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92 Cards in this Set

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What type of disorder is Arteriosclerosis?
most common chronic arterial disorder
What are the characteristics of arteriosclerosis?
thickening, loss of elasticity and calcification of arterial walls
What is atherosclerosis?
a form of arteriosclerosis
What are the characteristics of atherosclerosis?
deposits of fat and fibrin....that prevent flow and harden arteries

fat - prevents flow
fibrin - hardens arteries
List some common cues to C/V problems.
fatigue
dyspnea
fluid retention/edema
irregular HB
palpitations
chest pain
calf/leg tenderness
numbness and tingling in legs
being dizzy, light headed, syncope
What does coronary artery disease mean?
atherosclerosis of the coronary blood vessels
What are some synonyms of CAD?
CHD, IHD, ASHD, CVHD
Where are the deposits with CAD? What is it...arterio or athero?
focal deposits of cholesterol and lipids in the INTIMAL WALL of the heart

it is athero
List some age related changes to the heart.
calcified valves
stiffened arteries
valve rigidity
inelasticity
How does an old heart respond to a stress test?
Heart has less increase in HR and longer period of recovery needed

There is a decreased response to stress when we age
What is collateral circulation?
When the veins regenerate around a block. It happens more when we get older. Be aware that a heart issue in a younger person is much more of a problem than in an older person due to decreased collateral circulation
What is the name of the marker of inflammation related to CAD?
C-reactive protein (CRP) is a nonspecific marker of inflammation that is increased in many patients with CAD. Chronic exposure to even minor elevations of CRP can trigger the rupture of plaques and promote the oxidation of LDL cholsterol leading to increased uptake by macrophages in the endotheial lining
How does CAD develop?
slow progressive disease
Who has the highest incidence of CAD?
white middle aged men
Who has earliest onset of CAD?
african americans (b/c of diet)
Who has highest death rate related to CAD?
african american women
List the nonmodifiable risk factors for CAD.
age (older)
gender (men)
ethnicity (white)
genetic predisposition with family history of heart disease
List the modifiable risk factors for CAD.
increased lipids (LDL/low HDL)
HTN
smoking
obesity
inactivity
DM
stress
medication noncompliance
BMI>25
Old age brings on what type of artery disease?
arteriosclerosis....age, chronic, hardening
The first major risk factor for CAD is highserum lipids. What is the second major risk factor and how is it defined?
hypertension

BP 140/90
What is the most common problem of the elderly and their health?
arteriosclerosis
An older person's HR is ___________. Their Cardiac Output is __________. Their peripheral pulses are ___________. Their valve rigidity is ________. Dysrhythmias are __________.
HR decreased
CO decreased (35%)
peripheral circulation (decreased)
peripheral pulses (decreased)
Heart valve rigidity is INCREASED
DysRHYTHMIAS are INCREASED.
What is the difference between arrhythmias and dysrhythmias?
arrhythmias are abnormal, but dysrhythmias are DEADLY
What are the clinical manifestations of CAD?
angina pectoris
acute coronary syndrome
sudden cardiac death
Angina pectoris is really __________ ________ ________ expressed symptomatically as angina.
transient myocardial ischemia
What are the LDL goals of CAD when the person is at high risk?
lower than 100 make lifestyle changes and then add drugs if it doesn't work
What are the LDL goals of CAD when the person is at low risk?
LDL lower than 160
What are the LDL goals of a moderate at risk person?
lower than 130
Angina pectoris should not persist more than 20 minutes after rest and.....
nitro
The patho of angina pectoris is....
Angina is due to myocardial demand for oxygen exceding ability to supply it....ANAEROBIC METABOLISM leads to LACTIC ACID leads to CHEST PAIN
Why doesn't the heart just supply more oxygen so the pain will stop?
b/c the veins are arterioscerotic and they can't dilate
How do you assess angina?
PQRST
Define the letters in a PQRST angina assessment.
P-precipitating events
Q-quality of pain
R-radiation of pain
S-severity of pain
T-timing
What do you mean by timing of pain?
When did the pain begin? Has the pain changed since this time? Have you had pain like this before?
When do the manifestations of CAD (angina, acute coronary syndrome and sudden cardiac death) usually occur during the day?
in the early morning after wakening
What are the types or kinds of angina?
stable
unstable
prinzmetals
nocturnal
angina decubitus
What does angina decubitus mean?
chest pain only happens when you lay down and is relieved by getting up. Presents like gas
There are seven precipitating factors to angina. List them.
Physical exertion
Temperature extremes
Strong emotions
Consumption of heavy meal
Tobacco use
Sexual activity
Stimulants
What does prinzmetal's angina look like?
rare, often at rest, is cyclical, and caused by spasm, NOT INCREASED PHYSICAL DEMAND. Frequently seen in patient's with migrane and Raynaud's.

Think of person on couch, eating pretzels and powdered donuts (Raynaud's)
What is stable angina?
intermittent, predictable, stops with stopping activity, usually infrequent
Where is a person with stable angina usually treated?

What are the treatments?
not in the hospital. they are given heart med to take at the predictable time

rest and sublingual nitroglycerine
What provokes stable angina?
exertion
How is the TIMING different in stable vs. unstable angina?
unstable is SUDDEN, NEW ONSET, occuring at REST
There are two parts to acute coronary syndrome. Name them.
Acute Coronary Syndrome includes:

1. Unstable Angina
2. Myocardial infarction
What are two side effects that are a problem with all nitrates?
headache ( you can take tylenol)

orthostatic hypotension
What causes an unstable angina?
break off of a plaque. You are concerned about MI due to thrombosis. Patient needs cardiac cath
How do you diagnose CAD?
ECG

Serum Cardiac Markers (triponin/CK-MB...creatnine kinase and C-reactive protein)
Explain what the CK-MB test is.
A blood study. The creatine kinase level is highly indicative of MI. CKMB levels increase 4-6 hours after MI.

Collected serial sampling way. Every 6-8 hours x3)
What is troponin?
a cardiac specific marker protein
What is c-reactive protein?
a marker of inflammation that can predict risk of cardiac disease and cardiac events, even in patients with normal lipid values
What is SO interesting about a BNP?
It is a peptide. Elevated indicates presence of heart failure and distinguishes cardiac vs. respiratory cause of dyspnea. INFUSION OF NATRECOR will elevate levels temporarily.
What is difference between ECG and echocardiogram?
ECG records cardiac electrical activity

Echocardiogram - records direction and flow of blood through heart...place patient in supine position on left side facing equipment
What does a cardiac catheterization study do?
obtains information about oxygen saturation and pressure readings within the heart chambers.
How is a cardiac cath done?
inject contrast medium to assist in examining structure and motion of heart. A catheter is either inserted into a vein (for right sided study) or into an artery (for left sided study). Brachial or Femoral vein.
Before a procedure, what are the nursing responsibilities for a cardiac cath procedure?
-obtain permission
-check for iodine sensitivity
-withhold food or fluids for 6-18 hours before procedure
-give sedative
-instruct patient to cough or take deep breath when catheter is inserted
-monitor patient on ECG throughout procedure
What type of sedative might be given to patient prior to cardiac catheterization?
valium PO
bendaryl
tagement
versed
What are the nursing responsibilities after a cardiac cath ?
-assess circulation to extremity
-check peripheral pulses, color/sensation of extremity every 15 minutes for 1 hour.
-Observe puncture site for hematoma and bleeding
-Place compression device over arterial site
-assess cardiovascular and respiratory
-watch for pulmonary embolism
What does a coronary angiography do?
study involves injection of radiopaque contrast medium directly into the coronary arteries. LOOKS AT BLOOD FLOW IN THE HEART VESSEL. It is used to evaluate patency of coronary arteries and collateral circulation.
What type of diet do you tell a CAD or angina patient to follow?
low fat, low sodium
What is laser angiography?
laser that widdles away the plaque
What type of sedative might be given to patient prior to cardiac catheterization?
valium PO
bendaryl
tagement
versed
What are the nursing responsibilities after a cardiac cath ?
-assess circulation to extremity
-check peripheral pulses, color/sensation of extremity every 15 minutes for 1 hour.
-Observe puncture site for hematoma and bleeding
-Place compression device over arterial site
-assess cardiovascular and respiratory
-watch for pulmonary embolism
What does a coronary angiography do?
study involves injection of radiopaque contrast medium directly into the coronary arteries. LOOKS AT BLOOD FLOW IN THE HEART VESSEL. It is used to evaluate patency of coronary arteries and collateral circulation.
What type of diet do you tell a CAD or angina patient to follow?
low fat, low sodium
What is laser angiography?
laser that widdles away the plaque
What is CABG?
bypass the occlusion
What is PTCA?
percutaneous translumina coronary angioplasty

(with or without stent placement)

pushes back the plaque
What is preload vs afterload?
preload is amount of blood in the heart AT REST

afterload is the PERIPHERAL RESISTANCE the heart must pump against
When you thinkcalcium channel blocker, you should think....
calcium channel blocker VASODILATION
Beta blockers reduce both....
heart rate and contractility

decrease afterload
What type of drug is famous for causing a 50% reduction in progression of CAD to an MI?
aspirin (antiplatelet agents)
When should antiplatelet drugs be administered?
should be administered as soon as ACS is suspected
Other than aspirin, what other drug is an antiplatelet?
plavix...it inhibits platelet aggregation and is an alternative for a patient that can not take aspirin
When singing the ABCs of chronic stable angina treatment, what is next after aspirin?
aspirin
antianginal
aceinhibitior
beta blocker blood pressure
cigarette smoking
cholesterol
diet diabetes
education
exercise
flu vaccination
Why do we give patients nitro?
it is a vasodilation It decreases both afterload and preload
Other than all the Nitros under nitrates, what is the one that is not a "nitro".
isosorbide dinitrate...it is an oral agent, standing order
Diferent than treating an stable angina, what are the ABCs of CAD tx?
Antiplatelet
Antianginal
Beta Blocker
Calcium channel
What are some calcium channel blockers?
amlodipine (Norvasc)
nifedipine (Procardia)
diltiazem (Cardizem)
nicardipine (Cardene)
A new diagnosis of CAD/Angina would have what type of treatment?
Aspirin, plavix or ticlid
Why might a angina patent have activity intolerance?
pain with activity
What are the treatments of an acute MI?
oxygen
morphine 1-2mg
nitroglycerine drip
aspirin 162mg
CK-MB q8x3
Troponin
Myoglobin
EKG
What is myoglobin?
low molecular weight protein that is 99-100% sensitive for MI. Serum concentrations rise 30-60 minutes after MI, but are rapidly cleared from body. Best if done within 12 hours of MI.
Where do you want your HDL to be?
greater than 35
Where do you want your LDL to be?
100-129
Where do you want triglycerides to be?
less than 150
Nursing requirements for checking lipids.
Fasting needed for 12 hours before. No alcohol for 24 hours
I am a test that illustrates contours, placement and chambers of the heart.
chest x-ray
What is a TEE?
visualizes structures in and around the heart by inserting transducer attached to an endoscope in the esophagus

Transesophageal Echocardiography
List additional nursing requirements prior to cardiac cath.
-consent
-iodine?
-NPO for 6-8 hrs?
-assess use of aspirin or NSAIDS
-discontinue oral anticoagulants
-IV started to KVO
-Establish baseline peripheral pulses
-Mark pulse sites with marker
-Take baseline VS
-administer sedative
-ECG monitoring
What is atherectomy?
removing plaque from the identified lesion by shaving plaque off vessel walls using rotary cutting device
What is dose for nitro?
1/150gr SL x 3 at five minute intervals
List the beta blockers
atenolol
metoprolol
propranolol