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Nursing of Adults I > Chapter 37: Coronary Artery Disease and Acute Coronary Syndrome 2 > Flashcards

Chapter 37: Coronary Artery Disease and Acute Coronary Syndrome 2 Flashcards

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1
Q

men or women: report more disability after heart event

A

women

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2
Q

symptoms occur within one hour: angina, palpitations, dizziness, or lightheadedness

A

sudden cardiac death (SCD)

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3
Q

___________ protects women in younger ages from CAD

A

estrogen

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4
Q

cardiac catheterization and PCI: assess catheter insertion site for these three things every ___ minutes for first hour, then agency policy

A

hematoma, bleeding, bruit
15

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5
Q

type of ischemia associated with diabetic neuropathy

A

silent ischemia

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6
Q

this form of angina is more common in women and occurs upon physical exertion

A

microvascular angina

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7
Q

absolute or relative contraindication: recent ischemic stroke within past 3 months

A

absolute

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8
Q

regular physical activity helps with these three things

A

decreased weight
decreased systolic BP
increased HDL cholesterol

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9
Q

after CABG surgery, monitor for this type of dysrhythmia

A

atrial fibrillation

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10
Q

arterial anastomoses within coronary circulation

A

collateral circulation

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11
Q

these changes on 12-lead ECG indicate ischemia

A

ST segment depression or T wave inversion

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12
Q

CABG is an option in these three conditions

A

diabetes, LV dysfunction, chronic kidney disease

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13
Q

men or women: mortality rates from CAD have decreased more rapidly for this gender

A

men

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14
Q

men or women: develop more collateral circulation

A

men

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15
Q

sudden cardiac death (SCD) occurs with these two conditions

A

prior MI (most common)
acute MI

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16
Q

two conditions that increase risk of CAD

A

diabetes mellitus, chronic kidney disease

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17
Q

stents/PCI require therapy with these medications afterward (also known as dual antiplatelet therapy or DAPT)

A

aspirin, clopidogrel or ticagrelor

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18
Q

men or women: first heart event is more often UA than MI

A

women

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19
Q

absolute or relative contraindication: current use of oral anticoagulants

A

relative

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20
Q

men or women: report more typical signs and symptoms of angina and MI

A

men

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21
Q

condition in which dysrhythmia causes disruption on cardiac function, resulting in loss of cardiac output and cerebral blood flow

A

sudden cardiac death (SCD)

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22
Q

absolute or relative contraindication: significant closed-head or facial trauma within past 3 months

A

absolute

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23
Q

men or women: those who have an MI are more likely to have a fatal heart event within 5 years than other gender

A

women

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24
Q

chest pain often occurs in early morning and greater than 20 minutes

A

myocardial infarction

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25
Q

grafts in traditional CABG surgery may involve any of these three vessels

A

internal mammary (thoracic) artery (IMA, ITA)*
saphenous vein*
radial artery
(*most common)

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26
Q

II, III, aVF leads

A

inferior leads (right ventricle)

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27
Q

these two MI complications are characterized by a new, loud systolic murmur and require emergency repair

A

ventricular septal wall rupture and left ventricular free wall rupture

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28
Q

the substances _________ and ___________ result in coronary artery spasm resulting in chest pain and MI

A

cocaine, methamphetamine

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29
Q

high-dose aspirin is treatment of choice for these two complications of MI

A

pericarditis, Dressler syndrome

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30
Q

normal HDL

A

men: >45 mg/dL
women: >55 mg/dL

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31
Q

treatment to lower LDLs may slow the process of forming ___________

A

fatty streaks

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32
Q

this MI complication causes acute and massive mitral valve regurgitation and a new systolic murmur

A

papillary muscle dysfunction or rupture

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33
Q

when to reassess patient after starting statin therapy

A

after 6 weeks

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34
Q

decreased urine output, crackles, JV distention, hepatic engorgement, peripheral edema are examples of manifestations of this

A

cardiovascular manifestations of MI

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35
Q

three things to look for in a chest X-ray for a patient with chronic stable angina

A

cardiac enlargement, pulmonary congestion, aortic calcification

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36
Q

decreased pumping power after an MI can cause this complication

A

heart failure

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37
Q

normal total cholesterol

A

<200 mg/dL

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38
Q

lipid profile screening begins at age ___ and continues every ___ years until age ___, when screening continues every ___ years

A

20, 5, 50, 1-2

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39
Q

nutritional therapy to prevent CAD involves reducing these five things

A

saturated fats, cholesterol, red meat, egg yolks, whole milk

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40
Q

intermittent chest pain that occurs over a long period with similar pattern of onset, duration, and intensity of symptoms

A

chronic stable angina

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41
Q

men or women: in early age have higher HDL and lower LDL levels

A

women

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42
Q

scar tissue is still weak ____________ after MI

A

10-14 days

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43
Q

nicotine use increases LDL, decreases HDL, and increases oxygen radicals, causing vessel _____________ and ____________

A

inflammation, thrombosis

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44
Q

second-hand smoke increases CAD risk by _____%

A

25-30

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45
Q

men or women: are undertreated with guideline-based recommendations, leading to worse outcomes and increased rates of readmission, reinfarction, and death in first year after MI

A

women

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46
Q

abnormal heart sounds that can occur with an MI

A

S3, S4, new holosystolic murmur

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47
Q

after CABG surgery, patients usually go to the cardiac ICU for ________ hours

A

24-36

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48
Q

absolute or relative contraindication: traumatic or prolonged (>10 min) cardiopulmonary resuscitation

A

relative

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49
Q

obesity includes a waist circumference of >___ in men and >___ in women

A

40, 35

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50
Q

absolute or relative contraindication: known structural or vascular abnormality

A

absolute

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51
Q

absolute or relative contraindication: suspected aortic dissection

A

absolute

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52
Q

Gender and ethnicity group at highest risk for CAD

A

white men

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53
Q

two dysrhythmias that are the most common causes of death in prehospitalization period of an MI

A

ventricular tachycardia (VT)
ventricular fibrillation (VF)

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54
Q

acute care/nursing management for chronic stable angina (7)

A
  1. position upright, apply oxygen
  2. assess VS, pain, heart/breath sounds
  3. continuous ECG; 12-lead ECG
  4. pain relief: NTG, IV opioid
  5. cardiac biomarkers
  6. chest X-ray
  7. provide support; reduce anxiety
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55
Q

balloon angioplasty is also known as

A

percutaneous coronary intervention (PCI)

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56
Q

lipids accumulate and migrate into smooth muscle cells

A

fatty streak

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57
Q

Which personality type has a higher risk of CAD, Type A or B?

A

Type A

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58
Q

men or women: receive more evidence-based therapies when acutely ill from CAD

A

men

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59
Q

gold standard intervention to identify and localize CAD

A

cardiac catheterization

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60
Q

complication of MI that is associated with a high death rate

A

cardiogenic shock

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61
Q

normal fasting triglycerides

A

40-160 mg/dL men
35-135 mg/dL women

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62
Q

two inclusion criteria for thrombolytic therapy

A
  1. chest pain less than 12 hours and 12 lead shows STEMI
  2. no absolute contraindications
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63
Q

absolute or relative contraindication: noncompressible vascular punctures

A

relative

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64
Q

what to do when ECG shows ST elevation

A

send to cath lab for PCI
thrombolytic therapy if cath lab not immediately available

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65
Q

men or women: have larger diameter coronary arteries; vessel diameter is inversely related to risk for restenosis after interventions

A

men

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66
Q

this MI complication is characterized by inflammation of visceral and/or parietal pericardium

A

pericarditis

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67
Q

LDL high risk for CAD

A

> 160 mg/dL

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68
Q

what to do when ECG shows ST depression or T-wave inversion

A

send patient to critical care or telemetry unit

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69
Q

two ways hypertension serves as risk factor for CAD

A

causes endothelial injury
decreases elasticity of vessels

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70
Q

men or women: fewer have “classic” signs and symptoms of angina or MI

A

women

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71
Q

homocysteine levels increase with increased breakdown of the essential amino acid __________

A

methionine

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72
Q

blood vessel disorder that involves soft deposits of fat that harden with age

A

atherosclerosis

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73
Q

five postop complications after cardiopulmonary bypass used with CABG surgery

A

systemic inflammation, bleeding, anemia, infection, hypothermia

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74
Q

pathogenesis of atherosclerosis (4)

A
  1. chronic endothelial injury
  2. fatty streak
  3. fibrous plaque
  4. complicated lesion
75
Q

normal LDL

A

<130 mg/dL

76
Q

severe chest pain not relieved by rest, position change, or nitrate administration characterized by heaviness, pressure, tightness, burning, constriction, or crushing

A

myocardial infarction

77
Q

nicotine increases ____________ levels, reducing oxygen-carrying capacity of Hgb

A

carbon monoxide

78
Q

MI healing process after fourth day (three things)

A
  1. catecholamine-mediated lipolysis and glycogenolysis result in increased glucose
  2. necrotic zone identifiable by ECG changes
  3. collagen matrix laid down- scar tissue
79
Q

common locations of MI pain

A

substernal, epigastric that may radiate to neck, lower jaw, arms, back

80
Q

three causes of dysrhythmias in MI patients

A

ischemia, electrolyte imbalances, SNS stimulation

81
Q

LDL moderate risk for CAD

A

130-159 mg/dL

82
Q

diagnostic study specific to sudden cardiac death

A

electrophysiology study (EPS)

83
Q

absolute or relative contraindication: active internal bleeding

A

absolute

84
Q

cardiac catheterization/PCI within ______________ for NSTEMI

A

12-72 hours

85
Q

type of contraction that typically proceeds VT or VF

A

premature ventricular contractions (PVCs)

86
Q

three medications given during PCI

A

unfractionated heparin or low-molecular weight heparin
direct thrombin inhibitor
glycoprotein IIb/IIIa inhibitor

87
Q

men or women: higher mortality rate and more complications after coronary artery bypass graft surgery

A

women

88
Q

six complications of PCI

A

dissection or rupture of artery
abrupt closure
acute stent thrombosis
failure to cross blockage
extended infarct
in stent restenosis

89
Q

HDL high risk for CAD

A

<40 mg/dL

90
Q

ischemia that occurs in absence of any subjective symptoms

A

silent ischemia

91
Q

scar tissue has replaced necrotic tissue _____________ after MI; said to be healed

A

6 weeks

92
Q

FITT formula: FITT stands for

A

Frequency, Intensity, Type, and Time

93
Q

three ways increased homocysteine levels affect blood vessels

A

damage endothelium
promote plaque buildup
enhance clotting

94
Q

acute care for ACS upon admission to ICU/telemetry unit

A
  1. monitor VS, pulse ox
  2. continuous ECG
  3. serial 12-lead ECGs
  4. serial cardiac biomarkers
  5. bed rest/limit activity for 12-24 hours; increase gradually
95
Q

when can sexual activity be resumed after ACS/MI

A

7-10 days afterward or when patient can climb 2 flights of stairs or brisk walking

96
Q

two main goals of treatment for chronic stable angina

A

reduce oxygen demand and/or increase oxygen supply

97
Q

V1-V4 leads

A

anteroseptal leads (left ventricle)

98
Q

cardiopulmonary bypass (CPB) is associated with these complications

A

neurological dysfunction
renal problems
systemic inflammatory response

99
Q

collateral circulation allows adequate blood and oxygen to heart except with _____________

A

increased workload (exercise)

100
Q

women take __________ time than men to accumulate comorbidities

A

longer

101
Q

men or women: seek medical care later in CAD process, most likely because of lack of recognition of atypical symptoms

A

women

102
Q

absolute or relative contraindication: prior ischemic stroke over 3 months ago

A

relative

103
Q

three examples of Omega-3 fatty acid sources

A

tuna, salmon, mackerel

104
Q

absolute or relative contraindication: pregnancy

A

relative

105
Q

restenosis may occur ________ after cardiac catheterization and PCI

A

3-6 months to a year

106
Q

absolute or relative contraindication: significant hypertension on presentation (SBP >180 or DBP >110)

A

relative

107
Q

absolute or relative contraindication: active peptic ulcer disease

A

relative

108
Q

total occlusion of coronary artery indicates this condition

A

STEMI

109
Q

two contributing factors to collateral circulation

A
  1. inherited predisposition for angiogenesis
  2. presence of chronic ischemia
110
Q

V5, V6 leads

A

lateral leads (toward apex)

111
Q

oxygen demand greater than oxygen supply results in ________________

A

myocardial ischemia

112
Q

MI healing process within 24 hours

A

inflammatory process: leukocytes infiltrate area of cell death; enzymes released

113
Q

non-ST elevation acute coronary syndrome can indicate one of these two conditions

A

unstable angina
non-ST segment elevation myocardial infarction (NSTEMI)

114
Q

how many IV lines are required for thrombolytic therapy

A

2-3

115
Q

thrombolytic therapy within ______________ for STEMI for hospitals without access to cath lab

A

30 minutes

116
Q

absolute or relative contraindication: known intracranial cancer

A

absolute

117
Q

after sudden cardiac death (SCD) episode, implantable cardioverter-defibrillator (ICD) implant is placed with left ventricular dysfunction with ejection fraction <__%

A

30

118
Q

partial occlusion of coronary artery indicates one of these two conditions

A

unstable angina, NSTEMI

119
Q

statin therapy is recommended for these four patients***

A
  1. patients with known CVD
  2. LDL cholesterol > 190 mg/dL
  3. Age 40-75 with diabetes and LDL 70-189 mg/dL
  4. Age 40-75 with LDL 70-189 mg/dL and 10-year risk for CVD at least 7.5%
120
Q

plaque ruptures, platelets accumulate, thrombus forms, and vessel further narrows or totally occludes

A

complicated lesion

121
Q

I, aVL leads

A

lateral leads (toward base)

122
Q

which type of biomarkers are the best indicators of MI

A

cardiac-specific troponins

123
Q

absolute or relative contraindication: history of intracranial hemorrhage

A

absolute

124
Q

four advantages of off-pump coronary artery bypass (OPCAB)

A

less blood loss
less renal dysfunction
less postop AFib
fewer neurological complications

125
Q

absolute or relative contraindication: dementia

A

relative

126
Q

emergency care for acute coronary syndrome (6)

A
  1. Oxygen and upright position
  2. 12-lead ECG
  3. IV access
  4. Drugs: nitroglycerine (SL), ASA (chewable), morphine, statin
  5. treat dysrhythmias per agency protocol
  6. monitor serum biomarkers
127
Q

three ways in which diabetes increases risk of CAD

A

increased endothelial dysfunction
altered lipid metabolism
increased cholesterol and triglycerides

128
Q

how long are heart cells viable after hypoxia occurs

A

20 minutes

129
Q

CAD negatively affects cardiac ________, decreasing ___________ and __________

A

function, cardiac output (CO), perfusion

130
Q

most common complication that presents in 80-90% of MI patients

A

dysrhythmias

131
Q

(Women, Men) are more likely to survive a cardiovascular event

A

Men

132
Q

absolute or relative contraindication: severe uncontrolled hypertension

A

absolute

133
Q

men or women: standard screening for risk for sudden cardiac death is more predictive

A

men

134
Q

after total coronary occlusion, heart muscle becomes hypoxic within ____________, after which __________ metabolism begins and increases _______________ levels

A

10 seconds, anaerobic metabolism, lactic acid

135
Q

absolute or relative contraindication: intracranial or intraspinal surgery within 2 months

A

absolute

136
Q

this diagnostic study can show hypokinesis or akinesis of necrotic areas of heart

A

echocardiogram

137
Q

coronary artery bypass graft (CABG) surgery recommended in these four situations

A
  1. medical treatment failed
  2. disease involves left main coronary artery or three vessels
  3. PCI cannot be done
  4. failed PCI or chest pain continues
138
Q

cardiac biomarkers are important in absence of ST elevation because they distinguish against _____________, which is negative, and _______________, which is positive

A

unstable angina, NSTEMI

139
Q

men or women: have more “silent” MIs

A

women

140
Q

after age ____, the incidence of MI in men and women equalizes

A

55

141
Q

cardiac-specific troponin I is increased ______ after onset of MI, peaks at ______, and returns to baseline over ______

A

4-6 hours, 10-24 hours, 10-14 days

142
Q

this MI complication is characterized by thin myocardial wall that bulges out during contraction

A

left ventricular aneurysm

143
Q

nutritional therapy to prevent CAD involves increasing these three things

A

complex carbohydrates, fiber, Omega-3 fatty acids

144
Q

two dysrhythmias that may occur after an MI, especially if sinus or AV nodes were involved

A

bradycardia, heart block

145
Q

incidence of CAD is ____ times greater among people who have diabetes

A

2-4

146
Q

manifestations include mild to severe chest pain, pericardial friction rub, fever, decreased BP, ECG changes (diffuse ST elevation)

A

pericarditis

147
Q

MONA acronym for nursing care for angina and MI

A

Morphine for pain
Oxygen
Nitroglycerine
Aspirin

148
Q

cardiac catheterization/PCI within _____________ for STEMI

A

90 minutes

149
Q

absolute or relative contraindication: recent internal bleeding within 2-4 weeks

A

relative

150
Q

pain lasts more than 10 minutes with this type of angina

A

unstable angina

151
Q

men or women: fatigue is often first symptom of ACS

A

women

152
Q

four risk factors of CAD related to metabolic syndrome

A

central obesity
hypertension
abnormal serum lipids
high fasting BG

153
Q

collagen covers fatty streak, narrowing vessel lumen and reducing blood flow

A

fibrous plaque

154
Q

manifestations include chest pain, fever, malaise, pericardial friction rub, arthralgia, increased WBC and sedimentation rate

A

Dressler syndrome

155
Q

five causes of cardiogenic shock

A

decreased oxygen and nutrients related to:
severe LV failure, papillary muscle rupture, ventricular septal rupture, LV free wall rupture, right ventricular infarction

156
Q

absolute or relative contraindication: history of chronic, severe, poorly uncontrolled hypertension

A

relative

157
Q

fasting triglycerides risk for CAD

A

> 150 mg/dL

158
Q

why is serum glucose high after an MI

A

it is required to rebuild myocardium

159
Q

cardiac catheterization and PCI: how often to perform neurovascular assessment for first hour afterward

A

every 15 minutes

160
Q

Which has a higher risk of obesity, an apple or pear figure?

A

apple figure

161
Q

absolute or relative contraindication: major surgery within past 3 weeks

A

relative

162
Q

angina occurs when one or more arteries are blocked ___% or more by atherosclerotic plaque or left main coronary artery is blocked by ___% or more

A

70, 50

163
Q

absolute or relative contraindication: for streptokinase, prior treatment within past 6 months

A

absolute

164
Q

initially in an MI, HR and BP are ____________, then BP ______________ secondary to decreased ____

A

increased, decreases, cardiac output

165
Q

heart sound that could be present with chronic stable angina

A

transient S3 murmur

166
Q

rare form of angina that occurs at rest with or without CAD involving a spasm of a major coronary artery from increased intracellular calcium

A

Prinzmetal’s angina

167
Q

two things that can increase catecholamine levels

A

nicotine
SNS stimulation

168
Q

types of intracoronary stents

A

bare metal stent (BMS)
drug-eluting stent (DES)

169
Q

causes of chronic endothelial injury (7)

A

hypertension, tobacco use, hyperlipidemia, hyperhomocysteinemia, diabetes, infections, toxins

170
Q

high risk for CAD is considered ___ or more risk factors with ____% chance in next 10 years of having heart attack

A

2, 10-20

171
Q

men or women: experience onset of heart disease about 10 years later than the other gender

A

women

172
Q

three examples of onset of chronic stable angina

A

physical exertion
stress
emotional upset

173
Q

new-onset chest pain that occurs at rest or with increase in frequency, duration, or with less effort than chronic stable pattern

A

unstable angina

174
Q

a wearable cardioverter-defibrillator

A

amiodarone

175
Q

two types of anesthesia given during cardiac catheterization and PCI

A

dissociative and local

176
Q

this MI complication is characterized by pericarditis and fever that develop 1-8 weeks after an MI

A

Dressler syndrome

177
Q

sudden cardiac death (SCD) is most commonly caused by these three things

A

CAD
structural heart disease
conduction disturbances

178
Q

endothelial injury leads to _____________ and _____________

A

left ventricular hypertrophy, reduced stroke volume

179
Q

after starting a lipid-lowering drug, if lipids are still high after initial reassessment, do this

A

change to alternate drug

180
Q

men or women: first heart event is more often MI than angina

A

men

181
Q

process by which normal myocardium will hypertrophy and dilate in an attempt to compensate for infarcted muscle

A

ventricular remodeling

182
Q

chest pain in the absence of significant CAD and in the absence of a coronary spasm of a major coronary artery

A

microvascular angina

183
Q

men or women: in later age LDL levels and risk for MI increase

A

women

184
Q

MI healing process by fourth day

A

proteolytic enzymes of neutrophils and macrophages begin to remove necrotic tissue resulting in thin wall

Nursing of Adults I (21 decks)

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