Coronary Artery Disease Flashcards
(83 cards)
1
Q
what are 4 actions of atherosclerotic heart disease (ASHD)?
A
- narrows the lumen of the vessel
- reduces elasticity
- increases risk of plaque rupture and subsequent plaques
- increases vasospasm
2
Q
what happens with narrowing the lumen?
A
reduces blood flow to the area supplied by the artery
3
Q
what is the result of reduced elasticity?
A
makes it less resilient in the face of volume of pressure changes, and increases the risk of vasospasm
4
Q
what is the result of increased risk of plaque rupture?
A
clot formation
5
Q
what are some non-modifiable atherosclerosis risk factors?
A
- family Hx
- sex
- race
6
Q
what are some medically alterable risk factors of athero?
A
- hypertension
- hyperlipidemia
- diabetes mellitus
7
Q
why is diabetes a risk factor for athero?
A
damage vessel walls, gets plaque formation
8
Q
what are some modifiable risk factors of athero?
A
- smoking
- stress
- central obesity
- sedentary lifestyle
9
Q
what are neurological symptoms of an MI?
A
- dizzy
- restless
- lightheaded
- anxiety
- pain
10
Q
what are some cardiovascular symptoms of an MI?
A
- chest pain
- jugular vein distention (JVD)
- inc., dec., or abnormal HR
11
Q
what are GI symptoms of an MI?
A
- nausea
- vomiting
- burping
- heartburn
12
Q
what are respiratory symptoms of an MI?
A
- SOB
- dyspnea
- crackles (in HF)
13
Q
what are some integumentary symptoms of an MI?
A
- cool
- clammy
- diaphoretic (sweating)
14
Q
what is a psychological symptom of an MI?
A
- feeling of impending doom or denial that anything is wrong
15
Q
what is an ECG?
A
measures the electrical activity of the heart, NOT the mechanical
- look at the rhythm of the heart
- can give info on the area of the heart damaged
16
Q
what is an ECG used to help diagnose?
A
acute coronary syndrome (ACS)
17
Q
what is an angiogram?
A
allows x-ray visualization of the coronary arteries following the injection of contrast medium
- can see blockage
18
Q
what is an echocardiogram?
A
sound waves create an image of the heart in motion
19
Q
what does an echo show?
A
how much damage has been done to the heart
20
Q
what can an echo evaluate? (6)
A
- heart wall motion
- ventricular function
- valvular disease
- heart under stress
- pericardial fluid
- ejection fraction
21
Q
what is the equation for the ejection fracture?
A
amount of blood pumped out of the ventricle / total amount of blood in the ventricle
22
Q
what does the lipid profile consist of?
A
- total cholesterol
- high-density lipoprotein cholesterol (HDL-C)
- low-density lipoprotein cholesterol (LDL-C)
- triglycerides
23
Q
what is total cholesterol?
A
this test measures all the cholesterol in the lipoprotein particles
24
Q
what is high-density lipoprotein cholesterol (HDL-C)?
A
measures the cholesterol in HDL particles, often called the “good cholesterol” because it removes excess cholesterol and carries it to the liver for removal
25
what is low-density lipoprotein cholesterol (LDL-C)?
calculates the cholesterol in LDL particles, often called the "bad cholesterol" because it deposits excess cholesterol in the walls of BVs, which can contribute to atherosclerosis
26
what are triglycerides?
measures all triglycerides in all the lipoprotein particles, most is in the very low-density proteins
27
what does the amount of damage in an MI depend on?
- the degree of obstruction
- the duration
- collateral circulation
28
what reduces blood flow/oxygen to to myocardium?
- the atherosclerotic process
| - the development of a clot around a ruptured atherosclerotic plaque causes a sudden occlusion
29
when do symptoms of an MI appear?
when the coronary artery blood flow is reduced by at least 75%
30
is increased workload on the heart in the face of a fixed supply supply or demand?
demand
31
is reduced blood supply to the heart supply or demand?
supply
32
is reduced oxygen carrying capacity of coronary arteries supply or demand?
supply
33
what can increased workload on the heart be caused by? (3)
- HTN
- aortic stenosis
- increased metabolic demand
34
what is reduced blood supply to the heart caused by? (3)
- atherosclerosis
- coronary artery vasospasm
- thrombus/embolus
35
what is reduced oxygen carrying capacity of coronary arteries caused by? (3)
- anemia
- hemodilution
- acute blood loss
36
what is the nursing care for reduced O2 demand d/t MI?
- rest
- nitrates
- morphine
- beta blockers
- Ca channel blockers
- ACE inhibitors (ARB)
37
what is the nursing care for inc. O2 supply d/t MI?
- oxygen when indicated (only when <90%)
- aspirin 160-325 mg chewed
- thrombolytic
- PCI (percutaneous coronary interventions)
- coronary artery bypass
38
what are medications used for MIs?
- heparins
| - antiplatelets
39
what is the management for ischemia?
- oxygen
- nitrates
- activity/asprin
- morphine
- beta blocker
40
what do nitrates do?
relax vascular SM in arteries, particularly in veins, reducing preload and consequently reducing cardiac workload
41
what is the worst thing that could happen to someone on nitrates?
vessels dilate too much and blood pools in periphery --> reducing CO
42
what do you do if someone has a nirto patch and their BP is tanking?
REMOVE THE PATCH
43
what routes does nitro come in?
- sublingual tablets
- spray (fastest onset)
- patches
- IV
44
what is a common side effect of nitro?
headaches
45
what are pre/post assessments of nitro?
BP and pain
46
what does morphine do?
- reduces pain and anxiety which reduces SNS activity
- relaxes vascular SM
- reduces cardiac workload
- relaxes bronchial to enhance oxygenation
47
what does morphine slow?
the administration of the anti-platelet med being given
48
what is the worst that can happen with morphine?
- resp depression/arrest
| - hypotension
49
what does aspirin do?
- treats inflammation
| - inhibits coagulation
50
how much does aspirin reduce mortality by?
23%
51
what is the worst thing that could happen with aspirin?
allergic reaction
52
what do beta blockers do?
reduce CO by blocking beta receptors (beta 1)
53
what is the worst that could happen with beta blockers?
- bradycardia
- inadequate CO
- bronchospasm
54
what are some examples of beta blockers?
- atenolol
- metoprolol
- propranolol
- doxazosin
- terazosin
55
what do calcium channel blockers do?
relaxation of the vessel walls through blocking of calcium
| - reduce after-load and cardiac workload
56
what is the worst that could happen with calcium channel blockers?
- bradycardia
| - inadequate CO
57
what can someone not have on calcium channel blockers?
GRAPEFRUIT JUICE!!!
58
what are some examples of calcium channel blockers?
norvasc, renidil, diltiazem, verapamil
59
what do ACE inhibitors do?
inhibit the conversion of angiotensin 1 to angiotensin 2
| - reduces afterload and dec. workload of heart
60
what is the worst that can happen with ACE Inhibitors?
- inadequate CO
| - cough (angioedema) form action on vasodilator bradykinins
61
what are some examples of ACE inhibitors?
enalapril, captopril, ramipril, quinapril
62
what do fibrinolytics do?
dissolves body's fresh fibrin clots (all of them)
63
when are fibrinolytics used?
within 6 hours of the first symptoms of a STEMI and percutaneous coronary intervention is not available within 90 mins of first medical contact
64
how much can fibrinolytics reduce mortality by?
47-75% if delivered in first hour on onset of symptoms
65
what does heparin do?
- lengthen clotting time
- prevents thrombus formation/growth
- inhibits certain clotting
66
how long is the onset for IV heparin?
immediate
67
how long is the onset for SC heparin?
up to 1 hour
68
what is the half life for heparin?
1.5 hours
69
what lab value do you need to monitor closely when administering heparin?
PTT
70
what does heparin put you at risk for?
GI bleeding
71
what is the antidote for warfarin?
vitamin K
72
what do anti-platelet drugs do?
reduce platelet aggregation
73
when should you hold anti-platelet drugs?
when the platelet count 50 or lower
74
when are thienopyridines indicated?
especially after stents
75
when should glycoprotein be given?
when patient is going home eg. atrial fib
- do not require follow up blood work
- more stable then on warfarin
76
does glycoprotein have an antidote?
NO
77
what do statins do?
inhibit cholesterol production
| - 20-40% reduction in LDL, raise HDL, and lower triglycerides
78
what is the worst that can happen with statins?
liver dysfunction, LFT test needs to be done prior/ 3 months past
79
what is important about muscles when administering statins?
they become tender and weak
| - check CPK (creatinine phosphokinase)
80
what are some adverse effects of statins?
- heartburn
- abdominal cramping/diarrhea
- memory loss
81
when should you give statins?
with meal in evening
82
why can statins cause early dementia?
brain needs fat in order to function, therefore memory is decreasing when you use statins to get rid of fats including those in the brain
83
what is an example of a statin?
atorovastatin
