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coronary alterations management Focus Flashcards

(55 cards)

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1
Q

where is the left anterior descending coronary arteries

A

anterior and lateral wall of LV

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2
Q

where is the circumflex artery

A

posterior and lateral wall of LV

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3
Q

where is the Right coronary artery

A

SA and AV node

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4
Q

what helps in development of atherosclerosis

A

Endothelial injury and inflammation

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5
Q

what are some non modifiable risks for CAD

A

over 65, male, obese women, african amercian, 1st degree family history, genetics

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6
Q

what are some modifiable risks for CAD

A

HDL, LDL, cholesterol over 200, triglycerides over 150, hypertension, smoking, decreased physical activity, obese BMI over 30, drug use, pernicious anemia

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7
Q

what defines metabolic syndrome - insulin resistance

A

central obesity, hypertension, abnormal serum lipids, elevated fasting BG

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8
Q

what could be some contributing factors to CAD

A

DM, metabolic syndrome, psychological status, homocysteine level (pernicious anemia), substance abuse

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9
Q

what does the med atrovastain do

A

decreases lipids by inhibiting cholesterol synthesis= increasing HDL and decreasing LDL

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10
Q

what should you monitor for atrovastain

A

liver damage and myopathy

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11
Q

what changes should be made for the diet for CAD

A

decrease saturated fats, cholesterol, red meat, egg yolks, and whole milk
increase complex carbs, fiber, omega 3 fatty acids

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12
Q

what is ischemia cause

A

angina

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13
Q

what is ischemia

A

the demand for myocardial oxygen exceeds what the coronary arteries can give

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14
Q

what could be some cause of unstable angina

A

acute coronary syndrome (MI),

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15
Q

what are the 2 options for acute coronary syndrome (MI) and what are there differences

A

NSTEMI (no ST elevation )
STEMI (ST elevation)

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16
Q

what are the 2 procedures you can do for angina stable or unstable

A

Percutaneous coronary intervention or coronary artery bypass graft

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17
Q

how does nitroglycerin work

A

Dilates the peripheral and coronary blood vessels

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18
Q

what are some long acting nitrates

A

lsordill, limdur, nitroglycerin ointment, transdermal controlled release nitrglycerin

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19
Q

what is the main complication for nitrates and what is the intervention for that

A

orthostatic hypotension - monitor BP after initial dose, advise patient to change positions slowly

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20
Q

what med should not be taken with nitrates and why

A

erectile dysfunction (viagra) because it can cause severe hypotension

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21
Q

what are the meds used for stable angina

A

ACE (lisinopril), ARBs (losartan), beta blockers

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22
Q

what are some interventions for stable angina

A

upright position, supplemental O2, VS, ECG, assess lungs, nitroglycerin, tropnin lap values

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23
Q

what are troponin lap values normally for stable angina

24
Q

what is unstable angina

Study These Flashcards
A

deterioration of plaque blockage, which then ruptures, platelets go to fix it causing a bigger blockage and stops blood flow = irreversible myocardial cell death

25
what does a chest X ray show for CAD
heart enlargement, aortic calcifications, pulmonary congestion
26
what would a chest X ray rule out
aortic distension
27
what are you looking at on an 12 lead ECG for CAD
changes in baseline and ST elevation
28
what is normal troponin
0 - 0.04
29
what is normal high sensitivity troponin
less then 14
30
what does a coronary computed tomography angiography do
detects calcified/ non calcified plaques in the artery
31
what diagnostic test could you do for CAD
chest xray, ECG, labs (troponin), echocardiogram, exercise stress test, thallium scans
32
what should you do if someone has IV contrast allergy but needs to go to cath lab
pre-medicate with corticosteroids and still go to cath lab and use contrast
33
what is the treatment of choice for STEMI
emergent percutaneous coronary intervention
34
what are the 2 different stents for percutaneous coronary intervention and whats the difference
Bare metal (1mt-1yr dual anti-platelet therapy), drug-eluting stent (minimum of one year of anti-platelet therapy)
35
what does dual anti-platelet consist of
Aspirin + clopidogrel (plavix)
36
what are some alternatives for plavix
ticagrelor or prasugrel
37
what is the management after coronary revascularization
monitor for recurrent angina, VS, cardiac rhythmic/dysrhythmia, insertion site, neurovascular assessment (peripheral pulses), bed rest per policy
38
who gets thrombolytic therapy
STEMI who cant get to the lab so give within 30minutes of arrival
39
what interventions do you need to do for thrombolytic therapy
draw blood from 2-3 IV sites, do invasive procedures first, monitor for bleeding, neuro status,
40
what is the best sign after thrombolytic therapy
ST returning to baseline
41
how do you prevent reocclusion for thrombolytic therapy
heparin
42
what are the ss of acute thrombolytic syndrome
increased HR and BP first then a drop in BP, crackles, jugular vein distention, new murmur, diaphoresis, nv, fever (100 degrees in first 24-48 hours)
43
why would someone need coronary surgical revascularization with coronary artery bypass grafting
failed medical management, multivessel disease, non a candidate for percutaneous coronary intervention (because blockage too long or difficult to access), multiple comorbidities
44
what is part of the process for coronary surgical revascularization with coronary artery bypass grafting
sternotomy and cardiopulmonary bypass
45
what are some complications of coronary surgical revascularization with coronary artery bypass grafting
bleeding (anemia from RBC damage), fluid and electrolyte imbalances, hypothermia (bc blood is cooled when gone through bypass machine), infection
46
what should you monitor for coronary surgical revascularization with coronary artery bypass grafting
hemodynamic status, fluid status, monitor for afib (very common so restart beta blockers ASAP)
47
what is the most common complication of acute coronary artery syndrome (MI)
Dysrhythmias
48
what is the most common cause of death prehospitalisation
VT and VF
49
how does HF happening because of acute coronary artery syndrome (MI)
pumping power of the heart is diminished because of scaring
50
what is cardiogenic shock
heart is not working effectively leaving the body poorly perfused
51
what are the ss of acute pericarditis
mild-severe chest pain made worse with inspiration/coughing/movement of upper chest, relieved when sitting forward
52
what are the 2 med used for acute pericarditis
aspirin or colchicine
53
what will happen next if someone has ventricular wall rupture and papillary muscle rupture
new loud systolic murmur, HF, and cardiogenic shock will ensue
54
what is left ventricular aneurysm
myocardial wall becomes thinned and bulges out during contraction
55
what is usually recommended for someone who has LV aneurysm
anticoagulants unless contraindicated

Med surg 2 (12 decks)

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