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23 Cards in this Set
- Front
- Back
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Major Risk Factors of CAD
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• hyperlipidemia
• smoking • hypertension • diabetes mellitus • obesity • first degree relative with history of CAD ** want high HDL because HDL carries LDL to the liver to be destroyed. U want low LDL |
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Syndrome with 3 or more of the following:
• increased risk of CAD • insulin resistance (FBS >100) • abdominal obesity • hypertension • hyperlipidemia (triglycerides >150) • proinflammatory state (diabetes) -- increase hemocystine, c-reactive protein • prothrombotic state (increase in fibrinogen) |
Metabolic Syndrome
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Treatment for hyperlipidemia
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• diet (increase fiber), exercise
• statins: blocks cholesterol synthesis but may cause myopathy which is severe muscle aches ie: Zocor. Must monitor liver enzymes and should take at night • Niacin: decreases LDLand triglycerides and increases HDL but may cause gout and GI upset |
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Interventions for smoking cessation
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• Decreases risk of CAD by 30-50% within the 1st year
• Motivation assessment • Nicotine therapy • Buprion (wellbutrin) * Antidepression drugs |
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An imbalance between myocardial O2 demand and supply
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CAD (ischemia)
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• Not a disease but a symptom of CAD
• Refers to ischemic pain • Usually once the pt is symptomatic there is at least a 75% occlusion of one vessel |
Angina Pectoralis
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angina that does not get better with rest and/or nitro, nothing to do with supply and demand
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Unstable Angina (acute coronary syndrome)
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• Ischemic pain secondary to atherosclerosis of coronary arteries, alleviated with rest
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Stable angina
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Meds for angina
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• Aspirin
• Plavix • Talictid Beta Blockers “olol” • Give post MI also • Decrease O2 requirements by blocking beta receptors resulting in decrease HR, BP & increases exercise tolerance thus decreasing O2 requirements of myocardial demand • IE: propanolol (inderal), metoprolol (Lopressor), and atenolol (tenormin) • s/e: hypotension, bradycardia • use cautiously with asthmatics and diabetics Calcium Channel Blockers • indicated in CA spasms, CHF, and diabetes • blocks electrical excitation of cardiac cells and affects contraction of smooth and cardiac muscle • relaxes smooth muscle • decreases BP and HR which decreases O2 demand, decreases contractility (- ianotropic effect) • affects from the SA node down by working on action potentials • IE: procardia (nifedipine), Calan (verapamil), Cardizem( diltiazem) • s/e: bradycardia ACE Inhibitors “prills” • tells kidneys to not convert angiotensin 1 to 2 thus decreasing fluid and sodium retention • decreases circulating volume, decreases workload, decreases demand for O2 • monitor BP, sodium/potassium and urinary output |
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Meds prevent platelet aggregation
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ASA - 81mg daily (baby aspirin)
Clopidogrel - plavix Ticlopidine - ticlide |
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Meds promote peripheral vasodilation reduce vascular resistance and BP decrease cardiac workload
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Nitrated (NTG)
don't give if BP less than 90 |
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• Myocardial necrosis caused by lack of adequate blood supply and O2 supply to the myocardium
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Acute Myocardial infarction
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Manage acute MI
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• Immediately bedrest, O2 and vitals, EKG and labs
• MI profile (MIP) includes CK-MB isoenzymes which show tissue damage, shows expansion • Also includes Troponin (1.5 to 1.8) becomes elevated 3 hours after onset but can remain elevated 4 up to 15 days so does not show expansion • BMP: checking potassium • CBC • PTT PT/INR: want to know how the blood is clotting • BNP: beta neutretic peptide: Found in cardiac muscle, indicative of CHF, bodies own way of increasing heart contraction, positive ianotropic effect |
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Meds for MI
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• MONA: Morphine, oxygen, nitroglycerin, aspirin
• NGT gTT • Possibly vasopressors: watch BP • Beta blockers: decrease HR which decreases O2 consumption which decreases myocardial demand • Procardia: decreases BP; short acting • Lasix: decreases afterload, decreases preload, decreases volume, decreases resistance, decreases cardiac demand • Thrombolytic Agent “clot busters” such as Activase, Alteplase, TPA, Streptocinase. Must have sound decision that the person has had an MI b/c does not target just cardiac clots. Must have chest pain >30 mins that is unresponsive to Nitro and changes on the EKG that shows an MI |
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Post procedure meds (Percutaneous coronary intervention, percutaneous transluminal coronary angioplasty, drug-eluding stent)
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• Anticoagulation Therapy: heparin
• Anti Platelet Drugs: Plavix for 2 weeks and then a lifetime of aspirin. Also Glycprotein IIb/IIa inhibitors such as Reopro and Antegrilin IV for those with unstable lesion and/or with a risk for abrupt closure after the procedure |
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If pain acute related to ischemia, nurse must assess
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P = Provocation/ Palliative
Q = Quality/ Quantity R = Region/ Radiation S = Severity/ Scale T = Timing &Provide: MONA Stat 12 lead EKG Call DR PRN |
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• 2D ultrasound of the heart
• Checks Ejection Fraction ( normal 55, below 30 Bad) |
Echo (MI diag)
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• Thallium, Persantine, or Dobutamine injected with a normal stress test and absorbs in the tissue well and cold spots of dead tissue can be absorbed
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Radiological Nuclear test
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• Photo emission test
• Done rarely due to high levels of dye. Series of pictures to look at LV and the Ejection fraction |
SPECT/ MUGA
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Test that
• Determines patency of the CA’s and can open occluded vessels • PCI • PCTA : angio cracks the plaques, stretches the intima which decreases the likelihood of the plaques sticking • Stents • Brachytherapy: intracoronary radiation where radiation is implanted. This helps prevent overgrowth if the epithelium • Artherectomy: removal of plaque segments in fragments with use of a “rotoblade” • Thrombectomy: excision of abnormal growth with suction |
Cardiac Cath
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• Used to divert blood flow around an occluded CA through connecting the saphenous vein or internal mammary artery to the vessel distal to the obstruction or to the aorta.
• A cardiovascular bypass pump is used during surgery |
CABG
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Post op care for CABG
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• Assess PA cath pressure (SWAN GANZ cath)
• CVP assess right side of heart • PAWP PAS/PAD assesses the left side of the heart • Assess CO and SVR • Hourly assess urine output and IV intake • Hourly assess output from drains • For pain give morphine and other analgesics but encourage deep breathing and coughing to prevent atelactasis/pneumonia • For altered respiratory function use sterile suctioning every 4 hrs and prn. Monitor ABG’s, pulse Ox, and wean when possible • For risk of infection monitor for s/s of an infection, C & S wound PRN and treat • For risk of constipation provide fluids, stool softeners and encourage activity. Moving is the key to prevention • For risk of injury provide SCD’s and/or Teds, Heparin and early ambulation |
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Treatment for Sudden Cardiac Death
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• CPR
• ACLS • SHOCK THEM If survive prevent recurrence with : Antidysrhythmic drugs (pronestyl, quinidine) Pacemaker AICD (automatic implantable cardiac defibrillator) Induce hypothermia to slow down body processes |
