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23 Cards in this Set

  • Front
  • Back
Major Risk Factors of CAD
• 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
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
Treatment for hyperlipidemia
• 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
Interventions for smoking cessation
• Decreases risk of CAD by 30-50% within the 1st year
• Motivation assessment
• Nicotine therapy
• Buprion (wellbutrin)
* Antidepression drugs
An imbalance between myocardial O2 demand and supply
CAD (ischemia)
• 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
angina that does not get better with rest and/or nitro, nothing to do with supply and demand
Unstable Angina (acute coronary syndrome)
• Ischemic pain secondary to atherosclerosis of coronary arteries, alleviated with rest
Stable angina
Meds for angina
• 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
Meds prevent platelet aggregation
ASA - 81mg daily (baby aspirin)
Clopidogrel - plavix
Ticlopidine - ticlide
Meds promote peripheral vasodilation reduce vascular resistance and BP decrease cardiac workload
Nitrated (NTG)

don't give if BP less than 90
• Myocardial necrosis caused by lack of adequate blood supply and O2 supply to the myocardium
Acute Myocardial infarction
Manage acute MI
• 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
Meds for MI
• 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
Post procedure meds (Percutaneous coronary intervention, percutaneous transluminal coronary angioplasty, drug-eluding stent)
• 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
If pain acute related to ischemia, nurse must assess
P = Provocation/ Palliative
Q = Quality/ Quantity
R = Region/ Radiation
S = Severity/ Scale
T = Timing

&Provide:
MONA
Stat 12 lead EKG
Call DR PRN
• 2D ultrasound of the heart
• Checks Ejection Fraction ( normal 55, below 30 Bad)
Echo (MI diag)
• 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
Radiological Nuclear test
• Photo emission test
• Done rarely due to high levels of dye. Series of pictures to look at LV and the Ejection fraction
SPECT/ MUGA
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
• 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
Post op care for CABG
• 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
Treatment for Sudden Cardiac Death
• 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