Cardiac Assessment

Front 1

Atherosclerosis

Back 1

Form of Arteriosclerosis
–Hardening and thickening deposits often with calcium
–Affects aorta, large and/or medium arteries
–No symptoms until 60% or more occluded

Front 2

cholesterol

Back 2

Less than
200 mg/dL

Front 3

LDL

Back 3

100 -129 mg/dLwith 2 or more RF

Front 4

HDL-C

Back 4

40 –59 mg/dL
60 mg/dLand above

Front 5

triglyceride

Back 5

Below 150 mg/dL
Women 35-135 mg/dL

Front 6

HMG CoAReductaseInhibitors (Statins)
action

Back 6

Reduce LDL-C 18 –55% & TG 7 –30%
•Raises HDL-C 5.15%

Front 7

HMG CoAReductaseInhibitors (Statins)
Contraindications:

Back 7

–Allergy
–Liver Disease
–Pregnancy, Lactation
Caution: Impaired Endocrine Function

Front 8

HMG CoAReductaseInhibitors (Statins)
Major Side Effects:

Back 8

–CNS: h/a, DIZZINESS, BLURRED VISION, INSOMNIA
–Myopathy
–Rhabdomyolysis
–Liver failure
–Increased Liver Enzymes

Front 9

HMG CoAReductaseInhibitors (Statins)
drug to drug interactions

Back 9

Drug to Drug Interactions: Erythromycin, cyclosporine, gemfibrozil, and niacin. Digoxin and Warfarin. Estrogen. Grapefruit Juic

Front 10

Bile Acid Sequestrants
•Major actions:
–

Back 10

Reduce LDL-C 15 –30 %
–Raise HDL-C 3 –5%
–May Increase TG

Front 11

Bile Acid Sequestrants
Side effects:

Back 11

–GI distress/constipation; Vit A & E deficiencies
–Headache, fatigue, drowsiness
–Decreased absorption of other drugs
–Increased Bleeding Times

Front 12

Bile Acid Sequestrants
Contraindications:

Back 12

Biliary Obstruction, Pregnancy, Lactation; Abnormal intestinal function
–Dysbetalipoproteinemia

Front 13

Bile Acid Sequestrants
•Drug
ex

Back 13

•Cholestyramine ((Questran)
•Colestipol (Colestid)
•Colesevelam

Front 14

Nicotinic Acid -Niacin
•Major Actions:

Back 14

–Lowers LDL-C 5 –25%
–Lowers TG 20 –50 %
–Raises HDL-C 15 –35%

Front 15

Nicotinic Acid -Niacin
Side effects

Back 15

–Flushing
–Hyperglycemia

Front 16

Nicotinic Acid -Niacin
Contraindications:

Back 16

–Liver Disease
–Severe Gout

Front 17

fibric acids
Major actions:

Back 17

•
Reduce progression of coronary lesions
–Lower LDL-C 5 –20% (with normal TG)
–May raise LDL-C (with high TG)
–Lowers TG 20 –50%
–Raises HDL-C 10 –20%

Front 18

FibricAcids
Side effects:
–

Back 18

Dyspepsia
–Gallstones
–Myopathy

Front 19

Fibric Acid
•Contraindications

Back 19

Liver ds
renal ds
may be used during pregnancy

Front 20

Fibric acids
example

Back 20

Gemfibrozil
•Fenofibrate
•Clofibrate

Front 21

Intermittent claudication.

Back 21

(pain in Calf or leg brought on by exercise. Relieved by rest. Is most common early sign of
Arteriosclerosis

Front 22

Assessment of Chest Pain

Back 22

Pposition / location /Provocation discomfort
Qquality
Rradiates and location –Relief?
Sseverity and symptoms
Ttiming

Front 23

Nitrates
•Action

Back 23

–Act directly on smooth muscle to relax and depress muscle tone

Front 24

Nitrates
Indication

Back 24

–Prevent and treat attacks of angina pectoris

Front 25

Nitrates
Pharmacokinetics

Back 25

–Very rapidly absorbed
–Metabolized in the liver
–Excreted in the urine

Front 26

Nitrates
•Contraindications

Back 26

Allergy
–Severe anemia
–Head trauma and cerebral hemorrhage
–Pregnancy and lactation

Front 27

Nitrates
•Cautions

Back 27

–Hepatic or renal disease
–Hypotension, hypvolemia, and conditions that limit cardiac output.

Front 28

Nitrates
•Adverse effects

Back 28

–Related to vasodilation and the decrease in blood flow
–CNS: H/A, dizziness, and weakness
–GI: N/V
–CV: hypotension
–Flushing, pallor, and increased perspiration

Front 29

Nitrates
Drug to drug interactions

Back 29

–Heparin
–Ergot derivatives (used to treat migraine headache and enhance uterine contraction postpartum)

Front 30

Antiplatelet Drugs
action/use

Back 30

•Decrease platelet aggregation
•Decrease risk of thrombus formation in coronary arteries
•To treat acute unstable angina, MI, and during PCI, such as angioplasty.
•Contraindications: Known drug allergy, thrombocytopenia, active bleeding, leukemia, traumatic injury, GI ulcer, Vitamin K deficiency, and recent Stroke

Front 31

Clopidogrel(Plavix)
use

Back 31

-Reduction of atherosclerotic events; acute coronary syndrome w/o ST segment elevatio

Front 32

Eptifibatide(Integrilin):
use

Back 32

Unstable angina, MI, PercutaneousCoronary Procedures

Front 33

Patient Teaching
Angina

Back 33

•Lifestyle changes and reduction of risk factors
•Explore, recognize, and adapt behaviors to avoid to reduce the incidence of episodes of ischemia.
•Teaching regarding disease process
•Medications
•Stress reduction
•When to seek emergency care

Front 34

–Leading cause of death

Back 34

Coronary Artery Disease (CAD ) Myocardial Infarction

Front 35

ECG changes
MI

Back 35

In addition to ST-segment and T-wave changes, ECG may show tachycardia, bradycardia, or dysrhythmias.

Front 36

ECG changes
MI

Back 36

In addition to ST-segment and T-wave changes, ECG may show tachycardia, bradycardia, or dysrhythmias.

Front 37

Diagnostic assessment
•Std. serum labs

Back 37

–lipids, CBC, electrolytes, ABGs
–coagulation PT, PTT
–Cardiac enzymes
•troponin T and I, CK-MB, LDH, K / routine

Front 38

Cardiac Markers

Back 38

•Creatine Kinase (CK)
•Myoglobin
•Troponins
•Lactate Dehydogenase (LDH)
•LDH Isoenzymes
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Cardiac Markers –CK-MB
•CK-MB
–Marker for Acute MI
–Specific for Cardiac Event
–Rises within 2-8hrs of onset
–Serial values provide pattern
–Useful for Dx of a re-infarction
–Falls after one day
–Dissipates in 1-3 Days
–Subsequent rise indicates a new event
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Cardiac Markers -Troponin
•Troponins
–Components of Cardiac Muscle
–Released into bloodstream with an MI
–Highly specific for Myocardial injury –move so than CK-MB
–Increases in 3-12 hours and remains elevated longer than CK-MB
–Troponin I and T –Proteins regulate contractility
•Released during Injury
•Similar to CK-MB
•Rapid Assays available in Emergency

Front 39

Cardiac Markers –CK-MB
•CK-MB

Back 39

–Marker for Acute MI
–Specific for Cardiac Event
–Rises within 2-8hrs of onset
–Serial values provide pattern
–Useful for Dx of a re-infarction
–Falls after one day
–Dissipates in 1-3 Days
–Subsequent rise indicates a new event

Front 40

•Troponins

Back 40

Highly specific for Myocardial injury –move so than CK-MB
–Increases in 3-12 hours and remains elevated longer than CK-MB

Front 41

Nursing Process: The Care of the Patient with ACS: Assessment

Back 41

A vital component of nursing care!
•See Chart 28-8.
•Assess all symptoms carefully and compare to previous and baseline data to detect any changes or complications.
•Assess IVs.
•Monitor ECG.

Front 42

Nursing Process:
The Care of the Patient with ACS: Planning

Back 42

•Goals include the relief of pain or ischemic signs and symptoms, prevention of further myocardial damage, absence of respiratory dysfunction, maintenance of or attainment of adequate tissue perfusion, reduced anxiety, adherence to the self-care program, absence or early recognition of complications

Front 43

Cardiac Cath
Nursing Interventions / responsibilities

Back 43

Catheter access site is observed for bleeding or hematoma formation
Peripheral pulses in affected extremity are assessed every 15min for 1hr then every 1-2hrs until pulses stable.
Temperature and color evaluated
Evaluate any complaints of pain, numbness or tingling sensations
Report changes immediately
Cardiac monitoring
Bed rest for 2-6hrs after procedure
Safety, Safety, Safety.
HOB elevated 30 deg
leg straight

Front 44

Post cath Care

Back 44

•VS per protocol
–CSM
•insertion site
•bedrest
–sand bag to site
•Arteriotomy sutures / collagen plug
–quiet extremity
–HOB
•Provide hydration
•Monitor UO
•Observe for complications
–pain, CP, N
–neurological changes

Front 45

Post cath pt teaching

Back 45

No stairs or driving x 24 hours
•Avoid heavy lifting, strenuous exercise for 72 hours
•May shower in 24 hours (no bath)
•Change dsg next day
•Expect some bruising & soreness
•Notify MD if pain, swelling, …
•Call MD immediatelybleeding, CP, cold limb, dysrhythmias, neurological symptoms

Front 46

Angioplasty

Back 46

a balloon catheter is passed through the guiding catheter to the area near the narrowing. A guide wire inside the balloon catheter is then advanced through the artery until the tip is beyond the narrowing.
•the angioplasty catheter is moved over the guide wire until the balloon is within the narrowed segment.
•balloon is inflated, compressing the plaque against the artery wall
•once plaque has been compressed and the artery has been sufficiently opened, the balloon catheter will be deflated and removed

Front 47

Intermittant Claudation

Back 47

pain in calf or leg brought on by exercise and relieved by rest. Most common early sign or arteriosclerosis.

Front 48

Arteriosclerosis

Back 48

abnormal hardening of and thickening of the vessel wall

Front 49

athersclerosis

Back 49

for of Arteriosclerosis. Hardening an thickening deposits. occlud aorta and arteries

Front 50

Stable angina

Back 50

predictible and consistant pain that occurs on exertion and is relieved by rest

Front 51

Variant Angina

Back 51

Pain at rest with reversible ST segment elevations thought to be caused by coranary artery vasospasm

Front 52

Silent Ischemia

Back 52

objective evidence of ischemia ecg changes. Pt reports no symptoms.

Front 53

Treatment for CP

Back 53

Morphine
O2
NTG
ASA

Front 54

Specific Cardiac enzyme

Back 54

Troponin