What is Coronary Artery Disease (CAD)?
A type of blood vessel disorder included in the general category of athersclorsis.
What is Atherosclerosis characterized by?
Deposists of cholesterol and lipids within the intimal wall of an artery.
When CAD becomes symptomatic, what does the generally mean?
The disease process is usually well advanced.
What is Collateral Circulation?
Arterial Anastomoses or connections.
What is Collateral Circulation growth and extent attributed to?
Inherited predisposition to develop new blood vessels and the presence of chronic ischemia.
What are nonmodifiable risk factors for CAD?
Age, gender, ethnicity, family history and genetic inheritance.
What are modifiable risk factors for CAD?
Elevated serum lipids, elevated BP, tobacco use, physical inactivity, obesity, DM, metabolic syndrome, psychologic states, and homocysteine level.
What is one of the most firmly established risk factors for CAD?
Elevated serum lipid levels.
What are High Density Lipoproteins (HDLs)?
Carry lipids away from arteries and to the liver for metabolism. High levels are desirable.
How do you increase HDL levels?
Physical activity, moderate alcohol consumption and estrogen administration.
What does an Elevated Low Density Lipoprotein Level correlate with?
Increased incidence of atheroslcerosis and CAD>
What are recommended changes for the patient with CAD?
A regular physical activity program, a diet that limits saturated fats and cholesterol and emphasizes complex carbohydrates (e.g., whole grain, fruit, vegetables)>
How often is a complete lipid profile recommended for the patient with CAD or at risk for?
Every 5 years beginning at age 20.
What serum cholesterol level puts a person at risk for CAD?
Greater than 200 mg/dL.
If the levels of cholesterol remain elevated despite modifiable changes, what is considered?
Drug therapy with statins. Niacin, fibric acid derivatives, bile acid sequestrants and other agents may be used.
What drug is recommended for people at risk for CAD?
Antiplatelet therapy with low dose aspirin.
What can people take if they are Aspirin intolerant and at risk for CAD?
What is Chronic Stable Angina?
Refers to chest pain that occurs intermittently over a long period with the same pattern of onset, duration, and intensity of symptoms.
What is Angina rarely?
Sharp or stabbing, and usually does not change with position or breathing.
How long does Anginal pain usually last?
A few minute and commonly subsides when the precipitating factor is relieved. Pain at rest is unusual.
What is the treatment of chronic stable angina?
Aimed at decreasing oxygen demand, and or increasing oxygen supply and reducing CAD risk factors.
What is the first line therapy for treatment of angina?
How do Nitrates act?
Dilate peripheral blood vessels, coronary arteries and collateral vessels.
What other medications are used in the treatment of chronic stable angina?
How do beta blockers act?
Decrease myocardial contractility, heart rate, systemic vascular resistance, and blood pressure which reduce myocardial oxygen demand.
What is the diagnostic testing for a patient with a history of CAD?
CXRAY, 12-lead ECG, lipid profile, echocardiography, exercise stress testing, and coronary angiography.
What is Prinzmetals Angina?
A rare form of angina that occurs at rest, usually in respose to spasm of a major coronary artery.
What does the patient experience when spasms occur in Prinzmetals Angina?
Angina and transient ST segment elevation.
What may precipitate coronary artery spasms?
Smoking and tobacco use.
When else may prinzmetals angina be seen?
In a patient with history of migrane headaches and Raynauds Phenomenon.
What may relieve pain for the patient with Prinzmetals Angina?
Exercise or it may disappear spontaneously.
What medications are used for Prinzemtals Angina?
Calcium channel blockers and or nitrates to control the angina.
What is Acute Coronary Syndrome?
Develops when ischemia is prolonged and not immediately reversible. Encompases a spectrum of unstable angina, non-st-segment-elevation myocardial infaction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI).
What is Unstable Angina?
Chest pain that is new in onset, occurs at rest, or has worsening pattern. Unpredictable and represents an emergency.
Why does a Myocardial Infarction occur?
As a result of sustained ischemia, causing irreversible myocardial cell death. Contractile functions of the heart stops in the infarcted area(s).
How long does an acute MI evolve over?
A period up to 12 hours.
How are infarctions described?
Based on the location of damage.
What is the hallmark of an MI?
Severe, immobilizing chest pain that is not relieved by rest, position change, or nitrate administration.
How is pain usually described for a patient with an MI?
Heaviness, pressure, tightness, burning, constriction or crushing.
What are complications after an MI?
Dysrhythmias are the most common, heart failure, cardiogenic shock, papillary muscle dysfunction or rupture, ventricular aneurysm, and pericarditis.
What is the primary diagnostic study to determine whether the person has a UA or an MI?
ECG and serum cardiac markers.
What is necessary for a patient with ACS?
Rapid diagnosis and treatment.
What is recommended for a patient with STEMI or NSTEMI with positive cardiac markers?
Reperfusion therapy. This can include emergency PCI or fibrinolytic *thrombolytic) therapy).
What is cardiac catherterization used for?
To locate and assess blockage and implement treatment modalities if needed.
What is Fibrinolytic Therapies aim?
To stop infarction process by dissolving the thrombus int he coronary artery to reperfuse the mycocardium.
When is coronary revascularization with coronary artery bypass graft (CABG) surgery recommended?
For patients who fail medical management, have left main coronary artery or three vessel disease, are not candidates for PCI, have failed PCI with ongoing chest pain or have diabetes.
What is initial management of the patient with chest pain in regards to drug therapy?
Aspirin, IV nitroglycerin, systemic anticoagulation, morphine sulfate for pain unrelieved by nitroglycerin and oxygen.
When may IV antiplatelet agents be used for Chest Pain?
If PCI is anticipated.
Why are Stool softeneres given with Chest Pain?
Facilitate and promote the comfort of bowel evacuation.
What nursing measures should be instituted for a patient experiencing angina?
Administer supplemental oxygen and position the patient in upright position unless contraindicated, determine vital signs, obtain a 12 lead ECG, provide prompt pain relief first with a nitrate followed by an opiod analgesic if needed, and auscultate heart sounds.
What should teaching for a patient with angina include?
Information regarding ACD, managing angina, risk factor reduction and medication.
What does initial treatment of a patient with ACS include?
Pain assessment and relief, physiologic monitoring, promote of rest and comfort, alleviation of stress and anxiety, and understanding of the patients emotional and behavioral reactions.
What medications should be provided to reduce or eliminate chest pain?
Nitroglycerin, morphine sulfate and supplemental oxygen.
What should be monitored on a patient with ACS?
Continuous ECG monitoring, frequent VS, I & O, and physical assessment. Heart and lung sounds and inspect for evidence of early heart failure.
How may a patient with an uncomplicated MI rest for?
In a chair within 8 - 12 hours after the event.
What is important nursing implementation about anxiety with a patient following ACS?
Identify the source of anxiety, assist the patient in reducing it, and provide appropriate patient teaching.
What is it important to provide for the patient after ACS?
Adequate rest periods free from interruption.
What are comfort measures that can promote rest?
Frequent oral care, adequate warmth, a quiet atmosphere, use of relaxation therapy, and assurance that personnel are nearby and responsive to the needs.
After a PCI what are the major nursing responsibilities?
Monitoring for signs of recurrent angina, frequent assessment of VS, including HR and rhythm, evaluation of the groin for signs of bleeding and maintenance of bed rest per policy.
How long after having a CABG surgery is a patient in ICU?
First 24 - 36 hours, with ongoing ECG and hemodynamic monitoring.
After transfer from ICU, what is the focus for a CABG surgical patient for postoperative care?
Monitoring for dysrhythmias, providing wound care, managing pain and preventing complications.
What is the key to cardiac rehabilitation programs for the patient?
What are the six areas for cardiac rehabilitations focus?
Physiologic, psychologic, mental, spiritual, economic and vocational.
How long does post-MI depression usually last?
1 - 4 months.
What should patients know about erectile dysfunction and drugs?
Nitrates should not be used with drugs for erectile dysfunction.
How long till it is safe to resume sexual activity after an uncomplicated MI?
7 - 10 days.
What is Sudden Cardiac Death?
An unexpected death from cardiac causes producing an abrupt loss of cardiac output and cerebral blood flow. Usually occurs within an hour of onset of symptoms.
What are majority of cases of SCD caused by?
Ventricular dysrhythmias, and may have been accomplished by an acute MI.
What are risk factors for SCD?
Ventricular dysfunction, ventricular dysrhythmias following MI, males, african american, family hx of athersclerosis, tobacco use, DM, hyperthcolesterolemia, hypertension and cardiomyopathy.
What is the most common appraoch to preventing a recurrent of SCD?
Implantable cardioverter defibrillator (ICD) with drug therapy.