Flashcards in Chapter 33 Coronary Artery Disease and Acute Coronary Syndrome Deck (48):
What is Atherosclerosis?
Hardening of the arteries due to focal deposits of lipids
Where does atherosclerosis primarily occur in the body?
The coronary arteries
What lifestyle choices cause atherosclerosis?
Tobacco use, hyperlipidemia, hypertension, diabetes, toxins
What is C-reactive Protein and how does it relate to atherosclerosis?
It is a protein produced by the liver that is a marker of inflammation and is often seen in patients with CAD.
What are both some modifiable and non-modifiable risk factors for CAD?
Non-modifiable= Age, gender, ethnicity, family history, genetics
Modifiable= Tobacco use, elevated serum lipids, Hypertension, obesity, lack of physical activity
What age group has the highest incidence of CAD?
Middle aged men have the highest risk.
Past the age of 75 the risk is the same for each gender.
What is the difference between Whites, African Americans, Native Americans, and Hispanics in CAD?
Whites= have the highest incidence
African Americans= have the earliest onset and highest death from CV disease
Native Americans= die from heart disease at the earliest age
Hispanics- have the lowest death rates from CAD.
What kind of disease is the leading cause of death in women?
At how high of a level does ones serum cholesterol have to be at to be at a high risk for CAD?
The individual has to have a serum cholesterol level of 200mg/dL
A fasting triglyceride level of greater than 150mg/dL
After what age do men and women have the same risk for heart disease?
What are the three classes of lipoproteins, what are their desired levels, and which one is good, bad, and very bad
HDL (good)- desired levels are high
LDL (bad)- desired levels are low (under 160mg/mL for pt with low risk of CAD & under 70mg/dL for high risk CAD pt)
VLDL (Very bad)- desired levels are very low
what are the guidelines used to help treat LDL cholesterol (10 year risk and lifetime risk for heart disease or stroke)
4) use of tobacco
6) systolic BP
7) diastolic BP
8) use of BP drugs
9) total cholesterol level
10) HDL cholesterol
What is the second biggest risk factor in CAD?
Hypertension (BP greater than 140/90
What is the recommended BP for individuals over the age of 60?
A goal BP of under 150/90 to prevent stroke, CVD, and heart failure
What is the FITT formula?
According to the AHA, how often should people eat fish to lower their CAD risk and what kind of fish are ok to eat?
The AHA recommends eating fish two times a week (salmon and tuna)
At what age should an individual start getting a complete lipid profile and how often should one get done?
A complete lipid profile should be completed every 5 years starting at age 20
What kind of drug inhibits the synthesis of cholesterol in the liver?
HMG-CoA reductase inhibitor (statins)
What is the PQRST for assessment of angina
P- precipitating events (ask what led up to the pain)
Q- Quality of Pain (what does the pain feel like)
R- Region (where is the pain)
S- Severity of the pain
T- Timing (when did the pain begin? Has it gotten better?)
What is angina?
What is Chronic stable angina?
Chest pain that occurs intermittently and is often provoked by physical exertion, stress, or emotional upset (usually SL NTG fixes it)
What is Silent Ischemia?
Ischemia that occurs in the absence of any subjective symtpoms (can have pain or have no pain) USUALLY SHOWN BY AN EKG
What is Prinzmetal's angina?
Angina that is extremely rare and occurs at rest with no increase in physical demand
What is microvascular angina?
Angina that occurs due to atherosclerosis (or spasm) of the small distal branch of vessels of the coronary microcirculation (occurs more often in women)
What is the first line drug for angina treatment?
What are the a,b,c,d,e,f of chronic angina tx?
A- antiplatelet, antianginal, and ACE inhibitor therapy
B- Beta blocker, BP Control
C- cigarette cessation, cholesterol management, CCB, Cardiac rehab
D- diet, diabetes management, depression screening
E- education, exercise,
F- flu vaccine
What is the drug ending for ACE inhibitors?
What are Statin drugs used for?
lowering cholesterol levels
What kind of drugs are Sartans?
Angiotensin 2 Receptor blockers (results in vasodilation)
What is the recommended way of taking SL NTG?
Take one tablet with angina every 5 minutes for a maximum of 3 times if angina is not getting better. After the third call EMS
How long are opened NTG tablets good for?
What is a major complication of all nitrates?
What are some common routine procedures for a patient with suspected CAD?
12 lead EKG, echocardiogram, Electron beam computed tomography (EBCT), Coronary computed tomography angiography, stress testing
What percentage of coronary blockage must be present before a stress picks it up?
At least 70%
What is the nurses best intervention if a patient is allergic to the IV contrast dye used fro a CCTA or a cardiac cath?
Premedicate with corticosteroids
What is the nurses best intervention for a patient with chronic kidney disease getting a cardiac cath or a CCTA?
Pre and Post procedure hydration
Describe a balloon angioplasty
A balloon angioplasty has a catheter with a deflated balloon tip inserted into the occluded artery (usually coronary artery), then the balloon is inflated in the vessel and a stent is placed in to hold it in place
What are the two types of stents
Bare metal stent and a drug-eluting stent (coated with drugs to reduce risk of overgrowth of the intimal lining)
How long should a post balloon angioplasty patient be on dual antiplatelet drugs and what is one drug that is used indefinitely one this plan?
Usually a minimum of 12 months and aspirin
What is enhanced external counterpulsation (EECP)?
two large inflatable BP cuffs are placed around the legs and are deflated on systole and inflated during diastole 5 days a week for a total of 35 treatments.
A patient with acute coronary syndrome will have what EKG abnormality?
What is unstable angina?
Angina that occurs at rest and progressively increases in frequency, duration, and pain (usually lasts 10 or more minutes)
What is a STEMI?
MI caused by an occlusive thrombus that causes ST elevation
What is the most common complication after an MI?
What are the most common dysrhythmias that lead to death?
V tach and V fib
What is a basic assessment to help the nurse indicate that pericarditis is present?
Listening to heart sounds for pleural friction rub
What is Dressler Syndrome?
Pericarditis and fever that occurs 1-8 weeks after an MI. Pt will have angina, fevere, pericardial friction rub.