week 5- CAD

Question 1

heart disease

Answer 1

refers to conditions that impair the heart’s ability to pump blood effectively or damage the blood vessels that supply the heart
ie. CAD, heart failure, arrhythmias

Question 2

coronary artery disease

Answer 2

characterized by plaque buildup in the coronary arteries, leading to restricted blood flow

Question 3

heart failure

Answer 3

the heart’s inability to pump enough blood to meet the body’s needs, resulting in fluid buildup and shortness of breath

Question 4

arrhythmias

Answer 4

abnormal heart rhythms or heart rates

Question 5

causes of heart disease

Answer 5

often associated with risk factors like high blood pressure, high cholesterol, smoking, obesity, lack of exercise, and family history

Question 6

symptoms of heart disease

Answer 6

• vary depending on the type of heart disease and its severity
• common symptoms include chest pain, shortness of breath, dizziness, fatigue, and swelling in the legs

Question 7

prevalence of heart disease

Answer 7

• second major cause of death in canada (27.6%)
• around 2.4 million canadians over age 20 will experience ischemic heart disease

Question 8

etiology of CAD

Answer 8

a) nonmodifiable risk factors: gender, age, family history, ethnicity and genetics
b) modifiable risk factors: hypertension, smoking, obesity, lipid levels (LDL, HDL and cholesterol), diabetes, homocysteine level and substance use

Question 9

pathogenesis of atherosclerosis

Answer 9

1. chronic endothelial injury
   - inner lining of the BV is damaged, so there is no longer a balance vasodilation and vasoconstriction
   - can be damaged as a result of HT, high cholesterol, smoking, diabetes or inflammation
2. fatty streak
   - macrophages engulf cholesterol, becoming foam cells
3. fibrous plaque
   - the foam cells mix with SM cells and mineralize with calcium, to form a hardened plaque
4. complicated lesion
   - the plaque has become unstable as a result of inflammation, which increases the risk of heart attack or stroke

Question 10

collateral circulation

Answer 10

• refers toa network of blood vessels that provide an alternative path for blood flow when the main vessels are blocked or narrowed
• can help prevent/reduce tissue damage caused by lack of O2 or nutrients
• can be arteries, capillaries or veins
• dev stimulated by exercise, angiogenesis or chronic ischemia
• are often present but unused until needed, serving as a backup supply in case of conditions like atherosclerosis, coronary artery disease, or stroke

Question 11

nurses role in managing CAD

Answer 11

a) patient education: about CAD, risk factors, treatment options and importance of lifestyle modifications
b) medication management: administer meds (statins), monitor for adverse effects, ensure med adherence
c) monitoring and assessment: vital signs, cardiac rhythms
d) support and counselling: emotional support, address patient concerns and promote adherence to treatment plans
e) cardiac rehab

Question 12

statins

Answer 12

• most commonly prescribed cholesterol-lowering drugs
• work by blocking the liver’s production of cholesterol, thereby reducing its presence in the bloodstream

Question 13

antiplatelet therapy

Answer 13

• used to prevent blood clots in the arteries which can lead to heart attacks or strokes
• work by interfering with the process of platelet aggregation
• used in patients at high risk for CV events
• ie. aspirin, P2Y12,

Question 14

chronic stable angina

Answer 14

• a condition where chest pain or discomfort occurs predictably, usually during physical exertion, and is relieved by rest or medication like nitroglycerin
• symptoms are consistent and haven’t changed in frequency, severity, or triggering circumstances for at least two months
• caused by reduced blood flow to the heart, often due toCAD

Question 15

symptoms of chronic stable angina

Answer 15

• the main symptom is chest pain or discomfort, which can also radiate to the neck, shoulders, arms, or jaw
• pain might feel like tightness, squeezing, or pressure
• also nausea, exhaustion or dizziness

Question 16

treatment of chronic stable angina

Answer 16

a) beta blockers: reduce heart rate and blood pressure, decreasing the heart’s workload and oxygen demand
b) nitrates: dilate blood vessels, increasing blood flow to the heart and reducing chest pain
- short-acting nitrates like nitroglycerin are used for immediate relief, while long-acting nitrates prevent angina
c) calcium channel blockers: relax blood vessels, improving blood flow and reducing heart workload
d) ace inhibitors: help lower blood pressure and protect the heart, reducing the risk of future heart problems

Question 17

diagnostic tests for chronic stable angina

Answer 17

a) ECG: evaluate for active ischemia or prior infarction
b) chest x-ray: rule out noncardiac causes of chest pain, such as infections or pneumothorax
c) blood tests: including CBC, comprehensive metabolic panel, lipid panel, and troponin levels to assess overall health and rule out other potential causes
d) angina questionnaire: assess the frequency, severity, and impact of angina on the patient’s quality of life
e) stress test: to assess the heart’s response to physical exertion or medication, often combined with imaging
f) echocardiogram: assess heart structure and function, including left ventricular function and wall motion
g) cardiac CT: non-invasive imaging technique to visualize coronary arteries
h) coronary angiogram: an invasive procedure to visualize coronary arteries and assess for blockages or narrowing
- involves inserting a catheter into an artery and injecting dye

Question 18

acute coronary syndrome

Answer 18

• includes three types of CAD including NSTEMI, STEMI and unstable angina
• common signs includeshortness of breath(dyspnea), N/V,dizziness

Question 19

prinzmetal’s angina

Answer 19

• rare form of angina that often occurs at rest, usually in response to spasm of a major coronary artery
• when spasms occur, the patient
  experiences angina and transient ST segment elevation
• calcium channel blockers and/or nitrates are used to control the angina.

Question 20

unstable angina

Answer 20

• involves sudden, unexpected chest pain or pressure, even while resting
• warning sign of a heart attack and occurs whenstable anginaworsens

Question 21

non-ST-elevation MI (NSTEMI)

Answer 21

• a heart attack that providers can detect withblood testsbut not with anelectrocardiogram(EKG)
• it means the coronary arteries aren’t fully blocked or were blocked for a short amount of time

Question 22

ST-elevation MI

Answer 22

• a much more severe heart attack that providers can detect with blood tests and EKG
• it occurs when blood flow to the heart is fully blocked for a long time, affecting a large part of the heart

Question 23

pathophysiology of ACS

Answer 23

• results from a combination of plaque instability, thrombus formation, and the subsequent reduction in blood flow to the heart muscle
• in some cases, ACS can be caused by vasospasm

Question 24

myocardial infarction

Answer 24

• a blockage in the coronary arteries causes the heart muscle begins to die due to a lack of oxygen
• usually the result of ruptured plaques
• symptoms include chest pain, SOB, difficulty breathing, nausea, heart palpitations, anxiety or dizziness/lightheaded

Question 25

hallmark of MI

Answer 25

severe, immobilizing chest pain not relieved by rest, position change, or nitrate administration

Question 26

men vs women symptoms of MI

Answer 26

- women are less likely to have chest pain or discomfort that feels like indigestion - they’re more likely to have shortness of breath, fatigue and insomnia that started before the MI - also have nausea and vomiting or pain in their back, shoulders, neck, arms or abdomen

Question 27

healing from an MI

Answer 27

1. inflammatory phase: WBCs are recruited to the area to clean up damaged tissue and debris 2. repair phase: macrophages and myofibroblasts are involved in tissue repair - they secrete growth factors which recruit and activate mesenchymal reparative cells - these cells lay down 3. healing phase: inflammatory phase resolves and scar tissue formation begins - collagen is deposited - scar tissue is not as effective as muscle tissue, so heart's pumping function decreases

Question 28

MI complications

Answer 28

dysrhythmias, heart failure, cardiogenic shock, papillary muscle dysfunction, ventricular aneurysm, pericarditis, dressler syndrome

Question 29

diagnostic tests for unstable angina and MI

Answer 29

a) ECG: measures electrical activity of the heart - ST-segment depression or T-wave inversion can suggest myocardial ischemia in unstable angina, while ST-segment elevation indicates STEMI b) cardiac troponin: released from damaged heart muscle - elevated troponin levels indicate MI, while unstable angina typically shows normal or only slightly elevated troponin levels c) myoglobin: measures the amount of the protein myoglobin in blood or urine - myoglobin is released into the bloodstream when muscle tissue is damaged d) creatinine kinase-MB: found primarily in heart muscle cells - elevated levels indictae heart muscle damage

Question 30

requirements for coronay revascuarization

Answer 30

1. pts do not achieve satisfactory improvement with medical management 2. pts have left main coronary artery or three-vessel disease 3. pts are not candidates for PCI (e.g., lesions are long or difficult to access) 4. pts have failed PCI with ongoing chest pain 5. pts have diabetes mellitus 6. pts are expected to have longer-term benefits with CABG than with PCI

Question 31

medication management for MI

Answer 31

a) aspirin: reduces blood clotting, given immediately to those suspected of having an MI b) antiplatelets c) clot busters: dissolve existing clots and are used only within the first 12h of an MI d) beta blockers: slow heart rate, reducing workload on heart and improving recovery from injury e) ace inhibitors: bp medication, helps with recovery f) statins: reduce cholesterol and stabilize clots g) morphine: for pain during heart attack

Question 32

emergent percutaneous coronary intervention

Answer 32

- minimally invasive procedure used to open blocked or narrowed coronary arteries - involves inserting a catheter through a small incision in the wrist or groin, guiding it to the blocked artery, and then inflating a balloon to open the vessel - in many cases, a stent is deployed to keep it open

Question 32

nutritional therapy for MI

Answer 32

 focuses on a heart-healthy diet rich in fruits, vegetables, whole grains, and lean protein, while limiting saturated and trans fats, sodium, and added sugars

Question 33

fibrinolytic therapy

Answer 33

- a treatment that dissolves blood clots using medications (tPAs) - used to restore blood flow in conditions like MI, stroke, pulmonary embolism and DVT, preventing further damage to tissues and organ - not recommended with bleeding disorders

Question 33

coronary surgical revascularization

Answer 33

-  procedures that restore blood flow to the heart by rerouting blood around blocked or narrowed coronary arteries -  can be done through CABG or PCI

Question 34

CABG

Answer 34

- surgeon removes a blood vessel (usually from the arm, leg, or back) and uses it to connect the aorta (the main artery carrying blood from the heart) to the coronary artery beyond the blockage, creating a bypass - risks include infection, bleeding, blood clots, MI/stroke

Question 34

sudden cardiac death

Answer 34

- involves an abrupt disruption in cardiac function, producing an abrupt loss of cardiac output and cerebral blood flow - death usually occurs within 1 hour of the onset of acute symptoms - majority of cases of SCD are caused by acute ventricular dysrhythmias

Question 35

in what situations is cabbage more appropriate?

Answer 35

1. pts who do not achieve satisfactory improvement with medical management 2. pts who have L main coronary artery or three-vessel disease 3. pts who are not candidates for PCI 4. pts in whom PCI has failed and chest pain is ongoing

Question 35

risk factors for SCD

Answer 35

male gender (especially Black men), family history of premature atherosclerosis, tobacco use, diabetes mellitus, hypercholesterolemia, hypertension, and cardiomyopathy

Question 36

nurses role in managing CSA/ACS

Answer 36

a) pain management: administer pain meds, consider non-pharm interventions b) assessment and monitoring: vitals, lung sounds c) patient education d) medication management e) psychosocial support: address any MH concerns that may impact CV outcomes f) ECG interpretations: identify changes or arrhythmias that indicate deterioration

Question 37

prevention of SCD

Answer 37

use of an implantable cardioverter-defibrillator (ICD), also require a 24h holter monitor