Unit 9 - CAD

Question 1

coronary artery disease is cause by impaired blood flow to _____

Answer 1

myocardium

Question 2

chest pain caused by reduced cardiac blood flow

Answer 2

angina pectoris

Question 3

unstable cardiac ischemia

Answer 3

acute coronary syndrome (ACS)

Question 4

necrosis/death of myocardial cells

Answer 4

acute myocardial infarction (AMI)

Question 5

Pathophysiology/etiology of CAD:

• blood flow in coronary arteries regulated by aortic pressure, heart rate, other factors
• large arteries not connected: small arteries joined by _____ channels -> alternate routes for blood flow

Answer 5

collateral

Question 6

most common cause of reduced coronary blood flow

Answer 6

atherosclerosis

Question 7

high levels of low-density lipoprotein (LDLs) and toxins lead to arterial endothelial layer damage and plaque formation

Answer 7

atherosclerosis

Question 8

complex lesions of lipids, fibrous tissue, collagen, calcium, cellular debris, capillaries - develop -> can rupture or ulcerate causing emboli or thrombus

Answer 8

atheromas

Question 9

where does atherosclerosis develop

Answer 9

where arteries bifurcate or branch

Question 10

ischemia develops when…

Answer 10

oxygen supply inadequate to meet metabolic needs

Question 11

acute coronary syndrome

• coronary blood flow _____ but not entirely occluded
• rupture or erosion of _____ plaque (predominant cause)
• coronary artery _____
• progressive vessel _____
• _____ of coronary artery
• _____ myocardial oxygen demand and/or _____ supply
• ECG changes: inversion of T-wave, possible elevation of _____ segment

Answer 11

• coronary blood flow reduced but not entirely occluded
• rupture or erosion of atherosclerotic plaque (predominant cause)
• coronary artery spasm
• progressive vessel obstruction
• inflammation of coronary artery
• increased myocardial oxygen demand and/or decreased supply
• ECG changes: inversion of T-wave, possible elevation of ST segment

Question 12

acute myocardial infarction (MI) occurs when blood flow to a portion of cardiac muscle is completely _____, resulting in a prolonged tissue _____ by damages area of the heart

Answer 12

blocked

ischemia

Question 13

MI:

occlusion L anterior descending artery =

Answer 13

anterior MI

Question 14

MI:

left circumflex artery =

Answer 14

lateral MI

Question 15

MI can result from acute cocaine _____

Answer 15

toxicity

Question 16

angina classes:

Answer 16

I
II
III
IV

Question 17

Angina class:

does not occur with ordinary physical activity

Answer 17

Class I

Question 18

Angina class:

prolonged walking or stair climbing

Answer 18

Class II

Question 19

Angina class:

limits normal activities of daily living

Answer 19

Class III

Question 20

Angina class:

angina with rest or activity

Answer 20

IV

Question 21

substernal or epigastric chest pain =

Answer 21

acute coronary syndrome

Question 22

• continuous chest pain
• onset sudden; not precipitated by activity
• accompanied by nausea, vomiting, hypotension, bradycardia

Answer 22

acute myocardial infarction

Question 23

Diagnostic Tests:

proteins released during a myocardial infarction that are sensitive indicators of _____ _____

Answer 23

myocardial damage

Question 24

Diagnostic Tests:

not specific to _____ muscle; use is limited

Answer 24

cardiac

Question 25

Diagnostic Tests: | elevated white blood cell count and erythrocyte sedimentation rate because of _____ _____ _____

Answer 25

myocardial cell inflammation

Question 26

Diagnostic Tests: | assess blood oxygen and _____-_____ balance

Answer 26

acid-base

Question 27

``` Electrocardiogram: changes seen in acute myocardial infarction - T wave _____ - ST segment _____ - Formation of _____ wave ```

Answer 27

- inversion - elevation - Q wave

Question 28

Echocardiogram: | evaluate cardiac wall motion and _____ _____ function

Answer 28

left ventricular

Question 29

Radionuclide imaging: - evaluates myocardial _____ - cannot differentiate between _____ and _____ myocardial infarctions

Answer 29

perfusion | old and new

Question 30

Conservative management: | - reduce the risk of coronary artery disease (CAD) by _____ regardless of length of time smoking

Answer 30

50%

Question 31

Conservative management: Diet - _____ saturated fat and cholesterol intake - _____ LDL level - _____ intake of soluble fiber - _____ alcohol intake - overweight or obese: encourage to _____ weight

Answer 31

- reduce saturated fat and cholesterol intake - Lower LDL level - increase intake of soluble fiber - moderate alcohol intake - overweight or obese: encourage to lose weight

Question 32

drugs used to lower cholesterol: goal -> achieve LDL level < _____ mg/dL

Answer 32

130

Question 33

Drug of choice for CAD

Answer 33

nitrate (sublingual nitroglycerin)

Question 34

nitrate (sublingual nitroglycerin) acts within _____ minutes

Answer 34

1-2

Question 35

4 side effects of nitrate (sublingual nitroglycerin)

Answer 35

headache nausea dizziness hypotension

Question 36

first-line drug to treat stable angina

Answer 36

beta-blockres

Question 37

beta-blockers are contraindicated in clients with _____ or severe _____

Answer 37

asthma | COPD

Question 38

T/F: beta-blockers may make prinzemtal angina worse

Answer 38

T

Question 39

Calcium-channel blockers are used for long-term _____

Answer 39

prophylaxis

Question 40

Calcium-channel blockers are used with caution in clients with _____, _____ _____, _____

Answer 40

dysrythmias, heart failure, hypotension

Question 41

_____ reduce risk of platelet aggregation and thrombus formation

Answer 41

aspirin

Question 42

_____ is essential initial treatment for myocardial infarction

Answer 42

aspirin

Question 43

Fibrinolytics: - _____ infarct size - _____ heart damage - _____ outcomes

Answer 43

limits reduces improves

Question 44

purpose of percutaneous coronary revascularization

Answer 44

restore blood flow to ischemic myocardium by compressing plaque

Question 45

_____ catheter shaves plaque off vessel walls, removes it

Answer 45

atherectomy

Question 46

_____ uses section of vein, artery to create connection (bypass) between aorta and coronary artery beyond the obstruction

Answer 46

CABG

Question 47

CABG | _____ clients -> totally relieves or significantly reduces angina

Answer 47

90%

Question 48

CABG | heart is stopped during surgery for _____ techniques; newer techniques do not require stoppage and are safer

Answer 48

older

Question 49

2 approaches to minimally invasive coronary artery surgery:

Answer 49

- port-access coronary artery bypass | - minimally invasive direct coronary artery bypass

Question 50

laser drills tiny holes in myocardial muscle, provides blood flow to ischemic area

Answer 50

Transmyocardial laser revascularization:

Question 51

- balloon inflates during diastole, deflates during systole

Answer 51

intra-aortic balloon pump

Question 52

_____ _____ device - takes partial or complete control of cardiac function - risk for infection high

Answer 52

- ventricular assist device

Question 53

Diagnosis: CAD - imbalanced _____: more than body requirements - ineffective _____ maintenance

Answer 53

nutrition | health

Question 54

Diagnosis: Angina - ineffective _____ perfusion: cardiac - risk for _____ _____ regimen management

Answer 54

tissue | ineffective therapeutic

Question 55

``` Diagnosis: AMI - _____ pain - ineffective _____ perfusion - _____ coping - fear ```

Answer 55

acute tissue ineffective

Question 56

defined as an alteration in the structure and function of the right ventricle (RV) of the heart caused by a primary disorder of the respiratory system. Pulmonary hypertension is often the common link between lung dysfunction and the heart in _____ _____

Answer 56

cor pulmonale