CAD / ACS pt. 1 (Exam 1)

Question 1

Terms for Coronary Heart Disease

Answer 1

Coronary Artery Disease

Ischemic Heart Disease

Question 2

Coronary Heart Disease: Continuum

Answer 2

Chronic ischemic heart disease
(Stable angina)

or

Acute coronary syndrome (ACS)
(unstable angina)
(myocardial infarction)

Question 3

Chronic Ischemic Heart Disease

Answer 3

Stable Angina

Patient has for years and has been living with it

Question 4

Acute Coronary Syndrome

Answer 4

Unstable angina

Acute Myocardial infarction

Question 5

If patients stable angina goes to unstable angina the patient has went from ______ to ______

Answer 5

Chronic ischemic heart disease

to

Acute coronary syndrome (ACS)

Question 6

Regardless of what CHD the person has, what is typically responsible?

Answer 6

Atherosclerosis (hardening of artery)

Question 7

Non Modifiable RF for CHD

Answer 7

Age (older)

Gender (male)

Family History

Question 8

Modifiable RF for CHD (4 most)

Answer 8

1. Elevated serum lipids
   -Serum cholesterol >200 mg/dl or
   -Fasting triglyceride level > 150 mg/dL
2. Hypertension
   - >140/90 or
   - 130/80 with DM or CKD
3. Tobacco Use
   -Proportional to number of cigarettes smoked
4. Physical Inactivity
   -Lack of adequate exercise on regular basis

Question 9

What is elevated serum cholesterol?

What is elevated triglyceride?

Answer 9

Serum cholesterol > 200 mg/dL

Fasting triglyceride > 150 mg/dL

(HDL’s desirable; LDL’s not desirable)

Question 10

Risk factor: HTN

Answer 10

> 140/90 or

> 130/80 with DM or CKD

Question 11

Risk factor: Tobacco use

Answer 11

Risk is proportional to number of cigarettes smoked

Question 12

Risk Factor: Physical Inactivity

Answer 12

Lack of exercise on regular basis

Question 13

Other modifiable RF for CHD

Answer 13

Obesity
-Apple shape have higher incidence than pear shaped

Diabete Mellitus

Depression / Stress

Question 14

Patient Teaching RF: Patient with Elevated Serum Lipids

Answer 14

-Low fat diet

-Have lipid levels checked regularly

-Statins

Question 15

Patient Teaching RF: Patient with High blood pressure

Answer 15

-Check often

-Antihypertensive meds

-DASH diet

Question 16

Patient Teach RF: Tobacco

Answer 16

Do not start

Stopping = Immediate Change

Question 17

Patient Teaching RF: Patient is Physically Inactive

Answer 17

If middle age or history of problems: Check HCP before starting

Exercise periods should be at least 40 minutes long with 10 minute warmup and 5 min cool down

If cant exercise 3-4 times week, walk daily for 30 minutes at comfortable pace

If cannot walk daily, walk any distance you can (park farther away from a site necessary)

Question 18

Patient Teaching RF: Obesity

Answer 18

Avoid fad diets

Restrict saturated fats

Avoid sweets and cholesterol foods

Increase Physical Activity

Question 19

Patient Teaching RF: DM

Answer 19

Monitor Glycemic index foods; regular serum HbA1C checked often

Question 20

Angina Location

Answer 20

Substernal

Substernal (neck)

Substernal (radiate lower arm)

Epigastric

Neck

Midscapular

NOT PREDICTABLE

Question 21

Chronic stable angina occurs with

Answer 21

moderate to prolonged exertion in a pattern familiar to patient

Question 22

Chronic stable angina: Frequency, duration, intensity

Answer 22

Remain same over several months

Question 23

Chronic stable angina results in

Answer 23

only slight limitation in activity

Question 24

Chronic stable angina is associated with

Answer 24

fixed atherosclerotic plaque

Question 25

Chronic stable angina relieved by _____ or ______ and is managed long term by _______

Answer 25

NTG and or rest Drug therapy

Question 26

Does chronic stable angina require aggressive therapy?

Answer 26

Rarely

Question 27

How do we diagnose Stable Angina?

Answer 27

Through physical exam + complete history ECG/EKG Stress test -exercise or pharmacological stress Echocardiogram TEE

Question 28

Stress test of stable angina results help determine if

Answer 28

low and intermediate risk = manage without intervention high-risk patient = coronary angiography (cath) and revascularization with either percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG)

Question 29

Stress test determines patient is high-risk, what is next?

Answer 29

coronary angiography (cath) and revascularization with either percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG)

Question 30

Goal for Chronic Stable Angina

Answer 30

Decrease O2 demand and increase O2 supply Reduce risk factors as appropriate Medications (Reduce risk factors)

Question 31

Medications to reduce chronic stable angina RF's

Answer 31

Antiplatelet (ASA) (75-325 daily) -per day Lipid-lowering agents (statin)

Question 32

Medications to relieve angina

Answer 32

Beta blockers -Only classification proven to prevent re-infarction and to improve survival for MI patients CCB -Given with BB Nitrates -SL = first line treatment for acute angina symptoms -Use at onset or prophylactically Ranolazine -New therapy

Question 33

When should patients take nitrates

Answer 33

At the beginning of chest pain or prophylactically (before known trigger)

Question 34

Nitrate: Most Recent Guidelines If chest pain has not improved or has worsened 5 minutes after taking the first nitro, the patient should

Answer 34

Call 911 Chew 325 mg aspirin immediately (antiplatelet effect begins within 1 hour and continues through several days)

Question 35

Nitroglycerin Sublingual

Answer 35

Nitrostat

Question 36

Nitroglycerin IV

Answer 36

Tridil 5mcg/min then increase as needed

Question 37

Nitroglycerin: Skin Patch

Answer 37

Transderm-Nitro

Question 38

Nitroglycerin: Ointment

Answer 38

Nitro bid

Question 39

Notes on Nitroglycerin for the nurse

Answer 39

Translingual = on the tongue Use gloves to apply and remove ointment or patch (will vasodilate) Do not discharge defibrillator over patch Do not use with erectile dysfunction drugs IV form in glass bottle with special tubing

Question 40

Patient Education: Sublingual Nitroglycerin (Nitrostat)

Answer 40

Works in 3 min Should keep easily accessible AAT Protect from light Should tingle Use prn (only as needed) can build tolerance Replace bottle every 6 months

Question 41

Nitroglycerin: Side Effects

Answer 41

Vasodilate H/A Dizziness Flushing Hypotension

Question 42

Before giving nitroglycerin you should

Answer 42

Take blood pressure

Question 43

If blood pressure is low hold nitroglycerin and

Answer 43

give morphine