CAD

Question 1

CAD

Answer 1

• asymptomatic possible
• chronic stable angina
• unstable angina and MI more serious = ACS

Question 2

Atherosclerosis

Answer 2

• soft deposits of fat (atheromas) that harden with age

- leads to collateral circulation

Question 3

CAD Modifiable Risk factors

Answer 3

• elevated serum lipids
• HTN
• tobacco use
• physical inactivity
• diabetes and obesity

Question 4

HDL Level

Answer 4

• Recommended = Male > 40mg/dl & Female > 50 mg/dl
• ≥ 60 mg/dl – low risk for CAD
• < 40 mg/dl – high risk for CAD

Question 5

LDL Level

Answer 5

• Recommended = < 100 mg/dl

- > 160 = High risk for CAD

Question 6

Familial Hyperlipidemia

Answer 6

• autosomal dominant disorder
• leads to increased levels of LDL
• heterozygous less severe homozygous

Question 7

Health-Promoting Behavior

Answer 7

-FITT: 30 min > 5 days/wk

Question 8

Antihyperlipidemics

Answer 8

• Statins
• lower cholesterol & LDL, increases HDL
• contra: pregnancy & hep
• SE: myopathy-rhab & hepatotoxicity
• precautions: liver disease & excessive alcohol use

Question 9

Statins Nursing Implications

Answer 9

• instruct client to report unexplained muscle pain/tenderness
• monitor liver function
• admin in evening

Question 10

Simvastatin

Answer 10

Increased risk for rhabdomyolysis when also used with gemfibrozil (Lopid) or niacin.

Question 11

Cholesterol Absorption Inhibitors

Answer 11

• Ezetimibe (Zetia)
• Common addition to statin
• Contra: hypersensitivity, severe hepatic disease
• tabs 10 mg

Question 12

Niacin

Answer 12

• decreases cholesterol & LDL
• flushing (face & neck) may occur in 20 min and last for 30-60 min
• can premed with aspirin or NSAID 30 min before

Question 13

Fibrates

Answer 13

• reduce triglyceride & VLDLs
• tricor & lopid
• may increase risk of bleeding with wartfarin
• may increase effects of antihyperglycemic drugs

Question 14

How do … Bile Acid Sequestrants work?

Answer 14

Bind with acids in intestine
Binding results in removal of LDL and cholesterol
Example: Cholestyramine (Questran)

Question 15

Bile Acid Sequestrants Nursing Implications

Answer 15

GI upset
Interfere with absorption of other drugs
Give other drugs an hour to absorb before giving
Give questran 4 hours to absorb before giving other drugs

Question 16

What complementary & alternative therapies are used to lower lipid levels?

Answer 16

Garlic (not very effective but enhances warfarin)
Omega-3 fatty acids (fish and flaxseed oil)
Fiber (pectin, oat bran, psyllium, fruits, beans)
Phytosterols (nuts, seeds, soybeans, veg oils)
Soy
Milk Thistle, Hawthorn, Coenzyme Q10,

Question 17

Silent Ischemia

Answer 17

• asymptomatic
• associated with DM, diabetic neuro, HTN
• ECG changes

Question 18

Chronic Stable angina

Answer 18

Chest pain that appears intermittently over a period of time in a predictable fashion

• O2 demand > supply
• pain lasts 3-5 min
• ST depression and/or T inversion

Question 19

Unstable Angina

Answer 19

New onset, occurs at rest or occurs with increasing frequency or duration.

Question 20

Chronic Stable Angina Meds

Answer 20

• short acting nitrates:

- long acting: NTG & Isosorbide

Question 21

Nitrates & Angina

Answer 21

. Dilates venous and arterial vessels – which decreases preload and afterload.
Dilates coronary artery vessels
Lowers B/P

Question 22

NTG

Answer 22

Call 911 !!!! After 1st dose before taking 2nd dose

If significantly improved - Repeat in 5 minutes X 2 more doses (3 total max

Question 23

Proper use of NTG

Answer 23

Carry at all times
Keep in original container
Replace every 6 months
Should cause fizzing or tingling under tongue
Side Effects: headache, dizziness, flushing, hypotension (monitor for orthostatic hypotension)

Question 24

Prinzmetal Angina

Answer 24

• at rest
• with history of migrains & raynaud’s
• ST elevated
• T: calcium blocker or mod exercise

Question 25

CAD Diagnostics

Answer 25

- homocysteine: high = risk for thrombi - EKG - stress test: exercise, meds (dobu or lexi), stress EKG - cardiac catheter

Question 26

Cardiac Catherization Post

Answer 26

- bedrest for 4-6 hrs - keep insertion site straight - pressure dressing - 5-10lb sand bags - assessments q 15 min x 4 then hourly

Question 27

Acute coronary syndrome

Answer 27

- deterioration of once stable plaque -> thrombus - partial occlusion: UA & NSTEMI - total: STEMI (ST elevated) - AKA heart attack or MI

Question 28

MI Healing Process

Answer 28

- 24 hrs: WBCs infiltrate - 10-14 days: scar tissue weak - 6 wks: necrotic tissue replaces - ventricular remodeling

Question 29

Complications of MI

Answer 29

- dysrhythmias - HF - cardiogenic shock - papillary muscle dysfunction - ventricular aneurysm - acute pericarditis - dessler syndrome

Question 30

Heart Murmurs Causes

Answer 30

``` Stenosis of valve Partial obstruction Aortic regurgitation Mitral regurgitation Septal defect ```

Question 31

Serum Cardiac Markers

Answer 31

- > 4%-6% creatinine kinase | - > 2.3 troponin

Question 32

Treatment of MI

Answer 32

Morphine Oxygen (1st) Nitroglycerine ASA or Plavix

Question 33

ACS Care

Answer 33

- emergent PCI - fibrinolytic therapy - CA bypass graft - CABG: first 24-36 hrs

Question 34

Thrombolytics

Answer 34

- for MI - SE: streptokinase - admin within 4-6 hrs - monitor I&O and Hct - maintain bed rest

Question 35

thrombolytics contraindications

Answer 35

•Cerebrovascular disease and pregnancy •Active bleeding, aortic dissection, pericarditis •History of intracranial hemorrhage •Recent major surgery •History of gastrointestinal (GI) bleeding `

Question 36

CABG

Answer 36

Assessing the patient for bleeding (e.g., chest tube drainage, incision sites) Monitoring fluid status Replacing electrolytes PRN Restoring temperature (e.g., warming blankets)

Question 37

ACS Acute

Answer 37

Antiplatelet IV nitroglycerin Morphine sulfate

Question 38

ACS Post Acute

Answer 38

``` β-adrenergic blockers Angiotensin-converting enzyme inhibitors Antidysrhythmia drugs Cholesterol-lowering drugs Stool softeners ```

Question 39

ACS Nutritional Therapy

Answer 39

Low-salt Low-saturated fat Low-cholesterol

Question 40

Antiplatelt therapy

Answer 40

- low dose ASA (81 mg) - Plavix - 1st line for angina - give with heparin or asprin

Question 41

Improve Perfusion

Answer 41

- PCI | - cardiac monitoring

Question 42

Sudden cardiac death (SCD)

Answer 42

Unexpected death from cardiac causes Rapid CPR, defibrillation with AED, and early advanced cardiac life support increase survival rates Death usually within 1 hour of onset of acute symptoms Most caused by ventricular dysrhythmias

Question 43

SCD risk factors

Answer 43

Left ventricular dysfunction (EF 30%) | Ventricular dysrhythmias after MI