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128 Cards in this Set
- Front
- Back
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Cardiovascular disease is the major cause of death in the US. What is the most common type of cardiovascular disease?
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CAD
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What is coronary artery disease?
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a type of blood vessel disorder that is included in the general category of atherosclerosis.
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Describe the progression of atherosclerosis.
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begins as soft deposit of fat that harden with age
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Atherosclerosis is often referred to as what?
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"hardening of the arteries"
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While atherosclerosis can occur in any artery in the body, _______ have a preference for the coronary arteries.
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atheromas
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CAD is just one of the terms used to describe this particular disease. What are 4 others?
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- Atherosclerotic heart disease
- cardiovascular heart disease - ischemic heart disease - coronary heart disease |
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What is the major cause of CAD?
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atherosclerosis
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What are the characteristics of CAD development due to atherosclerosis?
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- focal deposits of cholesterol and lipids, primarily w/i the intimal wall of the artery
- inflammation and endothelial injury |
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The endothelial lining of arteries can be injured as a result of what? (6)
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1. tobacco use
2. hyperlipidemia 3. hypertension 4. diabetes 5. hyperhoocysteinemia 6. infectio n |
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What is C-reactive protein and how does it correlate with CAD patients?
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C-reactive protein is a nonspecific marker of inflammation. It is increased in many CAD patients.
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Chronic exposure to C-reactive protein triggers what?
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the rupture of plaques
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True/False:
When CAD becomes symptomatic, the disease is usually well advanced. |
True
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What are the 3 stages of development in atherosclerosis?
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1. fatty streak
2. fibrous plaques 3. complicated lesion |
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What are the earliest lesions seen in the development of atherosclerosis?
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fatty streaks
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Fatty streaks are characterized by what?
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lipid-filled smooth muscle cells
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Are fatty streaks reversible?
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potentially (it is generally believed that treatment that lowers LDL may reverse this process)
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The fibrous plaque stage of atherosclerosis is the beginning of what?
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progressive changes in the endothelium of the arterial wall
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During the fibrous plaque stage of atherosclerosis, LDLs transport what to the arterial intima?
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cholesterol and other lipids
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What happens to the fatty streak during the fibrous plaque stage?
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it eventually is covered by collagen forming a fibrous plaque that appears white or gray
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What is the result of the fibrous plaque that forms during the fibrous plaque stage?
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narrowing of the vessel lumen (and a reduction in blood flow to the distal tissues)
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What is the final stage in the development of atherosclerosis?
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the development of a complicated lesion
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During the development of the complicated lesion, what occurs?
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continued inflammation can result in plaque instability, ulceration, and rupture
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During the development of a complicated atherosclerotic lesion, what occurs once the integrity of the arteries' inner wall has been compromised?
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platelets accumulate in large numbers, leading to a thrombus
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During the development of a complicated lesion, the enlarging thrombus leads to what?
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increased narrowing or even total occlusion of the artery
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What is collateral circulation?
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arterial anastomoses (connections) that develop to bypass an occluded artery
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The growth and extent of collateral circulation is attributed to what 2 factors?
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- inherited predisposition to develop new vessels (angiogenesis)
- presence of chronic ischemia |
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What effect does the occlusion of arteries over a long time have on collateral circulation?
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slow-developing occlusions in arteries have a greater chance of collateral circulation (thus, a greater chance of the heart still receiving oxygen)
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Is CAD always symptomatic?
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No, it may not present symptoms for years
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What is unstable angina?
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chest pain that is new in onset, occurs at rest, or has a worsening pattern
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What are 2 of the more serious manifestations of CAD?
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USA (unstable angina) and MI
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What are 5 nonmodifiable risk factors for CAD?
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1. age
2. gender 3. ethnicity 4. family history 5. genetic predisposition |
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What are 9 modifiable risk factors for CAD?
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1. elevated serum lipids
2. hypertension 3. tobacco use 4. physical inactivity 5. obesity 6. diabetes 7. metabolic syndrome 8. psychologic states 9. homocysteine level |
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What group has the highest incidence of coronary artery disease?
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white, middle-aged men
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What group has an early age of onset for CAD?
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African Americans
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Are white or african american women have a higher incidence and death rate related to CAD?
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african american women
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Do whites or african americans have more severe cases of CAD?
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african americans
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Native americans under 35 have heart disease mortality rates twice as high as other americans. What are 2 modifiable risk factors that play a key part in this?
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diabetes mellitus
obesity |
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What are the 4 major modifiable risks associated with the development of CAD?
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1. elevated serum lipids
2. hypertension 3. tobacco use 4. physical inactivity |
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The risk of CAD is associated with a serum cholesterol level of more than what?
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200 mg/dl
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The risk of CAD is associated with a fasting triglyceride level of more than what?
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150 mg/dl
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What is the function of HDLs?
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To carry lipids away from arteries to the liver for metabolism
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What are 3 methods of increasing HDL levels?
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- limited alcohol intake
- physical activity - estrogen administration |
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Which lipoprotein class contains the most cholesterol?
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LDLs
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What factors have been linked with elevated triglyceride levels? (6)
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- certain diseases (type 2 diabetes, chronic renal failure)
- drugs (corticosteroids, hormones) - genetic disorders - high alcohol consumption - high intake of refined carbs and simple sugars - physical inactivity |
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Current national guidelines for treating LDL are based on a person's 10-year risk for having a nonfatal MI, dying from a coronary event, and his LDL levels. What factors are scored to generate this profile?
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1. age
2. gender 3. use of tobacco 4. systolic BP 5. use of BP meds 6. total cholesterol 7. HDL cholesterol level |
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Hypertension is associated with a higher incidence of CAD in what group?
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postmenopausal women
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Hypertension increases the risk of death from CAD how much?
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10-fold
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The stress of a constantly elevated BP (as seen in HTN) increases the rate of __________ development.
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atherosclerotic
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For a person with CAD and HTN, what might happen to the heart?
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left ventricular hypertrophy
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The risk of developing CAD is how much higher in smokers vs. non-smokers?
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2 to 6 times higher
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Tobacco smoking has been linked to a decrease in what level form women?
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estrogen levels
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Nicotine causes the release of what?
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catecholamines
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What effect does the catecholamines released due to nicotine intake have on the body?
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increased HR, peripheral vasoconstriction, and increased BP
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What is the current recommendation for health-promoting regular physical activity?
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- brisk walking, at least 30 minutes 5x's a week, increasing heart rate by 30-50 bpm
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Obesity is defined as a body mass index greater than what?
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30
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Obese people are thought to produce increased levels of what 2 things that are strongly implicated in the development of atherosclerosis?
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triglycerides and LDLs
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Obese people are how many more times likely to develop hypertension vs. a person of normal weight?
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3xs more likely
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What occurs when the demand for myocardial oxygen exceeds the ability of the coronary arteries to supply the heart with oxygen?
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myocardial ischemia
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(def)
chest pain |
angina
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What is the clinical manifestation of reversible myocardial ischemia?
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Angina
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What is the primary reason for insufficient blood blow to the myocardium?
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narrowing of the coronary arteries by artherosclerosis
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For ischemia secondary to atherosclerosis to occur, the artery is usually ___% or more obstructed (stenosed).
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75%
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(def)
chest pain that occurs over a long period with the same pattern of onset, duration, and intensity of symptoms |
chronic stable angina
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Pain experienced with chronic stable angina usually lasts how long?
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3-5 minutes
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Pain experienced with chronic stable angina usually subsides when?
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when the precipitating factor is relieved
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True/False:
Pain at rest is usual with Chronic Stable Angina. |
False- it is unusual
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What % of patients with myocardial ischemia are asymptomatic (silent ischemia)?
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up to 80%
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Silent ischemia is associated with what 2 disorders?
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- diabetes mellitus
- hypertension |
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How is silent ischemia confirmed?
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ECG changes
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What is the PQRST assessment of angina?
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P- Precipitating event
Q- Quality R- Radiation S- Severity T- Timing |
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(def)
angina that occurs only at night but not necessarily when the person is in the recumbent position or during sleep |
Nocturnal Angina
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(def)
chest pain that occurs only while lying down |
Angina decubitus
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How is angina decubitus usually relieved?
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by standing or sitting
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(def)
angina that occurs at rest usually in response to a spasm of a major coronary artery |
Prinzmetal's angina
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Prinzmetal's angina is seen in what type of patients? (2)
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- those with a history of migraine headache
- those with Raynaud's |
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True/False:
Prinzmetal's angina indicates CAD. |
False- these spasms may occur in the absence of CAD
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Why does prinzmetal's angina pain occur during REM?
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b/c myocardial oxygen demand increases during REM
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What are 2 medication groups used to treat Prinzmetal's angina?
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- Calcium Channel Blockers
- Nitrates |
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The treatment of chronic stable angina is aimed at what 2 goals?
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- decrease oxygen demand
- increase oxygen supply |
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What drug category is used for the first-line therapy of angina?
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short-acting nitrates
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What are the 2 principle effects of short-acting nitrates?
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- dilating peripheral blood vessels
- dilating coronary arteries and collateral vessels |
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Short-acting nitrates are usually given how?
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sublingually
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How soon will sublingual nitrates usually relieve pain? How long do they last?
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usually relieve pain in 3 minutes, usually last 30-60 minutes
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If symptoms of angina are unchanged 5 minutes after administration of sublingual nitro, what should the patient do?
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Conact the EMS system
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Sublingual Nitroglycerin should not be combined with drugs for what?
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erectile dysfunction
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After administration of sublingual nitroglycerin, the patient should be monitored for what?
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orthostatic hypotension
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How should sublingual nitroglycerin be stored to protect it from degradation?
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in a tightly closed dark glass bottle
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What are some known side effects of sublingual nitroglycerin?
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- increase in HR
- dizziness, flushing, or a pounding headache - orthostatic hypotension |
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What is the predominant side effect of all nitrates?
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headache
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Tolerance to nitroglycerin vasodilation can occur. What is recommended to counter this?
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an 8 hour free nitrate period every day (usually a night except in cases of nocturnal angina)
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What are 2 types of long-acting nitrates?
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- nitroglycerin ointment
- transdermal controlled-release nitroglycerin |
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What are the preferred drugs for the management of chronic stable angina?
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beta adrenergic blockers
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What effect do beta blockers have?
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decrease myocardial contractility, HR, SVR, and BP
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What are some of the more severe side effects seen with beta blockers?
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- bradycardia
- hypotension - wheezing - GI complaints Many patients complain of weight gain, depression, and sexual dysfunction. |
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Beta Blockers should be used cautiously in what 2 groups of people? why?
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Asthma (avoid b/c of wheezing)
Diabetes (BB mask signs of hypoglycemia) |
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What are two uses for Calcium Channel Blockers?
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- used in patients who cannot tolerate Beta Blockers
- used to manage Prinzmetal's angina |
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What are the 3 primary effects of calcium channel blockers?
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1. systemic vasodilation with decreased SVR
2. decreased myocardial contractility 3. coronary vasodilation |
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A patient beginning calcium channels blockers who is already on digoxin should be monitored for what? How long?
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Monitor for dig toxicity closely for the first week and periodically thereafter
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What is the mechanism of action for ACE inhibitors?
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Inhibit the conversion of A-1 to A-2, thus preventing Angiotensin II from vasoconstriction
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A chest x-ray is usually taken to look for what 3 things (related to CAD)?
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- cardiac enlargement
- aortic calcification - pulmonary congestion |
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What are common diagnostic studies for patients with known CAD and chronic stable angina?
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- 12-lead ECG
- echocardiogram - exercise stress testing - pharmacologic nuclear imaging - coronary angiography |
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A severely abnormal exercise stress test may indicate what?
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a significant disease process
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Are exercise stress tests always conclusive?
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No, these tests can give a false-positive (especially in women) or a false-negative if the patient is exercised submaximally or if only one coronary artery is involved.
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What 2 tests complement exercise stress testing to assist in findings?
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- pharmacologic nuclear imaging
- echocardiography |
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Describe cardiac catherization and coronary angiography.
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the catherization of the heart, followed by the injection of contrast material to be x-rayed
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What is percutaneous coronary intervention?
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the placement of a balloon or stent via a catheter
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What develops when ischemia is prolonged and not immediately reversible?
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ACS (Acute coronary syndrome)
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ACS encompasses what 2 things?
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Unstable angina
ECG elevation (MI) |
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True/False:
ACS presents the same in everyone. |
False- it is individualized, but women in particular present atypical symptoms
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What are 6 health-promoting behaviors that can be taught to a patient with hypertension?
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1. have regular BP checkups
2. take medications as prescribed 3. reduce salt intake 4. stop tobacco use 5. control or reduce weight 6. perform physical activity regularly |
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What are 6 health-promoting behaviors that can be taught to a patient with Elevated serum lipids?
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1. reduce total fat intake
2. reduce saturated fat intake 3. take prescribed medications for lipid reduction 4. adjust total caloric intake to achieve IBW 5. Engage in regular physical exercise 6. increase amt. of complex carbohydrates and vegetable proteins into the diet |
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What are 5 suggestions that may help a patient to quit smoking?
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- enroll in a smoking cessation program
- change routine - substitue other activities - ask family for support - avoid exposure to second-hand smoke |
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Total fat should be what % of daily intake?
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25-35%
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You should have what percent of saturated fat in your daily intake?
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Less than 7%
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Polyunsaturated fat should not exceed what percent of daily intake?
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10%
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Monounsaturated fat should not exceed what percent of daily intake?
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20%
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What percent of your daily intake should be carbohydrates?
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50-60%
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What percent of daily intake should be proteins?
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approximately 15%
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How much fiber should you have each day?
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20-30 g
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What subjective information regarding past health is important when assessing ACS?
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- previous history of CAD, angina, MI, aortic stenosis, heart failure, cardiomyopathy, HTN, diabetes, anemia, lung disease, etc.
- Medications related to treatment of the above, medications for preventative care, vitamins and herbal supplements |
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What subjective health pattern information is important when assessing ACS?
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- family history of heart disease
- sedentary lifestyle - tobacco use - GI problems (heartburn, nausea, etc.) - Elimination problems (voiding, constipation) - problems with exercise - pain location, quality, length, etc. - stress, depression, anger, anxiety, etc. |
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When assessing a person for ACS, what objective behaviors should you note? (3)
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anxiety, fear, restlessness
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When assessing a person for ACS, what should you specifically note regarding their integument?
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any cool, clammy, or pale skin
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When assessing a person for ACS, you should document any of these abnormal findings (list 6)
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- tachycardia
- bradycardia - pulsus alternans - dysrhythmias, S3 or S4 sounds - Increase or decrease in BP - murmurs |
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A nurse is present when a patient has an anginal attack. What measures should be instituted immediately? (6)
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1. administer oxygen
2. vital signs 3. 12-lead ECG 4. prompt pain relief (1st with a nitrate followed by an opioid) 5. auscultation of heart sounds 6. comfortably position the patient |
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What are some nursing interventions used to relieve pain with ACS? (4)
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- evaluate (to determine course)
- monitor oxygen therapy - administer medications - obtain 12 lead ECG to differientiate pain |
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What are some interventions for anxiety and the patient with ACS?
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-observe for verbal and non-verbal signs
- identify when level of anxiety changes (increases O2 need) - use a calm, reassuring approach - encourage family to stay - teach relaxation techniques - encourage verbalization - *provide factual information* |
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For ambulatory and home care settings, the nurse should give the patient what 4 important types of information?
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- CAD and angina info
- Precipitating factors for angina - risk factor reduction - medications |
