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89 Cards in this Set
- Front
- Back
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What are the risk factors for CAD?
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Age, men, white, genetic, diabetes, tobacco, sedentary, HTN, psychosocial, obesity, elevated homocysteine
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Total cholesterol should be...
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<200
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Fasting triglycerides level should be...
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<150
Fast for 12 hours before test. No alcohol for 24 hrs before test. |
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LDL should be...
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<160
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HDL should be...
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>50
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What is the initial cardiac event in men with CAD?
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MI
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What is the initial cardiac event in women with CAD?
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Angina
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How do you figure the risk for CAD?
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Divide total cholesterol by HDL level.
Ratio of <3 is low risk....>5 is high risk |
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What do HDL's do in the blood?
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Take fat away from arteries to the liver for metabolism.
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What hormone protects the HDL's?
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Estrogen
Post-menopausal women more at risk for CAD. |
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What do LDL's do in the blood?
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Deposit cholesterol on arterial walls.
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What diseases contribute to development of CAD?
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Diabetes type 2 and chronic renal failure
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What drugs contribute to the development of CAD?
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Corticosteroids, HRT
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LDL goal value for people with multiple risk factors for CAD is....
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<70
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2nd biggest risk factor for CAD development
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HTN b/c it increases the shearing stress on the blood vessels
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Smoking and CAD connection
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It is the 3rd major risk factor. This includes 2nd hand smoke.
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What kind of physical activity should one engage in that is at risk for CAD?
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Moderate physical activity
Brisk walking 30 min 5 or more times/week |
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What is the definition of obesity?
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BMI >30
Waist >40in in men or 35in in women Calculate BMI by weight in kilograms divided by height in meters squared |
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What type of psychologic states contribute to CAD?
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Type A personality, depression/anger/stress (due to increased epenephrine and norepinephrine secreted in these states)
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What is homocyteine?
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Amino acid produced during protein catabolism.
Risk factor for CAD. |
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What lowers homocysteine levels?
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B vitamins, folic acid
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What should the lab value of homocysteine be?
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Male: 5.2-12.9
Female: 3.7-10.4 |
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What is C-reactive protein?
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Marker of inflammation that predicts risk of cardiac disease in pts with normal lipid values
Should be <1, not >3 (high risk) Can get this lab in a nonfasting state any time of the day. |
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2 illicit drugs that put a person at risk for MI
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cocaine and meth
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Dietary modifications for persons at risk for CAD should include...
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a diet low in saturated fat and cholesterol and high in whole grains, fruits, and vegetables.
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What are the main sources of saturated fat?
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animal fat like bacon, lard, egg yolk, dairy, coconut/palm oil, butter, cream cheese, sour cream
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What are the best sources of polyunsaturated fats which should be included most in the diet?
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Vegetable oils (safflower, corn, soy, cottonseed, flax), shellfish, fish oil, walnuts, pumpkin seeds, sunglower seed, margarine
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What are sources of monounsaturated fats which should be used moderately?
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Olive oil, almonds, panuts, pecans, peanut oil, avacado, fish oil
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How often should one get a complete lipid profile?
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q5years beginning at age 20
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What are some complementary/alternative therapies for increased blood lipids?
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garlic, niacin, omega-3 fatty acids, psyllium, plant sterols, red yeast rice, and soy
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Can you stop taking your statins if you take garlic?
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Hell no!
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Statin side effects
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liver damage and skeletal muscle breakdown
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Signs of rhabdomylosis (muscle breakdown) include...
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increased creatinine kinase and muscle tenderness
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Side effect of taking niacin for CAD
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Flushing within 20 min after taking the drug that may last for 30-60 min
(Can premedicate with aspirin or NSAID 30 min before to reduce the flushing) |
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What are the side effects of fibric acid derivatives like TriCor and Lopid?
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Increases the side effects of statins
Increases the effects of warfarin and antihyperglycemics |
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How does cholestyramine help with CAD?
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Binds to bile acids in the intestine, increasing removal of LDL and cholesterol
May interfere with the abd=sorption of digoxin, thiazides, warfarin, penicillins |
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How does the body get rid of cholesterol?
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In the bile
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What kind of anti-platelet therapy is recommended for people at risk for CAD?
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81mg aspirin for men >45 and women >65 (unless the woman is high risk to begin with)
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If you can't take 81mg aspirin, you can always use....
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clopidigrel (Plavix)
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What does angina feel like?
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Heavy, choking, suffocating, constrictive, squeezing...doesn't change with breathing or position
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Where does pain radiate to when it is cardiac related?
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back, neck, arms, jaw, shoulder, elbow
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What is nitroglycerin's effect on angina?
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Helps stable angina
Does NOT help unstable angina (angina caused by a thrombus) |
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What is Prinzmetal's angina?
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Angina from coronary vasospasm seen in pts with migraine or Raynaud's hx. Rare. Happens at rest.
Tx: Ca channel blockers or nitrates |
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Rx for chronic stable angina
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Same as for CAD with the addition of beta-blockers, Ca channel blockers, nitrates
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Nursing considerations for short acting nitroglycerin
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If it is helping, you can repeat it q5 min for 3 times
Watch for orthostatic hypotension and don't combine with Viagra |
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Who can't have beta blockers?
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Asthmatics
Diabetics - mask signs of hypoglycemia |
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What is unstable angina?
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Angina that occurs at rest, or has a worsening pattern
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What is the hallmark of an MI?
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Seere, immobilizing chest pain not relieved by rest, position change, or nitrate administration
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Skin with an MI looks...
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ashen, clammy, diaphoretic
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Other s/s of MI include...
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fever, n/v, crackles, murmur
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What does papillary muscle dysfunction do?
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Cause mitral valve regurgitation
Lethal Tx: Nitro and surgery |
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What is pericarditis?
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inflammation of the pericardium
happen 2-3days post MI chest pain aggrevated by inspiration, coughing, and movement of the upper body...friction rub...fever treat with aspirin and corticosteroids |
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What is Dressler syndrome?
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Pericarditis with effusion and fever that develops 4-6 weeks post MI or cardiac surgery
Corticosteroids are the tx |
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How does an MI with complete occlussion show up on the EKG?
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ST elevation and a pathologic Q wave
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How long does it take the CK levels to rise after an MI?
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6-18 hrs
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Myoglobin raises...
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3hrs after MI and returns to normal in a day (vs weeks with troponin I)
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Troponin I level should be
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<0.5
>2.3 means there has been an MI |
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What is the tx for MI?
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ABC's!
O2 VS 12 lead ECG insert to large bore IV cathetars |
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Activity after an MI should be...
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bedrest for 12-24 hours and then gradual increase
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What is PCI?
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Percutaneous intervention - balloon angioplasty
done under local anesthesia, hospital stay 1-3 days |
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Contraindications for fibrinolytic therapy include
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internal bleeding, hx of cerebral aneurysm, intracranial neoplasm, previous cerebral hemorrhage, stroke in past 3 mo, closed-head/facial trauma w/in 3mo, suspected aortic dissection
HTN, advanced cancer/liver/kidney disease, traumatic CPR (>10min), pregnancy, dementia |
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Meds for Prinzmetal's angina
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Ca channel blockers
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What do you monitor during nitroglycerin therapy?
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BP!!
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Nursing Dx for acute coronary syndrome
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Acute pain
Decreased CO Anxiety Activity Intolerance Ineffective self-health management |
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What can bring on angina?
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Heavy meals
Extremes in temperature |
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Nursing intervention for nasal cannulas
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skin assessment!
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Activity level with ACS
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BEDREST
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The Borg scale to evaluate exercise...
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9 is light walking
13 is hard exercise but ok to continue 17 is hard and a fit person can go on 19 is the hardest exercise ever |
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How do you calculate the target HR?
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220-person's age
Limit exercise to RESPONSE to activity, not target heart rate. Especially b/c pt might be on beta blockers. |
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Sexual activity after ACS
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Avoid eating food or drinking alcohol 3-4hrs prior.
All types of sexual activity are ok besides anal b/c of the vasovagal response. No Viagra with nitrates. Can take nitrates before sex to reduce chest pain. |
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What is the cardiac output?
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HR x SV
Normal is 4-8L/min |
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What should the MAP be?
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Above 60
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Hallmark of MI
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Pain: chest, left arm, jaw, throat, back, shoulders - not relieved by rest or NTG
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What is the #1 killer of women?
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MI
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Symptoms of MI in a diabetic
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Maybe nothing
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What is papillary muscle rupture?
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A complication of MI. the heart attack causes the cordae tendenae break so the valve is just flapping open. Rapid pulmonary edema and failure.
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Hallmark and rx of pericarditis
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PAIN ON INSPIRATION
NSAIDS FOR INFLAMMATION |
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Dx studies for MI
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SERIEL ekg and cardiac enzymes to see if we are seeing changes
q8h x3 |
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What is the EKG change with MI?
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ST segment elevation
Tombstones |
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If you see a U wave, what are we looking for?
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Potassium imbalance
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What is indicative of past myocardial damage?
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Q wave >1mm
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PAWP significance
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gives you idea of fluid volume
left atrial pressure |
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Tx of choice for sudden cardiac death
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Amiodorone and ICD (defibrillator/pacemaker)
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What is sudden cardiac death?
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Loss of heart function from v tach or v fib, treat with electricity, pt needs ICD and amioderone
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Summarize ACS
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Sudden blockage of an artery
MONA Morphine Oxygen Nitro Aspirin |
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Summarize a fib
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Irregular rate
Impaired pumping function Absent or wavy P waves Treat with amioderone Risk for blood clotting - put on blood thinners Digoxin Diltiazem Ca channel blocker Beta blockers |
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How do we treat the inflammatory disorders of the heart?
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Anti-inflammatories
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How do we dx endocarditis?
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blood cultures, echocardiogram (look for vegetations)
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How is myocarditis dx?
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Myocardial biopsy
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