction
Occurs when plaque is disrupted and there is a subsequent clot in the arteries resulting in reduced blood flow and myocyte necrosis. May then progress to the thrombus blocking blood flow
34
What are the two types of AMI?
Subendocardial infarction
| Transmural infarction
35
Describe a subendocardial infarction
Occurs when a thrombus blocking coronary blood flow breaks up before distal tissue necrosis. Only involves the myocardium
36
Describe a transmural infarction
Occurs when a thrombus permanently blocks blood flow and necrosis extends through the myocardium to the endcaridum and pericardium = cardiac dysfunction
37
How long does it take before myocardial cell death occurs?
20 mins of reduced blood flow will lead to myocardial cell death
38
Identify 3 clinical manifestations of an AMI
Angina pain, but more intense
Nausea/vomiting
BP drop then increase (sympathetic NS)
Diaphoresis
39
What is coronary heart disease?
Is an overarching term for diseases which affect the coronary vessels, e.g. when coronary arteries clog and narrow due to plaque
40
Identify 3 risk facts of CHD
```
Atherosclerosis
Hypertension
High cholesterol
Obesity
Smoking
```
41
Identify 2 potential complications of CHD
AMI
Heart failure
Angina
42
Describe the pathophysiology of CHD
Disorders which affect the blood flow through the coronary vessels which supply the heart with oxygen and nutrients. Long term, pathological conditions
43
What is metabolic syndrome?
A collection of conditions that occur together and increase the risk of DM stroke and heart disease
44
What are the 5 main components of metabolic syndrome?
1. Obesity
2. Hypertension
3. Insulin resistance
4. Elevated blood triglycerides
5. Low levels if High Density Lipoprotein cholesterol
45
What is troponin?
A protein found in cardiac muscle that is released into circulation when there is damage to the myocardium
46
What does a blood test, specifically for troponin levels tell you about the heart?
Tells the nurse that there is damage to the myocardium often due to reduced blood flow and therefore needs to be explored for a underlying cause
47
List the 7 cardiac diagnostic tests
```
ECG
Echocardiogram
Exercise stress test
Chest Xray
Cardiac catherisation
Coronary angiogram
Coronary artery calcium scan
```
48
What is an ECG?
Measures electrical acitivity, rate and regularity of your heartbeat
49
What is an echocardiogram?
Uses US to create a picture of your heart. Used to see how blood moves through the heart
50
What is an exercise stress test?
Measures your heart rate while you walk on a treadmill. Determines how well your heart works when it has to pump more blood
51
What is cardiac catheterisation?
Checks inside of the arteries for blockages by inserting a thin flexible tube through an artery to reach the heart used to measure BP through the heart or collect blood
52
What is a coronary angiogram?
Monitors blockage and flow of blood through the coronary arteries. Uses Xray to detect dye injected via cardiac catheterisation
53
What is a coronary artery calcium scan?
A CT scan that looks into the coronary arteries for calcium buildup and plaque
54
Identify 3 nursing considerations when caring for cardiac patients
```
Vital signs
Pain assessment
Oxygen administration (PRN)
ECG
Reduce anxiety
Continuous monitoring
```
55
Lipid Lowering Agents (Antihyperlipidemic agents)
- Drug class
- Indications
- Mechanism of Action
- Adverse effects
- Nursing Consideration
SATINS
- HMG-CoA reductase inhibitor
- Hypercholestrolaemia, dyslipidaemia
- Reversibly inhibit HMG-CoA reductase reducing cholesterol synthesis
- GI upset, dizziness
- Avoid large amounts of alcohol (increased risk liver impairment)
56
What are 3 examples of lipid lowering agents
"SATINS"
- Atorvastatin
- Simvastatin
- Fluvastatin
57
What are the 4 categories of lipid lowering agents
- HMG CoA reductase inhibitors "Satins"
- Bile acid sequestrants
- Cholestrol absorption inhibitor
- Fibrates and vitamin B
58
ACE Inhibitors (Angiotension Converting Enzyme)
- Drug class
- Indications
- Mechanism of Action
- Adverse effects
- Nursing Consideration
- ACE inhibitor
- HTN, HF, AMI, prevent CVD events in high risk patients
- Prevents the conversion of Angiotensin 1 to Angiotensin 2 by inhibiting ACE = Decreased PVR and BP
- Cough, hypotension, dizziness
- Avoid dehydration and over sweating
59
What are 3 examples of ACE inhibitors
"PRIL"
- Captopril
- Enalapril
- Fosinopril
60
Anti-Anginal Agents
- Drug class
- Indications
- Mechanism of Action
- Adverse effects
- Nursing Consideration
- Organic nitrates
- Manage acute pain/Prevent further attacks
- Relaxes smooth muscle = vasodilation of peripheral arteries = decreased arterial pressure and CO = decreased oxygen demand, dilates coronary vessels
- hypotension, fainting (syncope)
- Warn patient of fainting, don't touch GTN
61
Calcium channel blockers (DIHYDROPYRIDINES)
- Drug class
- Indications
- Mechanism of Action
- Adverse effects
- Nursing Consideration
- Calcium channel blockers (Dihydropyridines primarily act on arterioles)
- HTN, Angina, dysrhythmias
- Impedes influx of calcium ions through slow channels of cell membrane during depolarisation of cardiac smooth muscle, dilates coronary and peripheral arteries to increase blood flow
- Constipation, dizziness
- Grapefruit juice can inhibit hepatic/intestinal metabolism and lead to toxicity
62
Calcium channel blockers (PHENYLALKYLAMINES)
- Drug class
- Indications
- Mechanism of Action
- Adverse effects
- Nursing Consideration
- Calcium channel blockers (Phenylalkylamines act on arterioles and heart)
- HTN, Angina, dysrhythmias
- Impedes influx of calcium ions through slow channels of cell membrane during depolarisation of cardiac smooth muscle, dilates coronary and peripheral arteries to increase blood flow
- Constipation, dizziness
- Grapefruit juice can inhibit hepatic/intestinal metabolism and lead to toxicity
63
Calcium channel blockers (BENZOTHIAZEPINES)
- Drug class
- Indications
- Mechanism of Action
- Adverse effects
- Nursing Consideration
- Calcium channel blockers (Benzothiazepines act on arterioles and heart)
- HTN, Angina, dysrhythmias
- Impedes influx of calcium ions through slow channels of cell membrane during depolarisation of cardiac smooth muscle, dilates coronary and peripheral arteries to increase blood flow
- Constipation, dizziness
- Grapefruit juice can inhibit hepatic/intestinal metabolism and lead to toxicity
64
What are the three types of calcium channel blockers?
Dihydropyridines
Phenylalkylamines
Benzothiazepines
65
What is the main function of Dihydropyridines (Seperates them from the other calcium channel blockers)
Primarily acts on the arterioles
66
What is the main function of Phenylalkylamines (Separates them from the other calcium channel blockers)
Acts on the arterioles and the heart
E.G. Verapamil
67
What is the main function of Benzothiazepines
Acts on the arterioles and the heart
E.G. Diltiazem
68
Beta Blockers (Beta adrenergic antagonists)
- Drug class
- Indications
- Mechanism of Action
- Adverse effects
- Nursing Consideration
- Beta blockers
- Angina, HTN, Dysrhytmias, AMI, HF
- Inhibits beta adrenoreceptors = Reduced HR, force of contraction and CO, inhibits renin release from kidneys
- Bradycardia, hypotension, fatigue
- Do not stop medication abruptly
69
What are 3 examples of beta blockers
Atenolol
Metoprolol
Propanolol
Bisoprolol
70
What are the three types of diuretics?
Thiazide diuretics
Loop diuretics
Potassium sparing diuretics
71
Thiazide diuretics
- Drug class
- Indications
- Mechanism of Action
- Adverse effects
- Nursing Consideration
- Thiazide diuretics
- HF, oedema with HF, HTN, renal impairment
- Increases excretion of sodium/chloride/water in distal tubule
- hypokalaemia, dehydration, hypovolaemia
- Daily weights to measure FB
72
What is an example of a thiazide diuretic?
Hydrochlorothiazide
73
Loop diuretics
- Drug class
- Indications
- Mechanism of Action
- Adverse effects
- Nursing Consideration
- Loop diuretics
- HF, oedema with HF, HTN, renal impairment
- Blocks absorption of sodium, chloride and water from filtered fluid in the kidney
- hypokalaemia, dehydration, hypovolaemia
- Fluid, electrolyte, acid base balances considered
74
Potassium sparing diuretics
- Drug class
- Indications
- Mechanism of Action
- Adverse effects
- Nursing Consideration
- Potassium sparing diuretics
- HF, oedema with HF, HTN, renal impairment
- Increases excretion of sodium in distal tubule and conserves potassium
- Hearing loss, dehydration, hypovolaemia
- Fluid, acid base balances
75
What is an example of a loop diuretic?
Furosemide
76
What is an example of a potassium sparing diuretic?
Spironolactone
77
Inotropic Agents
- Drug class
- Indications
- Mechanism of Action
- Adverse effects
- Nursing Consideration
- Cardiac glycoside
- HF, AF, Paoxysmal atrial tachycardia
- increases CO by inhibiting sodium potassium pump exchange, slows conduction rate through AV node to decrease HR
- Anorexia, bradycardia
- Aware of S&S of digoxin toxicity
78
What is an example of a inotropic agent?
Digoxin (PO)
| Lanoxin (CC environment)
79
Angiotensin receptor blockers
- Drug class
- Indications
- Mechanism of Action
- Adverse effects
- Nursing Consideration
- Angiotensin II receptor antagonists
- HTN
- Block the angiotensin II receptors to increase renal blood flow and maintain GFR
- Hypotension, dizziness
- Consider patients fluid/electrolyte balance
80
What are 3 examples of angiotensin receptor blockers ?
"SARTAN"
Irbesartan
Candesartan
Losartan
81
What is antithrombin?
Antithrombin is a protein that inactivates thrombin and factor Xa (clotting factors) leading to a reduction in the production of fibrin and clotting is supressed
82
What are the three classes of Heparin?
Unfractionated heparin
Low molecular weight Heaprin (LWMH)
Fonaparinux
83
Heparin
- Drug class
- Indications
- Mechanism of Action
- Adverse effects
- Nursing Consideration
- Anticoagulants
- Prophylaxis/Treatment DVT/PE, Clotting in cardiac curve ry
- Decreases the clotting ability of blood
- Haemorrhage, local irritation,
- rotate injection site
84
What is the additional indication for LMWH heparin?
Used with other therapies for treatment of unstable angina, MI an STEMI
85
Warfarin
- Drug class
- Indications
- Mechanism of Action
- Adverse effects
- Nursing Consideration
- Anticoagulant
- Long term prophylaxis of thrombosis, prevention of thrombosis in AF patients
- Supresses coagulation by decreasing production of clotting factors, interferes with vitamin k dependent synthesis of prothrombin
- Haemorrhage, red or brown urine
- Pressure to venepuncture to prevent bleeding
86
Aspirin
- Drug class
- Indications
- Mechanism of Action
- Adverse effects
- Nursing Consideration
- Acetylsalycyclic acid
- Ischaemic stroke, AMI or previous AMI, inflammation associated pain
- Supresses platelet aggregation by causing irreversible inhibition of cycloxegenase
- GI irritation, increased risk of GI bleeding
- Elderly are at more risk of adverse effects
