CAD/ACS

Question 1

CAD

Answer 1

Atherosclerosis of coronary arteries
“Hardening of the arteries”

Due to damage to vessel

Question 2

Risk factors of CAD
Non modifiable

Answer 2

Age: 55+ women 45+ men
FH

Question 3

Risk factors of CAD
Modifiable risks

Answer 3

Tabacco use
Sedentary lifestyle
stress
HTN
High cholesterol: total:200+ LDL:130+ triglycerides 150+
Obesity

Question 4

Cholesterol

Answer 4

Total cholesterol normal: <200

HDL:
Females: >50+
Males: >40+

LDL: <100

Triglycerides: <150

Question 5

Dietary interventions for hyperlipidemia
LDL

Answer 5

activity
Avoid trans/saturated fats and cholesterol in foods

Question 6

Dietary interventions for hyperlipidemia
Increase HDL

Answer 6

Physical activity
Healthy fats
Modify ETOH intake
Smoking cessation
Weight loss

Question 7

Dietary interventions for hyperlipidemia
Lower triglycerides

Answer 7

Control blood sugar (if DM)

Avoid excessive ETOH and refined sugars

Physical activity

Question 8

Tx for hyperlipidemia: drug therapy

Answer 8

On these meds for lifetime

Types:
Statins (lower LDL raise HDL)
Niacin
Fibrates
Bile acid sequestrants
PCSK9 inhibitors

Question 9

Statins

Answer 9

First line tx (best chance of reducing risk)

Lower LDL and triglycerides
Small increase in HDL

AE:
-Muscle aches
-Rhabdomylosis (DARK URINE, muscle pain, high CK) STOP STATIN
-Increase in AST/ALT

Question 10

Niacin

Answer 10

B vit
Lower LDL and triglycerides
Increases HDLs

AE: flushin, pruritus

Taken if statin doesnt help enough
(For cholesterol)

Question 11

Fibric acid derivates (gemfibrozil)
And
Bile acid sequestrants (cholestyramine)

Answer 11

Both work in the gut

Also given if statin doesnt help enough

(For cholesterol)

Question 12

PCSK inhibitors (evolocumab)
And
Ezetimibe

Answer 12

Just know their also for cholesterol

Added to statins

Question 13

Angina

Answer 13

Chest pain from myocardial ischemia
(Increase o2 demand or decrease o2 supply)

Blockage causes symptoms

Question 14

Precipitating factors of angina

Answer 14

Physical exertion
Temp
Emotions
Consuming heavy meal
Tabacco
Sex
Stimulants

(Any thing to increase demand of O2)

Question 15

Chronic stable angina

Answer 15

Episodic pain

Pattern: provoked by stress and activity

Improves with rwst or NTG

No longer than 15 mins

Question 16

Unstable angina

Answer 16

New or change pattern

Occurs at rest
Does not imporve with NTG or rest

Emergency!

Question 17

Prinzmetals angina

Answer 17

Caused by coronary vasospasm

Comorbid with migraines, raynauds, heavy smoking

Question 18

Diagnostic studies for CAD

Answer 18

12 lead ECG

Labs: cardiac enzymes

Stress test: see if activity causes symptoms

Cardiac catheterization

Question 19

Cardiac enzymes

Answer 19

Markers of injury

CK total: nonspecific, any muscle injury

Specific:
CKMB: ⬆️ 4-8 hours, peals 12-24 hours
Troponin: ⬆️ 3-4 hours peaks 4-24 hours

Get 3 sets of cardiac enzymes 3-6 hours apart

Question 20

Cardiac catheterization
Gold standard
PCI
Complications

Answer 20

Gold standard to localized CAD for pt with worsening angina symptoms

PCI (percutaneous coronary intervention) can be done if a block is found
(stent placement)

Complication’s: infection, poke hole in heart, bleeding

Question 21

Cardiac cath nursing care
Pre and post procedure

Answer 21

Pre procedure:
Allergy: shell fish (contrast dye)
Lab studies: bleeding, kidney function

Post procedure:
Monitor: bleeding, dysrhythmia, chest pain

Question 22

Nitroglycerin (short acting nitrate)
Why important
MOA
Route
Other use
Cause

Answer 22

First line for acute angina

MOA: vasodilations
Route: SL 1 tab every 5 mins, mac 3 then call EMS
Spray can be on or under tongue

Used Prophlactically in stable angina before activity

HA common (Tylenol), watch BP

Question 23

Topical NTG

Answer 23

Nitro ointment (nitro-paste)
Ordered by inch
Wear gloves

Transdermal patch
Apply over non-hairy area, occlusive dressing

Question 24

Long acting nitrates

Answer 24

Used to reduce frequency
Tx for prinzmetals angina
Orthostatic hypotension

Ex: isosorbide

Question 25

Antiplatelet therapy Med and dose Why given Risk Use What else we can give if not tolerant

Answer 25

Low dose ASA (81mg) daily Decrease platelet to prevent clots Bleeding risk Used for primary prevention Or can give clopidogrel (plavix) if ASa intolerant

Question 26

MI/ACS

Answer 26

Prolonged ischemia Non-ST elevation (NSTEMI): Not as much of a emergency ST-segment-elevation MI (STEMI): emergency right now Need pci within 90 mins

Question 27

ACS clinical manifestations: MI

Answer 27

Severe chest pain not relieved by rest , NTG: Heaviness, pressure, crushing Radiate (jaw,neck,shoulder) Diaphoresis Tachycardia Palor Low grade fever, N/V

Question 28

ACS clinical manifestations: MI As it progresses

Answer 28

Low BP LOC weak pulse, oliguria

Question 29

MI diagnositic studies Test Gold standard to localize the lesion

Answer 29

ECG: show ST elevation Cardiac biomarkers: increased CKMB, Troponin Gold standard to localize the lesion: cardiac catheterization

Question 30

MI: intitial management Goal MONA

Answer 30

Goal: decrease O2 demand/increase O2 supply Semi fowler Bed rest Cardiac monitoring MONA: morphine, oxygen, nitroglycerin, ASA Asses pain/VS Plan for cardiac catheterization

Question 31

MI med management

Answer 31

Antiplatelet therapay (ASA, clopidogrel) Anticoagulation (Heparin/LMWH) Cardiac cath/PCI May require CABG Rural hospital may use thrombolytic meds to break up clot due to lack of resources

Question 32

CABG Coronary artery bypass graft

Answer 32

Placement of arterial or venous grafts to bypass coronary blockage Usually: internal mammary, saphenous, or radial artery Requires STERNOTOMY

Question 33

CABG postop care

Answer 33

Assess: bleeding, fluid status, dysrhymthmias Sternotomy site and harvest site would care Pain management Prevent VTE Resp tx: splinting, IS

Question 34

Post MI nursing management

Answer 34

Cardiac monitoring VS Labs/ECG Bedrest 12-24 hours Heparin drip Pain tx Oxygen

Question 35

MI complications

Answer 35

Dysrhythmias HF: pulmonary congestion, dyspnea, edema Cardiogenic shock: decompensated Increased HR Decreased BP ***New murmur is emergency post-op*** Will need surgery

Question 36

Discharge teaching

Answer 36

Lifestyle mods Cardiac rehab Likely to have another