Coronary Vascular Disease

Question 1

Progression of Coronary Artery Disease

Answer 1

atherosclerosis -> angina -> ACS -> MI

Question 2

Risk factors for CAD

Answer 2

• family hx
• gender (onset earlier in males)
• age (> 45 m; > 55 f)
• race (greater risk in African Americans)
• high cholesterol
• hyperlipidemia
• elevated TGs
• smoking/tobacco use
• HTN
• DM
• obesity
• physical inactivity
• metabolic syndrome

Question 3

stable angina

Answer 3

pain associated myocardial ischemia

Question 4

atherosclerosis

Answer 4

abnormal accumulation of lipid deposits and fibrous tissue within arterial walls and lumen

Question 5

What determines symptoms of atherosclerosis?

Answer 5

vessel location and amount of narrowing in the vessel

Question 6

How often should people with atherosclerosis receive routine follow-up labs?

Answer 6

every 6 months

Question 7

What are the modifiable risk factors of atherosclerosis?

Answer 7

• cholesterol/TG levels
• tobacco use
• hypertension
• DM
• activity
• weight

Question 8

syndrome brought on by an imbalance of oxygen supply to the demand of oxygen need in the myocardium

Answer 8

angina pectoris

Question 9

What are the main causes of angina pectoris?

Answer 9

• atherosclerosis
• myocardial ischemia
• any reduction in blood flow to the heart (HOTN)

Question 10

predictable and consistent pain that occurs on exertion and is relieved by rest and/or nitro

Answer 10

stable angina

Question 11

symptoms increase in frequency and severity; pain not usually relived with rest or nitro

Answer 11

unstable angina

Question 12

objective evidence of ischemia, but pt reports no pain

Answer 12

silent ischemia

Question 13

Common exacerbating factors of stable angina

Answer 13

• exercise
• extreme cold
• high stress situation
• substances (tobacco, caffeine, some illicit drugs)

Question 14

What is the big deal about unstable angina?

Answer 14

it is a health emergency as it is often an indicator of an impending MI

Question 15

S/S angina pectoris

Answer 15

• pain like indigestion, gripping, pressure, restlessness, anxiety, feeling of impending doom
• chest/neck/jaw/shoulder pain
• BP fluctuation, N/V, pallor, tachycardia, vasoconstriction

older adults will vary as will the symptoms vary in men and women

Question 16

atypical chest pain symptoms in women

Answer 16

• chest pain, discomfort, pressure
• unusual upper body pain
• cold sweat
• lightheadedness
• nausea
• fatigue
• shortness of breath

Question 17

angina pectoris medications

Answer 17

• NTG/Imdur
• beta-blockers
• CCBs
• supplemental oxygen
• aspirin, plavix, effient, heparin to prevent larger blockage

Question 18

emergent situation caused by the onset of myocardial ischemia

Answer 18

acute coronary syndrome

Question 19

occlusion of the coronary artery that leads to ischemia then to necrosis/death of the myocardium

Answer 19

myocardial infaraction

Question 20

acute coronary syndrome S/S

Answer 20

same as angina, but onset is faster and they are relieved by rest and medication

Question 21

ACS diagnostics

Answer 21

• 12 lead EKG
• cardiac enzymes/biomarkers
• echocardiogram
• stress test
• cardiac catheterization

Question 22

Left Heart Catheterization

Answer 22

radial or femoral artery to insert a catheter, catheter is guided to coronary arteries and contrast is injected

MD can see where vessels are narrowed or blocked

Question 23

How often should vitals be assessed post-cardiac cath?

Answer 23

usually q15 minutes for the first hour

Question 24

Post-cardiac cath nursing considerations

Answer 24

• assess vitals, insertion site
• maintain hydration
• maintain bedrest for 4-6 hours (per MD order)

Question 25

expected ECG changes with ischemia

Answer 25

- ST segment elevation - ST depression - T wave inversion - Pathologic Q wave

Question 26

pt is symptomatic, but dx are negative for acute ischemia

Answer 26

unstable angina

Question 27

pt asymptomatic, but dx shows evidence of cardiac ischemia

Answer 27

silent MI

Question 28

abnormal biomarkers, but no ECG changes

Answer 28

NSTEMI

Question 29

abnormal biomarkers and ST changes in at least 2 leads

Answer 29

STEMI

Question 30

What are the two types of STEMIs?

Answer 30

LAD and RCA

Question 31

widow-maker, anterior wall MI

Answer 31

LAD occlusion

Question 32

most common, inferior wall MI

Answer 32

RCA occlusion

Question 33

goals of care for USA and MI

Answer 33

- reestablish blood flow - decrease damage - balance supply and demand of oxygen

Question 34

meds for USA and MI

Answer 34

- NTG/Imdur - beta-blockers - CCBs - supplemental oxygen - aspirin, plavix, effient, heparin to prevent larger blockage - ACE-inhibitors - statins

Question 35

Procedures for USA and MI

Answer 35

- PCI (angioplasty and stent placement) - Surgery (CABG)

Question 36

USA and MI nursing interventions

Answer 36

- position client safely, implement bedrest - administer MONA if indicated - call for help from charge nurse - page provider asap - call for stat EKG per protocol/MD order - call for stat labs per protocol/MD order

Question 37

MONA

Answer 37

- morphine (reduction of workload, pain, and anxiety) - oxygen (increases oxygen supply) - nitroglycerin (increases bloodflow to myocardium) - aspirin (prevention of platelet aggregation)

Question 38

How fast does reperfusion need to occur with a STEMI?

Answer 38

within 12 hours

Question 39

What is the "door to needle" time from STEMI indication to thrombolytic admin?

Answer 39

- 30 minutes for best outcomes - can be within 6-12 if PCI isn't indicated