Cardiac 3 Flashcards
Nitroglycerin (NTG, a nitrate)
is a drug of choice for acute anginal attacks. It dilates coronary arteries to increase oxygen to the myocardium, and dilate peripheral vessels so the heart does not have to work so hard to pump blood into them.
calcium channel blockers?
required for electrical excitability of cardiac cells and contraction of the myocardium and vascular smooth muscle. this relaxes vascular smooth muscle, which leads to decreased peripheral vascular resistance (after load) and decreased myocardial oxygen demand. {also used to decrease systolic and diastole blood pressures and to slow the heart rate.
what do anti platelets do?
inhibit platelet activation, adhesion, or procoagulant activity. (aspirin)
what are side effects and nursing implications of antiplatelets?
SE=increased risk of bleeding. NI= enteric coated may be given for daily dosing.
what are statins?
first- line drugs to reduce low- density lipoprotein by reducing cholesterol synthesis. atorvastatin (lipitor) fluvastatin(LescolXL) lovastatin(Mevacor) pravastatin(Pravachol) simvastatin(Zocor) rosuvastatin(Crestor)
what are side effects and nursing implications of statins?
SE: impaired liver functions, rhabdomyolysis (lethal breakdown or skeletal muscle) NI: tell patient to take in the evening when cholesterol synthesis is highest. Teach patient to report any muscle pain. monitor liver function studies.
anti-ischemic agent?
antianginal agent used as combination therapy for those not responding to other antianginal.
ranolazine (Ranexa)
what are side effects and nursing implications of anti-ischemic agent?
SE:prolongs QT interval on ECG, dizziness, headache, nausea
NI: may not be effective in women
what are beta blockers?
decrease pulse, BP, and cardiac output and suppress renin activity, decrease the risk of sudden death.
metoprolol (Lopressor, Troprol XL)
atenolol (Tenormin)
what are side effects and nursing implications of beta blockers?
SE: cold extremities, constipation, diarrhea, diaphoresis, dizziness, fatigue, and nausea ,abrupt withdrawal may result in diaphoresis, palpitations, headache and tremors
NI: if pulse less than 60 beats per minute or systolic BP less than 90 mm Hg. notify physician
what are calcium channel blockers?
dilate peripheral arteries, decrease myocardial contractility, depress conduction system, and decrease workload of the heart. in variant angina, reduce coronary artery spasms
what are side effects of calcium channel blockers?
SE: headache, peripheral edema, flushing, dizziness, atrioventricular blocks, nausea
NI:if pulse less than 60 beats per minute or systolic BP less than 90 mm Hg. notify physician. Administer before meals and at bedtime
what are nitrates?
vasodilate to reduce preload and afterload. reduce oxygen consumption of myocardium.
what are side effects and nursing implication of nitrates?
SE: hypotension, headache, orthostatic hypotension, dizziness
NI: document onset, type, radiation, location, and duration of the chest pain. Take apical pulse and BP pre- and post administration
what is unstable angina?
occurs when patient with worsening CAD and is notes by its changing or unpredictable pattern. rest does not decrease the chest pain of unstable angina. this pain may even occur when the patient is at rest. the eoisodes of of chest pain with unstable angina increase in frequency and severity. placing the patient at risk for myocardial infarction or sudden death. symptoms of angina are usually occur when an artery is narrowed by atleast 60% to 70%
what is a myocardial infarction or a heart attack?
the affected myocardial cells in the heart are permanently destroyed, An MI occurs from a partial or a complete blockage of a coronary artery, which decreases the blood supply to the cells of the heart supplied by the blocked artery. the extent of the cardiac damage depends on the location and amount of blockage in the coronary artery.
how is a myocardial infarction identified?
it is identified by type. Non-ST-segment elevation myocardial infarction (NSTEMI) is also known as a non-Q–wave MI. An ST-segment elevation myocardial infarction (STEMI) is also known as a Q-wave MI and is the deadliest type because it is usually caused by a complete blockage of the artery.
what is silent ischemia?
silent ischemia ocurs without pain and carrys many risks. the older adults and people with hypertension or diabetes are most often notes to have silent ischemia.
what is sudden cardiac death?
is a cardiac arrest triggered by lethal ventricular dysrythmias or asystole from the abrupt occlusion of a coronary artery. prompt treatment is required to prevent death.
when does a myocardial infarction happen?
it does not happen immediately. Ischemic injury evolves over several hours before complete necrosis and infarction take place. the ischemia proccess affects the subendocardial layer, which is the most sensitive to hypoxia.
what can prolonged ischemia produce?
it can produce severe cellular damage and necrosis of cardiac muscle. once necrosis takes place. the contractile function of the muscle is permenantly lost. if treatment is intiated within the first hour of symptoms of the MI, the area of damage can be minimized.
what wall does the left coronary artery feed?
feeds the anterior wall of the heart, which also includes most of the left ventricle. An occlusion in this area causes an anterior wall MI. when the left ventricle is affected, there can be severe loss of left ventricular function, leading to severe loss of left ventricular function, leading to severe changes in the hemodynamic status of the patient.
what does the right coronary artery feed?
feeds the inferior wall and parts of the atrioventricular node and the sinoatrial node. an occlusion of the RCA leads to an inferior MI abnormalities in impulse formation and conduction. Serious dysrhythmias can occur early in an inferior MI that may be life threatening.
what does the left circumflex coronary artery feed?
feeds the lateral wall of the heart and part of the posterior wall of the heart. A lesion in the circumflex leads to a lateral wall infarction of the left ventricle.
what are some signs and symptoms of MI?
chest pain is a classic symptom. the pain begins suddenly and continues without relief with rest or administration of NTG. the pain in the center of the chest is usually described as crushing, viselike, or as if an elephant is standing on the chest. the pain may radiate to the back, one or both arms and shoulders, neck, or jaw. the pain can imitate indigestion and a gallbladder attack with abdominal pain and vomiting. [shortness of breath, dizziness, nuas
what does time have to do with an MI?
“time is muscle” as time passes during the MI, more muscle is lost.
what is the leading cause of women death in the USA?
heart disease
what are some indicators of an MI?
patient history, ECG, and serum cardiac troponin I or T, myoglobin, and CK-MB levels. C-reactive protein is elevated in the presence of inflammation. Magnesium levels are also checked, especially for those in diuretic therapy. The ECg usually shows the area that has infarcted, as well as the ischemia areas of the heart.
what are some recommendations of onset chest pain?
the american heart association recommends chewing one uncoated adult aspirin at the onset of chest pain. delays i seeking care can limit treatment options and result in more cardiac damage.
how are patients repotting chest pain treated like?
they are treated as if they are having an MI until proven otherwise through testing.
when is oxygen administered?
it is administered immediately, usually at 2L/min via nasal cannula. oxygen therapy may be limited to the first 6 hours in stable patients. too much oxygen can lead to a systemic vasoconstriction,which may increase myocardial workload. Arterial blood gases (ABG’s)are drawn to determine the patients oxygen needs. oxygen saturation should be monitored and kept above 95%.
What is a percutaneous coronary interventions?
(PCI) is a variety of mechanical procedures used to increase blood flow and oxygen to the myocardium. Emergency PCI is used frequently in management of acute myocardial infarction with improved outcomes.
what is balloon angioplasty ?
is a catheterization laboratory, a catheter with a balloon tip is interested, usually via the femoral artery, and advanced into the heart to open the blocked coronary artery. once the blocked artery is entered, the balloon in the catheter is inflated and the atherosclerotic plaque is compressed. the dilated vessel is able to deliver more oxygen- rich blood to the myocardium. angioplasty can be done with or without the placement of stents.
what is a coronary artery stent?
a coronary artery stent is placed during angioplasty, is used to prevent closure of a coronary artery from an athersclerotic lesion. a stent is an expandable metal mesh tube that is implanted at the site of blockage in the coronary artery. a stent provides support to a coronary artery wall at the area of stenosis to keep blood flowing through the artery.
what are some complication associated with stent placements?
include thrombosis (formation of a blood clot inside a blood vessel), bleeding from anticoagulation, stent occlusion, or coronary artery dissection.
what is a drug eluting stent, and what is it coated with?
coated with immunosuppressants medication that can be released at the implantation site to reduce the risk of restenosis.
for those with unstable angina taking tha “fab four “ has shown beneficial to health care, what is the fab four?
fab four includes anitplatelets, statins, ACEI’s, and beta blockers.
