CAD Flashcards by Amanda S.

atherosclerosis starts with (NOT inflammation for this one)

a fatty streak sticks

How well did you know this?

Not at all

Perfectly

total cholesterol (cholesterol has your fav numbers)

< 200 low risk
200-239 borderline
>239 high risk

How well did you know this?

Not at all

Perfectly

HDL (H High at 35)

> 35 low
< 35 high

How well did you know this?

Not at all

Perfectly

LDL (29, 30, and 59 are liddle old)

<129 low
130-159 medium
>159 high

How well did you know this?

Not at all

Perfectly

triglycerides (try 201 units to get high)

<200 low
201-399 high
400-1000 very high
>1000

How well did you know this?

Not at all

Perfectly

how atherosclerosis forms

inflammation, formation of fibrous cap, if thrombus, it’s just a ruptured plaque.

How well did you know this?

Not at all

Perfectly

blood sugar with athleroscoloris should be

right at 100

How well did you know this?

Not at all

Perfectly

signs of CAD (Caddy is 4th) - AND BP and heart rhythm? (CAddy can be high or low)

4th heart sound, tachycardia, hypotension, HTN, angina

How well did you know this?

Not at all

Perfectly

signs of CV disease (my CV has some pulses and headaches)

Diminished carotid pulses, carotid artery bruits, focal neurological deficits, headaches

How well did you know this?

Not at all

Perfectly

signs of PVD

Decreased peripheral pulses, peripheral artery bruits, pallor, peripheral cyanosis, gangrene, ulceration, difficulty ambulating, pain with ambulation

How well did you know this?

Not at all

Perfectly

signs of AAA

Pulsatile abnormal mass, peripheral embolism, circulatory collapse, pre/syncope, weakness

How well did you know this?

Not at all

Perfectly

Atheroembolism (if Athens is blocked, it will fall off the map)

Gangrene, cyanosis, ulceration

How well did you know this?

Not at all

Perfectly

athero risk factors (DH LAGGS in athens)

Risk factor assessment (diabetes, HLPD, gender, LV function, provocation of angina, genetics, stress)

How well did you know this?

Not at all

Perfectly

athero - Echocardiography (The echo in athens is my liver EF)

to assess LV function, EF, predicts survival

How well did you know this?

Not at all

Perfectly

athero diagonostics (the 2 Es and a C in Athens)

ECG, CXR, Echo, labs

How well did you know this?

Not at all

Perfectly

CAD

RCA, L main, LAD (left anterior descending), circumflex

How well did you know this?

Not at all

Perfectly

cause of supply demand imbalance

thromus or embolus, spasm, hypovolemia, anemia, HR up or down, BP up or down

How well did you know this?

Not at all

Perfectly

prevention of CAD

Control cholesterol, diet, physical activity, medications, quit smoking, manage HTN, control diabetes

How well did you know this?

Not at all

Perfectly

angiography risk assessment (Angie is high, med, low - that’s it)

just know that there is risk assessment for high, medium, and low

How well did you know this?

Not at all

Perfectly

angina pectoris - cause?

A syndrome characterized by episodes or paroxysmal pain or pressure in the anterior chest caused by insufficient coronary blood flow

How well did you know this?

Not at all

Perfectly

angina pectoris - Physical exertion or emotional stress

increases myocardial oxygen demand, and the coronary vessels are unable to supply sufficient blood flow to meet the oxygen demand

How well did you know this?

Not at all

Perfectly

Chronic Stable Angina (stable will disappear with rest)

Decreased blood flow to myocardium usually caused by CAD
Temporary pain/pressure
Predictable, long term, familiar pattern
Resolves with nitroglycerin, oxygen or rest. This ALWAYS goes away with rest, etc.

How well did you know this?

Not at all

Perfectly

exertion angina (thanksgiving ppl) - how long does it last? (exert for less than 15 min)

Resolves with rest or NTG (nitrogycerin)
Lasts < 15 minutes
May radiate to arm, shoulder, back, jaw, neck, wrists

How well did you know this?

Not at all

Perfectly

Variant or atypical or Prinzmetal angina

Not caused by exertion
Often caused by coronary artery spasm

Often there is no coronary artery blockage or atherosclerosis

How well did you know this?

Not at all

Perfectly

angina described as

May be described as tightness, choking, or a heavy sensation

symptoms of angina - and what time of day usually?

dyspnea, SOB, dizziness, nausea, vomiting. will often wake up feeling this way.

angina pain is where? (Not chest)

retrosternal and may radiate to neck, jaw, shoulders, back or arms (usually left)

does angina pain subside with rest?

yes, or NTG

anxiety and angina?

usually happen together

unstable angina requires

medical intervention!

if ppl have to take 2 TNG,

call EMS.

assessment of chest pain

Scale of 1-10 Quality Severity Frequency Location and radiation Duration Precipitating factors Relieving factors

most common areas of pain for angina (just 4 places - most obvious)

left arm, left chest, around neck, middle of back

angina in males (men have chest pain, stomach pain and they sweat)

typical spots, chest pain, stomach pain, sweating,

angina in females

anxiety, N/V, back of shoulder, dizziness, feels like a pulled muscle

angina - Gerontologic Considerations

Diminished pain transition that occurs with aging may affect presentation of symptoms “Silent” CAD Teach older adults to recognize their “chest pain–like” symptoms (i.e., weakness) Pharmacologic stress testing; cardiac catheterization Medications should be used cautiously! could have target organ damage

angina management - 3 Goals (gyna gets aspirin)

Identify and respond ASAP - rest the patient, call for help and give them an aspirin Establish prophylactic drug regimen Widen or circumvent narrowed arteries

angina treatment - HOB

decrease myocaridal O2 demand and increase 02 supply, reduce and control risk factors, medications, reperfusion therapy, HOB 30 degrees

meds for angina

NTG, beta-adrenargic blockers, calcium channel blockers, antiplatelet and anticoagulants

aspirin

Acetylsalicylic Acid Antiplatelet effect 81-325 mg Chewable. chew it, they need it fast!

NGT (Nitro dilates everything)

Causes venous and arterial dilation and dilation of coronary arteries, resulting in decreased preload, afterload and increased blood flow to the myocardium

NGT dosing

Take 1 every 5 minutes X 3 doses sublingually Don’t swallow Take out cotton ball in container as it absorbs the drug Keep in a dark, glass bottle, dry, cool & renew every 6 months Usually burns/fizzes under tongue HA

NGT before administration

Check BP before and after administration

NGT - after meds have been given

AHA recommends contacting EMS (911) after the client takes the first dose of NTG. Don’t wait more than 5 minutes to call 911

NGT almost always causes a

headache from the vasodilation

morphine

decreases cardiac workload Analgesic effects decreases the sympathetic response thereby decreased diaphoresis lightheadedness, & Decreases HR, BP and venous return Stimulates local histamine mediated responses Might inhibit or delay of antiplatelet absorption

beta blockers - what about the liver?

(beta1 selective Decrease BP, P and myocardial contractility Improve LV function

Calcium Channel Blockers (Calcium dilates)

Decrease BP and dilate coronary arteries

angina patient education - exercise?

Avoid isometric exercise Rest frequently

unstable angina - when does it occur? How long does it last?

Change in pattern = ⇧ severity or > time Not relieved by NTG or rest Occurs at rest or awakens patient at night > 15 minutes

acute coronary symptoms - WBC and temp? (Aces raises my WBCs)

Pain Cold and clammy Increased WBC and increased temp ECG changes N & V

serial cardiac enzymes

CPK (creatinine), LDH, troponin

acute coronary syndrome - Common Precipitating Factors - what triggers it? (A cute coronary in my sleep)

Exercise 13% Unusual exertion 18% Surgery 6% Rest 51% Sleep 8%

signs and symptoms of acute coronary syndrome (ACS) - how long? (Play aces for less than 30 min)

coronary pain < 30 min severe. Not relieved by NTG and/or rest. N/V anxiety, apprehension, denial. dyspnea, diaphroesis, palpitations, dysthrmias, orthopnea, weakness/fatigue, dizziness

ACS diagnosis (Aces is inverted)

Patient history Signs & Symptoms Type of pain ECG changes Inverted T waves ST elevation Q waves Other tests Cardiac enzymes Cardiac markers

ACS treatment (Aces gets hobs, then fiber)

meds first, HOB, Fibrinolytics

ACS - Fibrinolytics

not first choice. Goal is to dissolve the clot that is blocking the blood flow to the heart and thereby decreasing the size of the infarction

Fibrinolytics - nursing considerations (fiber bleeds)

Detailed H & P are critical (bleeding and time of onset) Initiate bleeding precautions, assess ECG, minimize anything that causes bleeding Must be given in a compressible site

can't use Fibrinolytics if BP is...

BP is higher than 180 or 100 diastolic

Fibrinolytics nursing considerations - when can you use an invasive device?

closely monitor, control high BP, avoid invasive device for 24 hrs, observe response, screen with provider all antiplatet or anticoagulants Rx

what labs to monitor with fibrolytics

hemoglobin, hematocrit, platelets, anti-Xa, PTT, INR/PT, fibrinogen

nursing management ACS/MI

Oxygen and medication therapy Frequent VS assessment Physical rest in bed with head of bed elevated Relief of pain helps decrease workload of heart Monitor I&O and tissue perfusion Frequent position changes to prevent respiratory complications Report changes in patient’s condition Evaluate interventions!!!!

invasive coronary artery procedures

Percutaneous transluminal coronary angioplasty (PTCA) Coronary artery stent Coronary artery bypass graft (CABG) Cardiac surgery

chest pain after PCI - percutaneous coronary intervention (basically just a stent) - could mean

stent moved.

PCI (Angie is PCP)

Known as balloon angioplasty or percutaneous transluminal angioplasty

PCI

Known as balloon angioplasty or percutaneous transluminal angioplasty

PCI - invasive or not?

non invasive

PCI used to treat

CAD, angina, acute MI in order to re-perfuse and save cardiac muscle. often combined with stent.

Coronary Artery Bypass Graft (CABG) (Cab in my thorax)

type of thoracic surgery

The choice of bypass graft depends on

where the blockage is, how much, size of arteries.

Left ventricular assist device (LVAD)

is a pump Patients will only have a MAP, no pulse

exertion angina - causes (my hypo is exerting my hyper)

Exercise, stress anxiety, large meals, tachycardia, anemia, hypoglycemia, hyperthyroidism

angina - eating?

Avoid overeating Avoid excess caffeine or any drugs the increase HR Lose weight if overweight Diet modifications/changes small meals

angina - how long to wait after eating before exercise?

Wait 2 hours after eating to exercise

angina - how to dress?

Dress warmly in cold weather Adhere to medication regimen Take NTG prophylactically Stop smoking Manage diabetes

can't use fibrinolytics with...

CNS disease or CVD

no fibrinolytics if pt had trauma or stroke how soon?

last 3 weeks

no fibrinolytics if pt had surgeries within

surgeries within 4 weeks

no fibronolytics if pt has what type of bleeding? And liver?

intercranial bleed, blood thinners, kidney liver disease, pregnant

after removing a client's femoral sheath after cardiac catheterization, have what med available?

atropine. can cause vagal stimulation and bradycardia