Coronary Artery Disease and Acute Coronary Syndrome

Question 1

Atherosclerosis

Answer 1

a chronic disease that causes the buildup of plaque in the arteries, which can narrow them and reduce blood flow

Question 2

Collateral Circulation

Answer 2

alternate or “backup” blood vessels in your body that can take over when another artery or vein becomes blocked or damaged

Question 3

Cholesterol

Answer 3

> 200 mg/dl

Question 4

Triglycerides

Answer 4

> 150 mg/dl

Question 5

HDL

Answer 5

< 40 mg/dl

Question 6

LDL

Answer 6

> 130 mg/dl

Question 7

White males

Answer 7

highest mortality from CAD

Question 8

Native Americans

Answer 8

die earlier than expected

Question 9

Nutritional Therapy

Answer 9

Decrease saturated fat and cholesterol
Increase complex carbohydrates and
fiber
Increase intake of Omega-3 fatty acids
Limit alcohol use
Limit red meats, full-fat dairy,
processed foods

Question 10

Activity

Answer 10

Track activity
30 minutes at least 5 days per week
Increase weight training (2 days a
week)

Question 11

Gerontology Consideration

Answer 11

Assess for readiness for enhanced learning
Symptoms are determined to be a result of CAD not “normal
aging”
Need to modify guidelines for physical activity

Question 12

Angina

Answer 12

clinical manifestation of
reversible cardiac ischemia

Question 13

Chronic Stable
Angina

Answer 13

1. Chest Pain that occurs
   intermittently over long period of
   time
2. Same pattern of onset, duration
   and intensity
3. Pain at rest is unusual

Question 14

Diagnostic studies

Answer 14

Chest x-ray
12-lead ECG
Laboratory studies
Echocardiogram
Exercise stress test
Coronary CT Angiography
Cardiac Catheterization

Question 15

Cardiac
Catheterization

Answer 15

Cardiac catheterization
—“gold standard” to
identify and localize CAD
Visualize blockages
(diagnostic)
Open blockages
(interventional)
Percutaneous coronary
intervention (PCI)
Balloon angioplasty

Question 16

Acute Coronary Syndrome

Answer 16

Unstable angina
ST-segmental elevation MI (non)
Blood flow to the heart muscle is suddenly reduced or blocked

Question 17

ACS Etiology

Answer 17

Deterioration of once stable plague –>Rupture –> Platelet
aggregation –> Thrombus

Question 18

Partial
occlusion of
coronary
artery

Answer 18

Unstable
angina or
NSTEMI

Question 19

Total occlusion
of coronary
artery

Answer 19

STEMI

Question 20

Clinical Manifestations:
Unstable
Angina

Answer 20

New in onset
Occurs at rest
Increase in frequency, duration, or with
less effort
Pain lasting > 10 minutes
Needs immediate treatment
Symptoms in women often under-
recognized
ECG Changes

Question 21

Pain

Answer 21

• Severe chest pain not relieved
  by rest, position change, or
  nitrate administration
• Often occurs in early morning
• Atypical in women, elderly
• No pain if cardiac neuropathy
  (diabetes)

Question 22

Sympathetic nervous system
stimulation

Answer 22

• Release of catecholamines
• Diaphoresis
• Increased HR and BP
• Vasoconstriction of peripheral
  blood vessels
• Skin: ashen, clammy, and/or
  cool to touch

Question 23

Clinical Manifestations: Cardiovascular

Answer 23

Initially, ↑ HR and BP, then ↓
BP (secondary to ↓ in CO)
↓renal perfusion leads to
↓urine output
Crackles
Jugular venous distention
Abnormal heart sounds
* S3 or S4
* New murmur

Question 24

Clinical Manifestations: Nausea and Vomiting

Answer 24

Reflex stimulation of the
vomiting center by severe
pain
Vasovagal reflex

Question 25

Clinical Manifestations: Fever

Answer 25

Up to 100.4° F (38° C) in first 24-48 hours Systemic inflammatory process caused by heart cell death

Question 26

ACS Treatment Priorities

Answer 26

12-lead ECG Upright position Oxygen – keep O2 sat > 93% IV access Nitroglycerin (SL) and ASA ! (chewable) Statin Morphine

Question 27

Ongoing monitoring

Answer 27

* Treat dysrhythmias * Frequent vital sign monitoring * Bed rest/limited activity for 12–24 hours

Question 28

UA or NSTEMI

Answer 28

* Dual antiplatelet therapy and heparin * Cardiac catheterization with PCI once stable

Question 29

ACS Treatment

Answer 29

EMERGENT PCI Treatment of choice for confirmed STEMI Goal: 90 minutes door to cath lab Balloon angioplasty + stent(s) Many advantages over CABG

Question 30

THROMBOLYTIC THERAPY

Answer 30

Only for patients with a STEMI Agencies that do not have cardiac catheterization resources Given IV within 30 minutes of arrival to the ED Patient selection critical

Question 31

CABG

Answer 31

24-48 hr ICU Hemodynamic monitoring Arterial Line Chest Tubes ECG monitoring Pacing wires Endotracheal tube Urinary catheter Nasogastric tube

Question 32

CABG Complications

Answer 32

Bleeding, dysrhythmias, pain, DVT prevention, Inflammation

Question 33

Nursing Goals

Answer 33

Relief of pain Preservation of heart muscle Effective coping with illness-associated anxiety Resumption of Sexual Activity Participation in a rehabilitation plan Health Promotion

Question 34

UAP

Answer 34

* VS * I&O’s * Assist with meals, toileting * Report complications

Question 35

LPN

Answer 35

* May handle stable patient * Cannot administer thrombolytic medications

Question 36

Sudden Cardiac Death (SCD)

Answer 36

Unexpected death from cardiac causes * Occurs within 1 hour of symptom onset

Question 37

SCD Symptoms

Answer 37

Dysrhythmia (e.g., VT, VF) causes disruption in cardiac function, resulting in loss of CO and cerebral blood flow

Question 38

After SCD

Answer 38

If survive, increased risk of another event due to electrical instability from scarred muscle “Brush with death”, “Time bomb” mentality, anger, depression Driving restrictions, change in occupation

Question 39

Serum Cardiac Biomarkers After MI

Answer 39

Troponin, CK-MB, and myoglobin

Question 40

ECG Changes