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520 > Coronary Artery Disease (CAD) & Acute Coronary Syndrome (ACS) > Flashcards

Coronary Artery Disease (CAD) & Acute Coronary Syndrome (ACS) Flashcards

1
Q

The myocardium is perfused during _____

A

Diastole

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2
Q

The coronary arteries arise from what great vessel ?

A

Aortic trunk

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3
Q

What are the layers of the heart ?

A

Pericardium
Epicardium
Myocardium
Endocardium

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4
Q

What are the two layers of pericardium ?

A

Parietal and visceral

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5
Q

What is a cardiac tamponade and what does this do to the heart ?

A

fluid accumulates in pericardial space

Decreases contractility of the heart therefore BP drops

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6
Q

An inflammation of the serous pericardium is called ______

A

pericarditis

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7
Q

What is the primary cause of coronary artery disease ?

A

Atherosclerosis

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8
Q

What non-specific marker of inflammation, produced by the liver, is often elevated in patients with CAD ?

A

C-reactive protein (CRP)

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9
Q

Name 5 factors that cause damage to the lining of the endothelium of a vessel

A 
tobacco use
hyperlipidemia
hypertension
diabetes
hyperhomocysteinemia
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10
Q

_____ are the earliest lesions of atherosclerosis

A

Fatty streaks

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11
Q

The _____________ stage is the beginning of progressive changes in the endothelium of the arterial wall

A

Fibrous Plaque

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12
Q

How would you define a complicated lesion ?

A

As the fibrous plaque grows, continued inflammation can result in plaque instability, ulceration, and rupture

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13
Q

What is collateral circulation ?

A

Normally some arterial anastomoses or connections, called collateral circulation, exist within the coronary circulation.

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14
Q

What 2 factors contribute to the growth and extent of collateral circulation ?

A

1: Inherited predisposition to develop new blood vessels (angiogenesis).
2: Presence of chronic ischemia.

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15
Q

What are the 5 main modifiable risk factors for CAD ?

A

1: Elevated serum lipids
2: Hypertension
3: Smoking
4: Physical inactivity
5: Obesity

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16
Q

Name 5 non-modifiable risk factors for CAD

A 
Age 
Gender (male)
Ethnicity (Af-Am)
Family history
Genetic predisposition
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17
Q

Name 3 types of Lipid-lowering drug therapy

A

1: Statins
2: Niacin
3: Fibric acid derivatives (Lopid)

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18
Q

What drugs Increase lipoprotein removal ?

A

Bile acid sequestrants

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19
Q

what drug will decrease cholesterol absorption ?

A

Ezetimibe (Zetia)

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20
Q

Name 2 forms of Antiplatelet therapy

A

Aspirin

Clopidogrel

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21
Q

Name 3 Strategies to reduce risk and treat CAD

A

Smoking cessation
Lower BP
Increased physical exercise

22
Q

What is Angina ?

A

Intense localized chest pain

23
Q

What is the most common cause of angina ?

A

Narrowing of one or more coronary arteries by atherosclerosis, pain can radiate.

24
Q

What are the two types of angina ?

A

Stable chronic angina

Unstable angina

25
Q

What will stable angina show on an ECG ?

A

ST Depression and/or T wave inversion

26
Q

What form of Angina often subsides with rest ?

A

Stable

27
Q

How do nitrates (long acting/short acting) treat angina ?

A

Dilate peripheral and coronary blood vessels.

Lower O2 demand and Increase O2 supply.

28
Q

What are 2 keys things to monitor in a patient taking nitrates ?

A

headache and orthostatic hypotension

29
Q

Name 3 other drugs that a patient who has chronic stable angina may be prescribed

A

1: CCB
2: Beta Blockers
3: ACE-i

30
Q

What is Percutaneous coronary intervention (PCI) ?

A

Balloon angioplasty which separates plaque to increase vessel diameter.
A stent can then be deployed that keeps the vessel patent.

31
Q

What is Enhanced external counterpulsation (EECP) and how is it used to treat stable angina ?

A

Inflatable BP cuffs placed around the legs which inflate during diastole and deflate during systole.

This action is thought to increase venous return and augment diastolic BP in order to increase coronary perfusion, improve LV diastolic filling, and help with collateral circulation.

32
Q

Which form of angina is most likely to lead to an MI ?

A

Unstable angina

33
Q

What are the 3 types of acute coronary syndrome ?

A

STEMI (ST elevated MI)
NSTEMI (Non-ST Elevated MI)
Unstable angina

34
Q

What type of occlusion is occurring in a NSTEMI ?

A

Partial occlusion of the coronary artery

35
Q

What type of occlusion is occuring in a STEMI ?

A

Total occlusion of the coronary artery

36
Q

What is often formed within a vessel where an atheromatous plaque has ruptured ?

A

Thrombus

37
Q

Define unstable angina

A

Chest pain that is new in onset, occurs at rest, or occurs with increasing frequency, duration, or with less effort than the patient’s chronic stable angina pattern. The pain typically lasts 10 minutes or more.

38
Q

What happens to the area of the heart that is now not receiving oxygenated blood during an MI ?

A

It becomes infarcted or necrosed

39
Q

What is the most common complication a patient presents with following an MI ?

A

Dysrhythmias

40
Q

Name 4 other complications of MI ?

A

Heart failure - When heart contractility is decreased due to to scarring
Cardiogenic shock
Papillary muscle dysfunction or rupture
LV Aneurysm

41
Q

What is acute pericarditis ?

A

Another complication of MI Pericarditis is an Inflammation of visceral and/or parietal pericardium

42
Q

What is Dressler syndrome ?

A

Pericarditis and fever that develops 1 to 8 weeks after MI

43
Q

What is the initial intervention for someone experiencing ACS ?

A 
12-lead ECG
Upright position
Oxygen – keep O2 sat > 93%
IV access 
Nitroglycerin (SL) and ASA (chewable)
Statin
Morphine  - (MONA)
44
Q

What would ongoing monitoring of a patient experiencing an ACS include ?

A

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

45
Q

What would be the immediate treatment for someone having UA or NSTEMI ?

A

Dual antiplatelet therapy and heparin

Cardiac catheterization with PCI once stable

46
Q

What would be the immediate treatment for someone having a STEMI ?

A

Reperfusion therapy (Emergent PCI )

47
Q

Thrombolytic (fibrinolytic) therapy is only indicated for patients with a _______

A

STEMI (Agencies that do not have cardiac catheterization resources)

48
Q

What other form of revascularization surgery is available ?

A

CABG (Coronary artery bypass graft)

49
Q

What 2 vessels are often harvested for CABG surgery ?

A

Internal mammary artery (IMA) is the most commonly harvested vessel and the saphenous vein is also considered.

50
Q

Post operative nursing care of a patient who has had CABG would include what ?

A 
Assess patient for bleeding 
Monitor hemodynamic status
Assess fluid status
Replace blood and electrolytes PRN
Restore temperature 
Monitor for atrial fibrillation (which is common)
Surgical site care
Radial artery harvest site
Leg incisions
Chest incision
Pain management
DVT prevention
Pulmonary hygiene
Cognitive dysfunction

520 (4 decks)

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