Coronary Artery Disease & Chronic Stable Angina

Question 1

What is the difference between Arteriosclerosis and Atherosclerosis?

Answer 1

Arterio = hardened or thickened inflexible arteries
Athero = type arteriosclerosis plaque build up

Question 2

What are the two types of CAD?

Answer 2

Obstructive = there’s a blockage that does not allow blood to perfuse to the heart
Non-Obstructive = there’s spasming occurring that prevents blood to perfuse to the heart, nothing is obstructing the blood vessel

Question 3

What is the difference in case presentation between women and men in regards to angina?

Answer 3

Women = having more GI symptoms
Men = substernal symptoms (more typical symptoms)

Question 4

What is the difference in case presentation between younger and older adults in regards to angina?

Answer 4

Younger adult = internal bias, more dismissive of symptoms
Older adult = more expected so they’re less dismissive of symptoms

Question 5

What is the most important comorbidity associated with angina? why?

Answer 5

diabetes bc of neuropathy - the loss of sensation; they’re sense of pain is different than those without neuropathy

Question 6

What is the time parameters for angina to be considered chronic?

Answer 6

3-6 months

Question 7

What is the difference between stable and unstable angina?

Answer 7

stable angina = relieved with rest
unstable angina = not relieved with rest

Question 8

T/F: it is recommended for LDL to be below 100

Answer 8

True

Question 9

At what value should total cholesterol be a concern?

Answer 9

above 200

Question 10

T/F: HDL should be low

Answer 10

False, you want them to be high because they’re “good” cholesterol

Question 11

What is the purpose of Cardiac Enzymes lab test?

Answer 11

primary indicator for ACS is troponin

Question 12

What is the purpose of CMP test?

Answer 12

potassium, magnesium, calcium levels, liver & renal function

Question 13

What is the purpose of Coagulation studies?

Answer 13

elevated fibrinogen level increase risk of developing a blood clot

Question 14

What is the purpose for Hemoglobin A1C test?

Answer 14

large contributor to cardiovascular disease from diabetes/pre-diabetes

Question 15

What is the difference between cardiac monitoring and an EKG?

Answer 15

Cardiac monitoring = monitoring and trending
12-Lead EKG = diagnostic

Question 16

When you are monitoring cardiac rhythms, what are you looking at?

Answer 16

always look at Lead 2 for NSR (normal sinus rhythm) – looking at the PQRST waves

Question 17

What is considered sinus bradycardia?

Answer 17

<60

Question 18

What is considered sinus tachycardia?

Answer 18

> 100

Question 19

What is the P wave?

Answer 19

atrial depolarizing by SA node

Question 20

What is the QRS complex?

Answer 20

ventricular depolarization

Question 21

What is the T wave?

Answer 21

ventricular repolarization

Question 22

What is the ST segment?

Answer 22

ventricular contraction

Question 23

What diagnostic test might the provider order to confirm or rule out CAD?

Answer 23

cardiac stress test using treadmill (start with least invasive measure first)

Question 24

What are the steps to verifying CAD?

Answer 24

• Electrocardiogram (EKG)
• Cardiac stress test (exercise stress test or Dobutamine stress test)
• Coronary angiography (angioplasty or stent placement [aka PCI])

Question 25

What is the Gold Standard: angioplasty or stent placement?

Answer 25

stent placement, aka Percutaneous Coronary Intervention (PCI)

Question 26

What is the Dobutamine Stress Test?

Answer 26

- uses medication to "stress" or increase workload of the heart - cannot tolerate exercise - mobility concerns - safety concerns

Question 27

What is an Exercise Stress Test? What can occur? What is monitored?

Answer 27

- a screening tool for symptoms of cardiovascular disease that may become apparent when the heart is stressed - chest pain, dizziness, dysrrhythmias, or SOB may occur during the test - HR, rhythm, and BP will be monitored during the test

Question 28

Why do you increase fluid intake during Cardiac Angiography/Angioplasty?

Answer 28

because a dye is put into you and can be damaging to the kidneys, therefore, it is important to keep the patient hydrated to get rid of the dye - important to monitor the kidneys

Question 29

T/F: some patients may experience "hot flashes" as the dye is injected during a cardiac angiography/angioplasty

Answer 29

True

Question 30

With confirmed diagnosis of chronic stable angina, what medications do you anticipate the provider to prescribe?

Answer 30

- nitroglycerin - aspirin

Question 31

What do ACE's and ARB's do?

Answer 31

- decrease BP - reduce risk of stroke - reduce risk of heart attack

Question 32

What do Beta Blockers do?

Answer 32

- decrease HR - decrease BP - reduce risk of heart attack - decrease O2 demand

Question 33

What do Calcium Channel Blockers do?

Answer 33

- increase O2 sent to the heart - relax heart vessels - decrease BP - decrease O2 demand

Question 34

What is the MOA for short-acting and long-acting nitroglycerin?

Answer 34

Vasodilation

Question 35

What is the frequency of dosing for short-acting nitroglycerin?

Answer 35

every 5 min, up to 3 doses

Question 36

What side-effects might you see?

Answer 36

- headache - hypotension - syncope

Question 37

What is important for your client to know when taking nitroglycerin?

Answer 37

- make sure you are sitting down prior to taking short-acting nitro - if one tablet relieves your symptoms; it is not necessary to take more

Question 38

What is MONA? in regards to treating angina?

Answer 38

Morphine, O2, Nitroglycerin, Aspirin