Coronary artery disease (CAD)/Stable angina

Question 1

Major types of angina

Answer 1

Chronic stable angina
Prinzmetal’s angina
Microvascular angina
Unstable angina

Question 2

-Episodic pain lasting 5-15 min
-Provoked by exertion
-Relieved by rest or nitro

Answer 2

chronic stable angina

Question 3

-occurs primarily at rest
-triggered by smoking and increased levels of some substances (histamine, epinephrine)
-may occur n presence or absence of CAD

Answer 3

Prinzmetal’s angina

Question 4

-more common in women
-triggered by activities of daily living
-treatment may include nitro

Answer 4

microvascular angina

Question 5

-new onset angina
-chronic stable angina that increases in frequency, duration, and severity
-occurs at rest or w/ minimal exertion
-pain refractory w/ nitro

Answer 5

unstable angina

Question 6

Usually occurs at points of turbulence (i.e. vessel bifurcations). As plaque increases, arterial lumen progressively narrows→ decreased blood flow to myocardium→ischemia

Answer 6

Atherosclerosis

Question 7

Angina pectoris

Answer 7

chest pain

Question 8

Sx of angina pectoris

Answer 8

o Pain symptoms vary - ranges from a vague, barely troublesome ache, bloating, gas to a crushing sensation. Common beneath the sternum, may radiate to L shoulder, down the left arm, straight through to the back, into the throat, jaw, teeth.

o Women may have atypical symptoms such as malaise, SOB, Anxiety & Fatigue

Question 9

What is the #1 modifiable risk factor for CAD?

Answer 9

smoking

Question 10

Bad cholesterol

Answer 10

LDL

Question 11

Good cholesterol

Answer 11

HDL

Question 12

Troponins indicate

Answer 12

heart tissue death

Question 13

Lab parameters for CAD

Answer 13

Total cholesterol <200 mg/dL
LDL <100 mg/dL
HDL >40 mg/dL
Triglycerides <150 mg/dL
C-reactive protein <0.175 mg/L (inflammation marker, but not cardiac specific)
Homocysteine <17

Question 14

Diagnostic tests for CAD

Answer 14

-ECG
-stress tests
-CT or PET scans

Question 15

Types of stress tests

Answer 15

o Treadmill/Bike - Exercise to stress the heart and look for symptoms of decreased perfusion

o Pharmacologic Stress Test - Same concept, uses dobutamine (increases contractility) or dipyridamole (coronary artery dilator) to stress the heart

Question 16

Cardiac cath pre-procedure considerations

Answer 16

• look for consent, check for metformin (Glucophage) use, or allergies to iodine or shellfish (contrast medium)
• Assess baseline neurovascular assessment, heart & breath sounds, VS
• Teaching Procedure/Post Procedure:
  Conscious sedation – awake during procedure
  May feel flushing or warmth when dye is injected

Question 17

What are the 6 P’s for the neurovascular assessment?

Answer 17

Pain
Pulse
Paralysis
Pallor
Paresthesia
Pressure

Question 18

Cardiac cath post-procedure considerations

Answer 18

• Sheath Removal – Bedrest, keep extremity straight
• Complications
  o Contrast-induced renal dysfunction, Hematoma/Bleeding, & Restenosis
• Patient Education re: discharge meds

Question 19

Medications for CAD

Answer 19

Nitrates, beta blockers, & calcium channel blockers

Question 20

Beta blockers can cause rebound hypertension. Advise patients that they should never

Answer 20

stop the medication abruptly

Question 21

With transdermal nitroglycerin (patch):

Answer 21

-apply to a clean, dry, hairless area so medication is better absorbed
-rotate application sites to prevent skin irritation
-remove patch before defibrillation to prevent burns
-remove patch after 12-14 hrs each day to prevent drug intolerance

Question 22

Beta blockers decrease in HR and cardiac output. Do not administer if

Answer 22

HR is <50-60 bpm or systolic <90-100 mmHg

Watch for signs of HF (cough, edema, SOB, weight gain)
Assess for wheezing & SOB because beta2 blockers causes bronchoconstriction

Question 23

Calcium channel blockers cause orthostatic hypotension which places patients at an increased risk for

Answer 23

falls

esp. elderly patients

Question 24

When patients are taking antiplatelets such as aspirin, clopidogrel, & prasugrel what education should be provided?

Answer 24

-bleeding is a side effect
-take w/food to avoid GI upset
-ringing in ears can be a sign of aspirin toxicity
-should not be stopped unless indicated by provider

Question 25

Statins reduce cholesterol synthesis in the liver and increase clearance of LDL-C from the blood. Statins are contraindicated for pts w/

Answer 25

liver disease

Question 26

Reminders for statins

Answer 26

Pregnant women should not take
Take a night
Avoid grapefruit juice
Risk for rhabdo

Question 27

Prevention of CAD - Patient self-management

Answer 27

Smoking cessation, healthy diet, lower LDL-C, physical activity, manage DM, lower BP, and lose weight if obese