CP 34 Coronary Artery Disease and Acute Coronary Syndrome – Flashcards
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What is Coronary Artery Disease (CAD)?
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A type of blood vessel disorder included in the general category of athersclorsis.
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What is Atherosclerosis characterized by?
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Deposists of cholesterol and lipids within the intimal wall of an artery.
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When CAD becomes symptomatic, what does the generally mean?
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The disease process is usually well advanced.
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What is Collateral Circulation?
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Arterial Anastomoses or connections.
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What is Collateral Circulation growth and extent attributed to?
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Inherited predisposition to develop new blood vessels and the presence of chronic ischemia.
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What are nonmodifiable risk factors for CAD?
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Age, gender, ethnicity, family history and genetic inheritance.
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What are modifiable risk factors for CAD?
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Elevated serum lipids, elevated BP, tobacco use, physical inactivity, obesity, DM, metabolic syndrome, psychologic states, and homocysteine level.
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What is one of the most firmly established risk factors for CAD?
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Elevated serum lipid levels.
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What are High Density Lipoproteins (HDLs)?
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Carry lipids away from arteries and to the liver for metabolism. High levels are desirable.
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How do you increase HDL levels?
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Physical activity, moderate alcohol consumption and estrogen administration.
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What does an Elevated Low Density Lipoprotein Level correlate with?
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Increased incidence of atheroslcerosis and CAD>
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What are recommended changes for the patient with CAD?
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A regular physical activity program, a diet that limits saturated fats and cholesterol and emphasizes complex carbohydrates (e.g., whole grain, fruit, vegetables)>
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How often is a complete lipid profile recommended for the patient with CAD or at risk for?
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Every 5 years beginning at age 20.
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What serum cholesterol level puts a person at risk for CAD?
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Greater than 200 mg/dL.
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If the levels of cholesterol remain elevated despite modifiable changes, what is considered?
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Drug therapy with statins. Niacin, fibric acid derivatives, bile acid sequestrants and other agents may be used.
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What drug is recommended for people at risk for CAD?
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Antiplatelet therapy with low dose aspirin.
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What can people take if they are Aspirin intolerant and at risk for CAD?
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clopidogrel (Plavix).
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What is Chronic Stable Angina?
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Refers to chest pain that occurs intermittently over a long period with the same pattern of onset, duration, and intensity of symptoms.
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What is Angina rarely?
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Sharp or stabbing, and usually does not change with position or breathing.
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How long does Anginal pain usually last?
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A few minute and commonly subsides when the precipitating factor is relieved. Pain at rest is unusual.
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What is the treatment of chronic stable angina?
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Aimed at decreasing oxygen demand, and or increasing oxygen supply and reducing CAD risk factors.
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What is the first line therapy for treatment of angina?
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Nitrates.
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How do Nitrates act?
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Dilate peripheral blood vessels, coronary arteries and collateral vessels.
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What other medications are used in the treatment of chronic stable angina?
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Beta blockers.
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How do beta blockers act?
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Decrease myocardial contractility, heart rate, systemic vascular resistance, and blood pressure which reduce myocardial oxygen demand.
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What is the diagnostic testing for a patient with a history of CAD?
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CXRAY, 12-lead ECG, lipid profile, echocardiography, exercise stress testing, and coronary angiography.
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What is Prinzmetals Angina?
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A rare form of angina that occurs at rest, usually in respose to spasm of a major coronary artery.
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What does the patient experience when spasms occur in Prinzmetals Angina?
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Angina and transient ST segment elevation.
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What may precipitate coronary artery spasms?
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Smoking and tobacco use.
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When else may prinzmetals angina be seen?
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In a patient with history of migrane headaches and Raynauds Phenomenon.
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What may relieve pain for the patient with Prinzmetals Angina?
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Exercise or it may disappear spontaneously.
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What medications are used for Prinzemtals Angina?
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Calcium channel blockers and or nitrates to control the angina.
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What is Acute Coronary Syndrome?
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Develops when ischemia is prolonged and not immediately reversible. Encompases a spectrum of unstable angina, non-st-segment-elevation myocardial infaction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI).
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What is Unstable Angina?
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Chest pain that is new in onset, occurs at rest, or has worsening pattern. Unpredictable and represents an emergency.
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Why does a Myocardial Infarction occur?
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As a result of sustained ischemia, causing irreversible myocardial cell death. Contractile functions of the heart stops in the infarcted area(s).
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How long does an acute MI evolve over?
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A period up to 12 hours.
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How are infarctions described?
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Based on the location of damage.
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What is the hallmark of an MI?
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Severe, immobilizing chest pain that is not relieved by rest, position change, or nitrate administration.
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How is pain usually described for a patient with an MI?
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Heaviness, pressure, tightness, burning, constriction or crushing.
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What are complications after an MI?
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Dysrhythmias are the most common, heart failure, cardiogenic shock, papillary muscle dysfunction or rupture, ventricular aneurysm, and pericarditis.
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What is the primary diagnostic study to determine whether the person has a UA or an MI?
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ECG and serum cardiac markers.
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What is necessary for a patient with ACS?
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Rapid diagnosis and treatment.
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What is recommended for a patient with STEMI or NSTEMI with positive cardiac markers?
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Reperfusion therapy. This can include emergency PCI or fibrinolytic *thrombolytic) therapy).
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What is cardiac catherterization used for?
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To locate and assess blockage and implement treatment modalities if needed.
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What is Fibrinolytic Therapies aim?
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To stop infarction process by dissolving the thrombus int he coronary artery to reperfuse the mycocardium.
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When is coronary revascularization with coronary artery bypass graft (CABG) surgery recommended?
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For patients who fail medical management, have left main coronary artery or three vessel disease, are not candidates for PCI, have failed PCI with ongoing chest pain or have diabetes.
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What is initial management of the patient with chest pain in regards to drug therapy?
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Aspirin, IV nitroglycerin, systemic anticoagulation, morphine sulfate for pain unrelieved by nitroglycerin and oxygen.
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When may IV antiplatelet agents be used for Chest Pain?
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If PCI is anticipated.
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Why are Stool softeneres given with Chest Pain?
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Facilitate and promote the comfort of bowel evacuation.
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What nursing measures should be instituted for a patient experiencing angina?
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Administer supplemental oxygen and position the patient in upright position unless contraindicated, determine vital signs, obtain a 12 lead ECG, provide prompt pain relief first with a nitrate followed by an opiod analgesic if needed, and auscultate heart sounds.
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What should teaching for a patient with angina include?
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Information regarding ACD, managing angina, risk factor reduction and medication.
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What does initial treatment of a patient with ACS include?
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Pain assessment and relief, physiologic monitoring, promote of rest and comfort, alleviation of stress and anxiety, and understanding of the patients emotional and behavioral reactions.
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What medications should be provided to reduce or eliminate chest pain?
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Nitroglycerin, morphine sulfate and supplemental oxygen.
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What should be monitored on a patient with ACS?
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Continuous ECG monitoring, frequent VS, I & O, and physical assessment. Heart and lung sounds and inspect for evidence of early heart failure.
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How may a patient with an uncomplicated MI rest for?
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In a chair within 8 - 12 hours after the event.
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What is important nursing implementation about anxiety with a patient following ACS?
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Identify the source of anxiety, assist the patient in reducing it, and provide appropriate patient teaching.
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What is it important to provide for the patient after ACS?
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Adequate rest periods free from interruption.
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What are comfort measures that can promote rest?
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Frequent oral care, adequate warmth, a quiet atmosphere, use of relaxation therapy, and assurance that personnel are nearby and responsive to the needs.
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After a PCI what are the major nursing responsibilities?
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Monitoring for signs of recurrent angina, frequent assessment of VS, including HR and rhythm, evaluation of the groin for signs of bleeding and maintenance of bed rest per policy.
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How long after having a CABG surgery is a patient in ICU?
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First 24 - 36 hours, with ongoing ECG and hemodynamic monitoring.
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After transfer from ICU, what is the focus for a CABG surgical patient for postoperative care?
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Monitoring for dysrhythmias, providing wound care, managing pain and preventing complications.
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What is the key to cardiac rehabilitation programs for the patient?
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Maintaining contact.
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What are the six areas for cardiac rehabilitations focus?
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Physiologic, psychologic, mental, spiritual, economic and vocational.
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How long does post-MI depression usually last?
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1 - 4 months.
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What should patients know about erectile dysfunction and drugs?
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Nitrates should not be used with drugs for erectile dysfunction.
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How long till it is safe to resume sexual activity after an uncomplicated MI?
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7 - 10 days.
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What is Sudden Cardiac Death?
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An unexpected death from cardiac causes producing an abrupt loss of cardiac output and cerebral blood flow. Usually occurs within an hour of onset of symptoms.
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What are majority of cases of SCD caused by?
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Ventricular dysrhythmias, and may have been accomplished by an acute MI.
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What are risk factors for SCD?
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Ventricular dysfunction, ventricular dysrhythmias following MI, males, african american, family hx of athersclerosis, tobacco use, DM, hyperthcolesterolemia, hypertension and cardiomyopathy.
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What is the most common appraoch to preventing a recurrent of SCD?
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Implantable cardioverter defibrillator (ICD) with drug therapy.
