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NUR102 Unit 6 Cardiology > Cardiovascular Needs and Angina > Flashcards

Cardiovascular Needs and Angina Flashcards

1
Q

Cardiovascular Disease Stats

A

Number 1 cause of death in the US. Leading cause of death in women. 1/5 people living with CAD.

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2
Q

Coronary Arteries

A

Feed O2 blood to the heart

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3
Q

Two main coronary arteries

A

LCA and RCA

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4
Q

When does blood flow to the myocardium occur?

A

Diastole (when heart is at rest)

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5
Q

MAP required to maintain adequate coronary blood flow

A

> 60, otherwise decreased tissue perfusion and damage and may result in CP (due to lack of blood flow)

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6
Q

9 external landmarks of the heart (arteries)

A

Aorta, RCA, posterior lateral artery, posterior descending artery, diagonal artery, obtuse marginal artery, left anterior descending artery, left circumflex artery, left main coronary artery

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7
Q

Cardiac conduction system

A

Specialized tissue capable of rhythmic electrical impulse formation seen on EKG

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8
Q

6 cardiac conduction landmarks

A

SA node (pacemaker), AV node, Bundle of his, Right and Left bundle branches, Purkinje fiber system

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9
Q

RCA

A

Encompasses heart and feeds the right side

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10
Q

Left main

A

feeds left side of the heart

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11
Q

Blood perfusion per beat

A

60 ml of blood per beat and can double with activity

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12
Q

layers of the heart

A

epi, myo, and endo

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13
Q

Pathway of blood in the heart

A

right atrium, right ventricle through the tricuspid, lungs through pulmonic valve to pulmonary artery, back to heart through left atrium, through mitral valve to left ventricle, through aortic valve to aorta

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14
Q

CV risk assessment

A

Thorough history, med hx, lifestyle hx (smoking, drinking, exercise), diet hx, dental hx (peridontal disease), PE (hip to waist ratio, pain, SOB, edema, fatigue, lipids cholesterol), women: post- menopausal, BMI >30, socioeconomic class (foods, occupation, fam support)

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15
Q

What percentage of deaths occur from cardiovascular disease in the US annually?

A

42%

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16
Q

Physical assessment

A

general appearance, skin, BP and peripheral pulses (bounding), heart sounds (APETM), lung sounds (fluid backup), psychosocial assessment (anxiety, depression, denial), EKG

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17
Q

CAD

A

Narrowing and/ or complete occlusion. Long latent periods (30-40 yrs) fatty streaks in childhood and sx in middle age

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18
Q

Causes of artery narrowing

A

atherosclerosis, thrombosis, spasm, coronary dissection, aneurysm formation

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19
Q

Fatty streaks (CAD beginning)

A

result from the buildup of fat in the artery wall

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20
Q

Atheroma (CAD)

A

As more fat and cellular debris collect, atheromas develop. As atheroma grows, it may begin to encroach on vessel lumen.

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21
Q

Vulnerable Plaques (CAD)

A

Plaques that contain at least 40% lipid in their core and
have a thin cap are more likely to rupture,
resulting in occlusion of the artery by a blood clot

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22
Q

Plaque rupture (CAD)

A

Vulnerable plaques that rupture trigger thrombus

formation and potential occlusion

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23
Q

Occlusion (CAD)

A

Thrombus formation often results in partial or complete occlusion leading to myocardial ischemia, infarction, and/or death

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24
Q

Ischemia

A

lack of oxygen flow to tissues

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25
Q

Infarction

A

death of tissue due to lack of oxygen

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26
Q

Major modifiable risk factors for CAD

A

Elevated serum lipids, HTN, smoking, impaired glucose tolerance, diet (inc sat fat, cholesterol, calories), physical activity

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27
Q

Risk of smoking and CAD

A

dec HDL and inc LDL and TG, impaired O2 transport, inc myocardial O2 demand, may alter intimal endothelial permeability and foster platelet agglutination

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28
Q

Risk of smoking and CAD

A

dec HDL and inc LDL and TG, impaired O2 transport, inc myocardial O2 demand, may alter intimal endothelial permeability and foster platelet agglutination

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29
Q

4 subtypes of cholesterol

A

HDL men >40 and women >50
LDL <100
VLDL (worse form of LDL)
triglycerides (TG) <150

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30
Q

Stages of HTN

A

normal: < 120/80
preHTN: 120/80 - 139/89
HTN: >135/85

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31
Q

Risk of oral contraceptives and CAD

A

after age 35: alters blood coag, platelet function, fibrinolytic activity, integrity of vascular endothelium

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32
Q

cholesterol levels and risk for CAD

A

total serum cholesterol >200
240= 2-fold inc risk
270= 4-fold inc risk

33
Q

cholesterol levels and risk for CAD

A

total serum cholesterol >200
240= 2-fold inc risk
270= 4-fold inc risk

34
Q

Atherosclerosis

A

The build-up of fats, cholesterol, and other substances in and on the artery walls

35
Q

thrombosis

A

formation of a blood clot inside a blood vessel, obstructing the flow of blood through the circulatory system

36
Q

coronary artery spasm

A

brief, sudden narrowing of one of these arteries

37
Q

embolus

A

a blood clot, air bubble, piece of fatty deposit, or other object that has been carried in the bloodstream to lodge in a vessel and cause an embolism (often small piece broken off from thrombus)

38
Q

embolus

A

a blood clot, air bubble, piece of fatty deposit, or other object that has been carried in the bloodstream to lodge in a vessel and cause an embolism (often small piece broken off from thrombus)

39
Q

coronary dissection (SCAD)

A

uncommon emergency condition that occurs when a tear forms in one of the blood vessels in the heart

40
Q

aneurysm

A

an excessive localized enlargement of an artery caused by a weakening of the artery wall

41
Q

risk of obesity and inactivity and CAD

A

leads to HTN, IGT, hyperlipidemia

42
Q

normal hip to waist ratio for men and women

A

men <0.85 women <0.75

43
Q

risk of stress and anxiety and CAD

A

inc circulating catecholamine leads to HTN, platelet function abnormalities, inc free fatty acids

44
Q

factors of cardiovascular supply

A

blood volume, Hb, oxygen concentration and transport, coronary blood flow and resistance

45
Q

factors of cardiovascular demand

A

exercise, stimulant drugs, inc HR and BP, inc O2 demand (ex COPD, smoking, stress, pain), coronary lesions

46
Q

define angina pectoris

A

chest pain caused by lack of oxygen to the heart

47
Q

four types of angina

A

stable, unstable, variant, silent

48
Q

sudden cardiac death

A

usually caused by dysrhythmias (most common vfib) and stopped by AED or internal defibrillator and/ or pacemaker

49
Q

acute coronary syndrome

A

umbrella term to cover unstable angina, acute myocardial ischemia, STEMI, and NSTEMI

50
Q

STEMI

A

occlusion of major artery (full thickness occlusion)

51
Q

NSTEMI

A

occlusion of minor artery (partial thickness occlusion) *electrical activity can still go through

52
Q

significance of P- wave on EKG

A

atrial depolarization

53
Q

significance of QRS complex on EKG

A

ventricular depolarization

54
Q

significance of ST segment and T wave on EKG

A

ventricular repolarization

55
Q

typical pain sites of angina

A

chest and left arm most common, anything “waist up” in females, elderly: dyspnea, confusion, disorientation, GI sx, otherwise pain can present anywhere including epigastric, neck/jaw, left shoulder, nausea, GERD

56
Q

Stable angina

A

predictable and lasts less than 30 mins, controlled by rest and/or vasodilator

57
Q

typical precipitating factors of stable angina

A

exercise, emotional upset, tachycardia

58
Q

factors that cause demand to be > supply in stable angina

A

HR, BP, O2 demand, coronary lesion, blood volume, Hb, O2 concentration, coronary blood flow and resistance

59
Q

unstable angina

A

unpredictable - a change in previously established stable pattern OR new onset of severe angina lasting greater than 20 mins and not relieved by vasodilator

60
Q

potential causes of unstable angina

A

may be due to plaque hemorrhage or fissure causing acute thrombosis

61
Q

variant angina/ prinzmetal’s angina

A

coronary artery spasm with or without lesion (usually occurs at site of lesion, 75% do have lesion) and occurs at rest

62
Q

causes of variant angina

A

smoking, alcohol, or cocaine

63
Q

pattern of variant angina

A

may be cyclic and typically occurs at the same time each day, typically occurs 12AM-8AM

64
Q

treatment of variant angina

A

EKG changes may occur, pt given nitro and Ca channel blockers to prevent vasoconstriction

65
Q

silent ischemia

A

“painless infarct” with objective EKG evidence of myocardial ischemia (ST segment changes) without symptoms

66
Q

silent ischemia demographics

A

diabetics (neuropathy), elderly, women, HTN patients

67
Q

4 mechanisms for diagnosing ischemia

A

reporting CP, EKG changes, coronary angiography, stress test (either chemical or exercise)

68
Q

What associated symptoms of chest pain may the older client with coronary artery disease be more likely to experience?

A

Dyspnea: w/ confusion, disorientation, and GI sx

69
Q

exercise stress test

A

Assess cardiovascular response to increased workload and determines if heart is functioning normally with closely monitored VS and EKG

70
Q

criteria for completion of stress test

A

a predetermined HR is reached and tolerated, S & S develop, ST depression or T wave inversion occurs

71
Q

Cardiac cath

A

Most definitive but most invasive test for diagnosis of heart disease, may include right heart catheter or left or both

72
Q

indications for cardiac cath

A

Confirm suspected myocardial disease, CAD, or valvular disease, determine the location and extent of disease, assess ventricular EF

73
Q

percutaneous interventions during cardiac cath

A

angioplasty (inflating and deflating balloon to open artery) and stent (placement of wire stent)

74
Q

normal EF and EF that indicates HF

A

normal: 55-70%
HF: <40%

75
Q

cardiac cath post-op

A

extended bed rest, precautions with vascular closure device, bed <30 degrees, frequent VS, check puncture site, assess distal pulse and CMS, assess pain, and notify doc with sudden changes

76
Q

discharge criteria of cath patients

A

most same day unless intervention (otherwise spend the night), discharge teaching and fu, referral to cardiac rehab, new medication instruction, education on activity and diet

77
Q

collaborative goals of CAD

A

inc coronary artery perfusion, dec myocardial workload, intervene in unstable angina, prevent MI

78
Q

ABCDE of goals of CAD

A 
A: aspirin
B: beta blocker
C: cholesterol and cigarettes
D: diet and diabetes
E: education and exercise
79
Q

nursing management of CAD

A

ID and relieve CP, maintain calm environment, monitor for change in condition, patient education

NUR102 Unit 6 Cardiology (4 decks)

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