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From Flashcardlet > (3) Exam 3-❤️ Lecture #2- Coronary Artery Disease & Angina > Flashcards

(3) Exam 3-❤️ Lecture #2- Coronary Artery Disease & Angina Flashcards

0
Q

Coronary Artery Disease

In CAD, what happens to fatty deposits over time?

A

They harden

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1
Q

Coronary Artery Disease

🚬 CAD is the leading cause of death in what gender?

A

Females

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2
Q

Coronary Artery Disease

“Hardening of the Arteries” is another name for what disease?

A

CAD

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3
Q

Coronary Artery Disease

What is Atheromas?

A

Fatty Deposits

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4
Q

Coronary Artery Disease

What is a major cause of CAD that is characterized by lipid deposits within intima (inner lining) of the artery?

A

Atherosclerosis

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5
Q

Coronary Artery Disease

What plays a major role in the development of fatty deposits that get under the endothelial and build up plaque?

A

Inflammation

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6
Q

Coronary Artery Disease
💉 What is nonspecific marker of systemic inflammation that isn’t specific to the location of inflammation but tends to indicate CAD when the results are high?

A

C-Reactive Protein (CRP)

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7
Q

Coronary Artery Disease

🚬 What is the #1 cause of chronic injury that results in fat and plaque build up over time to become a major blockage?

A

Hypertension

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8
Q

Coronary Artery Disease

🚬 Two or more of what problems will cause the development of CAD?

A 
▪️Hypertension
▪️Tobacco Use
▪️Diabetes
▪️Infections
▪️Toxins
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9
Q

Coronary Artery Disease
♿️ The artery has its own capillaries and blood supply so when there’s a tear in the lining it starts to bleed and develops a blood clot in the blood vessel that causes what complication due to the artery being locked?

A

Heart Attack

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10
Q

Coronary Artery Disease
When there is a slow build of plaque and not enough oxygen, what can develop that causes small blood vessels around the heart to incease their blood flow and the growth of new blood vessels to supply the ischemic area with blood flow?

A

Angiogenesis

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11
Q

Coronary Artery Disease
If there is a massive coronary artery blockage, what may protect from an infarction by still supplying adequate blood flow to the heart muscle?

A

Collateral Circulation

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12
Q

Coronary Artery Disease

When may collateral circulation be inadequate causing a heart attack to occur?

A

Rapid onset of CAD. Blood clot develops rapidly

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13
Q

Coronary Artery Disease

🚬 Increased risk for CAD occur at what age for men and woman?

A

Men >45 years

Woman >55 years

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14
Q

Coronary Artery Disease

🚬 Men have more CAD until woman reach what age in which it becomes equal for both genders?

A

Woman reach age 55

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15
Q

Coronary Artery Disease

🚬 African Americans have a higher mortality but what ethnicity has the highest incidence?

A

Caucasians

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16
Q

Coronary Artery Disease

🚬 What ethnicity have heart attacks at a younger age and double the mortality compared to the rest of the population?

A

American Indians

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17
Q

Coronary Artery Disease

🚬 What ethnicity have a very low incidence of CAD and a low mortality rate?

A

Hispanics

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18
Q

Coronary Artery Disease

🚬 What has a major contributing component and is the #1 modifiable risk factor for CAD

A

Elevated Serum Lipids

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19
Q

Coronary Artery Disease

🚬 What cholesterol levels increase the risk for CAD?

A

> 200 mg/dL

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20
Q

Coronary Artery Disease

🚬 What Triglyceride levels increase the risk for CAD?

A

> 150 mg/dL

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21
Q

Coronary Artery Disease

🚬 What LDL levels increase the risk for CAD?

A

> 160 mg/dL

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22
Q

Coronary Artery Disease

🚬 What HDL levels increase the risk for CAD in men and woman?

A

Men >40 mg/dL

Woman >50 mg/ dL

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23
Q

Coronary Artery Disease

🚬 What BP puts someone at high risk for CAD?

A

140/90

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24
Q

Coronary Artery Disease

💊 What is treatment for patients with prehypertension?

A

Lifestyle changes?

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25
Q

Coronary Artery Disease

💊 What aggressive treatment is used for patients with stage 1or 2 hypertension?

A

Medication and lifestyle modifications

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26
Q

Coronary Artery Disease
🚬 What 3rd highest risk factor for CAD↑HR BP due to vasoconstriction, ↑LDL, ↓HDL, ↑Oxygen Radicals, and ↑Carbon Monoxide?

A

Tobacco use

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27
Q

Coronary Artery Disease

🚬 What is not a high risk factor for CAD but tends to go along with physical inactivity?

A

Obesity

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28
Q

Coronary Artery Disease

🚬 What are the top 4 modifiable risk factors for CAD?

A

1) Elevated Serum Lipids
2) Hypertension
3) Tobacco Use
4) Physical Inactivity

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29
Q

Coronary Artery Disease

🚬 Waist circumference >40” in men, >35” in woman, or a BMI greater than what increases the risk for obesity?

A

BMI >30

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30
Q

Coronary Artery Disease

🚬 Because diabetes is a risk factor for CAD, A1C should not be greater than what percentage?

A

Don’t want it > 7%

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31
Q

Coronary Artery Disease
😷 When encouraging lifestyle changes, what realistic goals do you want to set with the patient to achieve risk reduction?

A

Pick one of the big four modifiable risk factors for the patient to work on. Don’t be unrealistic and suggest multiple changes.

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32
Q

Coronary Artery Disease
📚 A physical fitness plan using the FITT formula recommends how many minutes of aerobic exercise most days of the week plus weight training 2 days per week for patients with CAD

A

30 mins

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33
Q

Coronary Artery Disease

🍓 Any fat that comes from an animal has what in it?

A

Cholesterol

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34
Q

Coronary Artery Disease

🍓 A decrease in what dietary changes should be recommended to patients with CAD?

A

↓Saturated fats & Cholesterol

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35
Q

Coronary Artery Disease

🍓 Patients with CAD should decrease the consumption of what specific foods that come from animals?

A

↓Red Meat, Egg Yolk, & Whole Milk

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36
Q

Coronary Artery Disease

🍓 What dietary changes should be increased in patients with CAD?

A

Complex Carbohydrates, Fiber, & Omega-3 Fatty Acids.

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37
Q

Coronary Artery Disease
🍓To increase complex carbohydrates in patients with CAD, complex carbs such as candy and maple syrup should be avoided and what foods containing starch should be suggested?

A

Potatoes and Beans

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38
Q

Coronary Artery Disease
🍓 Patients with CAD should be taught to increase or add chia seeds, nuts, and what fatty fish in their diet to increase Omega 3-Fatty Acids?

A

Sardines
Salmon
Tuna
Mackerel

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39
Q

Coronary Artery Disease

🍓 In patients with CAD, most of the fat intake should be from what type of oils?

A

Vegetable Oils (olive, safflower, corn, soybean, flaxseed, cottonseed) or oils in nuts.

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40
Q

Coronary Artery Disease
🍓 Patients with CAD should reduce their fat intake to what percent with most from monounsaturated fats and less from saturated fats?

A

25-35%

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41
Q

Coronary Artery Disease

💊💥 What type of drugs are initially started if diet and exercise doesn’t effectively lower lipid levels?

A

Statins

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42
Q

Coronary Artery Disease
💊💥 Zocor is what type of drug given to patients with CAD to increase cholesterol synthesis, decrease LDL, and increase HDL?

A

Statin

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43
Q

Coronary Artery Disease
💊💥 What Statin drugs is commonly given to patients with CAD when diet and exercise are not effectively lowering lipid levels?

A

Zocor (simvastatin)

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44
Q

Coronary Artery Disease

💊💥 When the patient is prescribed Statin drugs, what is initially monitored and rechecked with any increase in dosage?

A

Liver enzymes

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45
Q

Coronary Artery Disease
💊💥 Statins, Niacin, Fibric Acid, Bile Acid Sequestrants, and Cholesterol Absorption Inhibitors are what type of drugs used in patients with CAD?

A

Lipid-Lowering Drugs

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46
Q

Coronary Artery Disease

💊💥 What Lipid Lowering drug↓LDL, and↑HDL?

A

Statins

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47
Q

Coronary Artery Disease

💊💥 What Lipid-Lowering Drug↓LDL,↓Triglycerides, and↑HDL?

A

Niacin

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48
Q

Coronary Artery Disease

💊💥 What Lipid Lowering Drug↓triglycerides and↑HDL?

A

Fibric Acid

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49
Q

Coronary Artery Disease

💊💥 What Niacin drug is a high dose B Vitamin?

A

Niaspan

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50
Q

Coronary Artery Disease
💊💥 What Lipid-Lowering Drug has side effects of Flushing, Pruritus, GI side effects, and Orthostatic Hypotension due to vasodilation?

A

Niacin (Niaspan)

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51
Q

Coronary Artery Disease

💊💥 The Lipid-Lowering Drugs Niacin, Fibric Acid, and Bile Acid Sequestrants all have what common side effect?

A

GI side effects

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52
Q

Coronary Artery Disease

💊💥 What is the most common Bile Acid Sequestrant used for Lipid Lowering Drug Therapy?

A

WelChol (colesevelam)

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53
Q

Coronary Artery Disease

💊💥 What Lipid-Lowering Drug binds with other drugs so must be taken separately from other drugs?

A

Bile Acid Sequestrans - WelChol (colesevalam)

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54
Q

Coronary Artery Disease

💊💥 What Lipid-Lowering Drug increases conversion of cholesterol so that it can be excreted through the feces?

A

Bile Acid Sequestrans - WelChol (colesevelam)

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55
Q

Coronary Artery Disease

💊💥 What Fibric Acid Derivative is commonly given as Lipid-Lowering Drug Therapy?

A

Lopid (gemfibrozil)

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56
Q

Coronary Artery Disease
💊💥 What Cholesterol Absorption Inhibitor is commonly used for Lipid-Lowering Drug Therapy to prevent cholesterol absorption in the blood stream?

A

Zetia (ezetimibe)

57
Q

Coronary Artery Disease
💊💥 In addition to lowering cholesterol and lipids and increasing HLD, what other therapy is started on patients with CAD?

A

Anti-platelet Therapy

58
Q

Coronary Artery Disease

💊💥 For Anti-Platelet Therapy, how many mg of Aspirin is usually recommended for patients with CAD?

A

81 mg

59
Q

Coronary Artery Disease

💊💥 For Anti-Platelet Therapy in patients CAD, 81 mg of what type of Aspirin is prescribed daily?

A

Enteric Coated so it doesn’t cause GI upset

60
Q

Coronary Artery Disease

💊💥 What Drug Therapy is started in patients with CAD so that clots don’t form as easily?

A

Anti-Platelet

61
Q

Coronary Artery Disease

💊💥 What drug is used for Anti-Platelet Therapy in patients that cant take Aspirin?

A

Plavix (clopidogrel)

62
Q

Coronary Artery Disease

🚬 How do strategies to reduce the risk for CAD change when treating CAD in older adults?

A

It doesn’t. Reducing risk factors are still effective in older adults.

63
Q

Coronary Artery Disease

💊 Aggressive treatment for what problems are needed in older adults with CAD?

A

Hypertension and Hyperlipidemia

64
Q

Coronary Artery Disease
📚 When planning a physical activity program for older adults, physical activity should be encouraged for how long on most days at minimum?

A

30 mins

65
Q

Coronary Artery Disease

📚 What guidelines for physical activity are necessary to modify in older adults?

A 
▪️Longer warm-up
▪️Longer periods of low-level activity
▪️Longer rest periods
▪️Avoid extreme temperatures
▪️30 minutes most days minimum
66
Q

Coronary Artery Disease

😰 What is it called when there ischemia of the heart under known circumstances?

A

Stable Angina

67
Q

Coronary Artery Disease

😰 What is angina?

A

Chest pain / discomfort above the waist

68
Q

Coronary Artery Disease

💊 Angina is reversible ischemia with what treatment?

A

Rest or rest and medication

69
Q

Coronary Artery Disease

😰 Angina doesn’t usually occur until how much of the arteries are blocked?

A

75%

70
Q

Coronary Artery Disease

How long after an occlusion do the cells start to suffer from the lack of oxygen?

A

10 seconds

71
Q

Coronary Artery Disease

Cardiac cells can live for how long without adequate blood flow and oxygen?

A

20 mins

72
Q

Coronary Artery Disease

What occurs with oxygen demand and supply with angina?

A

O2 demand > O2 Supply

73
Q

Coronary Artery Disease

Because the vessels are narrowed and calcified they become ischemic which causes a build up of what in the heart muscle?

A

Acid

74
Q

Coronary Artery Disease

What in the heart muscle causes angina pain?

A

Acid

75
Q

Coronary Artery Disease

When does myocardial ischemia occur?

A

When O2 demand > O2 supply

76
Q

Coronary Artery Disease

😰 Angina pain is usually described as what?

A

Pressure / Ache

77
Q

Coronary Artery Disease
😰 Squeezing, heavy, chocking, suffocating sensation, and the feeling of an elephant sitting on the chest is commonly described in what type of pain?

A

Angina

78
Q

Coronary Artery Disease
😰 Although most of the pain experienced by people with angina appears substernally, the sensation may also occur in what other regions?

A

Neck, Jaw, Shoulders, and down the Arms

79
Q

Coronary Artery Disease

😰 Many people with angina complain of what sensation in the epigastric region?

A

Indigestion or Burning

80
Q

Coronary Artery Disease

😰 Are epigastric pain and intrascapular considered typical or atypical angina pain?

A

Atypical

81
Q

Coronary Artery Disease
😰 What is described as intermittent chest pain that occurs over a long period with the same pattern of onset, duration, and intensity of symptoms?

A

Chronic Stable Angina

82
Q

Coronary Artery Disease

😰 How long does chronic stable angina usually last?

A

5-15 mins

83
Q

Coronary Artery Disease

💊 Chronic Stable Angina is controlled with rest and what typical medication?

A

Nitroglycerin

84
Q

Coronary Artery Disease

📈 A 12-lead ECG often shows what results that indicate ischemia

A

ST segment depression and/or T-Wave inversion

85
Q

Coronary Artery Disease

😰 What are the three types of Angina?

A

Silent, Prinzmetal (Variant), and Microvascular

86
Q

Coronary Artery Disease
😰 What type of Angina is ischemia that occurs in the absence of any subjective symptoms, is often associated with diabetic neuropathy, and is confirmed by ECG?

A

Silent Angina / Ischemia

87
Q

Coronary Artery Disease
😰 What type of Angina can occur with or without CAD and is usually at rest in response to a spasm of the major coronary artery?

A

Prinzmetal

88
Q

Coronary Artery Disease

😰 Prinzmetal’s (varient) Angina occurs at rest due to what?

A

Spasm of a major coronary artery

89
Q

Coronary Artery Disease
📈 What ECG results is seen with Prinzmetal (Varient) Angina indicates ischemia of the heart muscle and that the patient could be having a heart attack?

A

Significant elevation of ST segment

90
Q

Coronary Artery Disease
😰 What type of angina affects the small, distal coronary arteries and cant be seen well during cardiac catheterization because it only looks that the major arteries?

A

Microvascular Angina

91
Q

Coronary Artery Disease

💊 What medication achieves the goal to treat angina which is to↓O2 demand and↑O2 supply?

A

Nitroglycerin

92
Q

Coronary Artery Disease

💊 In what ways can short acting Nitroglycerin be administered?

A

Sublingually tablet (Nitrostat) or translingual spray (Nitrolingual)

93
Q

Coronary Artery Disease

💊 If there is some relief with Nitroglycerin, how often may 3 additional doses be administered?

A

Every 5 minutes

94
Q

Coronary Artery Disease

💊 How often does Nitroglycerin have to be replaced after it has been opened?

A

Q6 Months

95
Q

Coronary Artery Disease

💊 What kind of bottle is Nitroglycerin stored in?

A

Dark Glass Bottle

96
Q

Coronary Artery Disease

💊 Because Nitroglycerin will degrade and become less effective, how should tablets be stored?

A

Protect from light, air, and heat (including body heat)

97
Q

Coronary Artery Disease

💊 Nitroglycerin should not be combined with what other medication?

A

Erectile Dysfunction Medication (Viagra)

98
Q

Coronary Artery Disease

💊 What instructions should be given to patients that are prescribed Nitrolingual?

A

Spray directly on the tongue. Not underneath. Do not inhale

99
Q

Coronary Artery Disease

💊 Why should patients be instructed to sit when taking Nitroglycerin?

A

Orthostatic Hypotension

100
Q

Coronary Artery Disease

💊 What are the side effects of Long-Acting Nitrates?

A

Headache & Orthostatic Hypotension

101
Q

Coronary Artery Disease

💊 What are the methods of administration for Long-Acting Nitrates?

A

▪️Oral
▪️Ointment
▪️Transdermal Patch

102
Q

Coronary Artery Disease

💊 What type of medication is Imdur (isoisorbide mononitrate)?

A

Long-Acting Nitrate

103
Q

Coronary Artery Disease
💊 Nitroglycerin Ointment is usually given every 6 hours, is dosed by the inch, and is administered by putting it on a piece of paper and placed on what area of the body?

A

Upper body or arm, over a flat muscular area that is free of hair and scars

104
Q

Coronary Artery Disease

💊 Why is a Nitrate free period needed with Transdermal Nitroglycerin?

A

Body develops a tolerance. Usually removed at night and reapplied in the morning

105
Q

Coronary Artery Disease

💊 Besides Nitroglycerin, what other drugs are used to prevent angina in patients with CAD?

A

▪️ACE Inhibitors
▪️β- Adrenergic Blockers
▪️Calcium Channel Blockers
▪️Sodium Current Inhibitors

106
Q

Coronary Artery Disease

💊 What medications end in “pril”?

A

ACE Inhibitors

107
Q

Coronary Artery Disease

💊 What medications end in “lols”?

A

β-Adrenergic Blockers

108
Q

Coronary Artery Disease

💊 What medications end in “pines”, “zems”, and “mils”?

A

Calcium Channel Blockers

109
Q

Coronary Artery Disease

💊 What ACE Inhibitor is commonly used to prevent angina?

A

Captopril (Capoten)

110
Q

Coronary Artery Disease
💊 What type of drug is Ranolazine (Ranexa) which is used for the treatment of angina when other antianginals haven’t worked?

A

Sodium Current Inhibitor

111
Q

Coronary Artery Disease
📈 When a patient has a history of CAD or CAD is suspected, what is the first diagnostic study done that will determine if the heart is enlarged?

A

Chest X-Ray

112
Q

Coronary Artery Disease

📈 What initial diagnostic studies are done when the patient has a history of CAD or CAD is suspected?

A

▪️Chest X-Ray
▪️Laboratory Studies
▪️12 Lead ECG
▪️Calcium-Score Screening Heart Scan

113
Q

Coronary Artery Disease

📈 What does ST depression indicate?

A

Ischemia

114
Q

Coronary Artery Disease

📈 What does ST elevation indicate?

A

Heart Damage

115
Q

Coronary Artery Disease

📈 Why would pharmacologic nuclear imaging where IV medication is given be used to raise the patients HR?

A

When the patient is not able exercise for an exercise stress test

116
Q

Coronary Artery Disease

📈 What diagnostic study is used when there is a positive stress test?

A

Cardiac Catheterization

117
Q

Coronary Artery Disease
📈 What diagnostic study looks at heart wall movement and valve movement and can be done with a stress test to determine if the heart can handle exercise?

A

Echocardiogram

118
Q

Coronary Artery Disease

📈 What diagnostic study is diagnostic for CAD because it can be used to visualize and open blockages?

A

Cardiac Catheterization

119
Q

Coronary Artery Disease

📈 What is the most common entry for cardiac catheterization?

A

Femoral Artery

120
Q

Coronary Artery Disease

📈 Where can a cardiac catheter be inserted to go into the aorta?

A

▪️Femoral Artery
▪️Brachial Artery
▪️Radial Artery

121
Q

Coronary Artery Disease

📈 Where is a cardiac catheter inserted to go into the right side of the heart?

A

Must go in a vein

122
Q

Coronary Artery Disease
📈 When a cardiac catheter is inserted it goes against the flow and the tip of the catheter ends right above the aortic valve where what is located and dye is injected?

A

Coronary Ostia

123
Q

Coronary Artery Disease

📈 How much of the coronary arteries usually have to be blocked for a stent to be placed?

A

70-75%

124
Q

Coronary Artery Disease

📈 Why is a Drug-Eluting Stent used with cardiac catheterization?

A

To prevent the build up of protein over the surface of the stent that could cause another blockage

125
Q

Coronary Artery Disease

📈 What is used to prevent overgrowth of new intima which is the primary cause of restenosis?

A

Drug Eluting Stents

126
Q

Coronary Artery Disease

📈 What is the patient at risk for when a stent is placed?

A

Clots

127
Q

Coronary Artery Disease
📈 To prevent clots the patient is put on an anticoagulant during cardiac catheterization and put on what two anti-platelet agents after the procedure?

A

Aspirin & ticagrelor (Brilinta)

128
Q

Coronary Artery Disease
📈 After cardiac catheterization, how long will the patient be on the two anti-platelet drugs (Aspirin & ticagrelor (Brilinta))?

A

12 months or more

129
Q

Coronary Artery Disease

😷 After a stent is placed through cardiac cauterization, how often is the patient assessed for the first hour?

A

Q15 mins x 1 hour

130
Q

Coronary Artery Disease

😷 After a stent is placed through cardiac catheterization, what areas are assessed Q15 x 1H for circulation?

A

Extremity used for insertion and distal to insertion site.

131
Q

Coronary Artery Disease

😷 What are you looking for when assessing for bleeding after a stent is placed through cardiac catheterization?

A

Hematoma (Raised blood clot)

132
Q

Coronary Artery Disease

😷 After a stent is placed through cardiac catheterization, what vital signs changes are indicative of internal bleeding?

A

↑Pulse & Respirations (↓BP is a later sign)

133
Q

Coronary Artery Disease

😷💥 What do you do if the patient experiences chest pain after a stent placement?

A

Call HCP ASAP. If Nitroglycerin is ordered, it can be given.

134
Q

Coronary Artery Disease

😷 Respiratory distress after stent placement is usually associated with what complication?

A

Hemorrhage or chest pain

135
Q

Coronary Artery Disease
😷 If external bleeding occurs after a stent is placed, nonstop manual pressure without lifting is to be applied for at least how long?

A

20 minutes

136
Q

Coronary Artery Disease

PCI (stent placement) is not used in patients with what specific CAD?

A

▪️3 Vessels CAD

▪️Significant Left Main CAD

137
Q

Coronary Artery Disease

💊 What surgical treatment is needed for patients with 3 Vessel CAD?

A

Bypass Graft

138
Q

Coronary Artery Disease

💊 What surgical treatment is used for patients with Significant Left Main CAD?

A

Open Heart Surgery with Bypass

139
Q

Coronary Artery Disease

📚 What discharge teaching related to CAD and PCI need to be provided to the patient?

A

▪️Stent is not a cure. Need to start lifestyle modifications

▪️Call HCP with any chest pain

140
Q

Coronary Artery Disease

😰 Chronic Stable Angina can turn into what cardiovascular disorder?

A

Acute Coronary Syndrome

From Flashcardlet (47 decks)

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