Unit 4A: Alterations In Perfusion

Front 1

-The major cause of CAD
-Focal deposit of cholesterol and lipids, primarily within the intimal wall of the artery
-Inflammation and endothelial injury play a central role in the development of this condition

Back 1

-Atherosclerosis

Front 2

What are the 3 stages of development of atherosclerosis?

Back 2

1.) Fatty Streak
2.) Fibrous Plaque
3.) Complicated Lesion

Front 3

This stage of development of atherosclerosis is of the earliest lesions; characterized by lipid-filling smooth muscle cells; a yellowish tinge appears and can be observed in the coronary arteries by the age of 15; treatment that lowers LDL cholesterol may reverse this process:

Back 3

-Fatty Streak

Front 4

During this stage of atherosclerosis development:
-beginning of progressive changes in the endothelium of the arterial wall
-age 30 and increases with age
-with CAD, the endothelium is not rapidly replaced, allowing LDLs and growth factors from platelets to stimulate smooth muscle proliferation and thickening of the arterial wall
-Fibrous plaque that appears grayish or white
-can form on one portion of the artery or in a circular fashion involving the entire lumen
-narrowing of the vessel lumen and a reduction in blood flow to the distal tissues

Back 4

-Fibrous Plaque

Front 5

During this stage of atherosclerosis development:
-it is the final stage
-the most dangerous
-once the integrity of the artery's inner wall has become compromised, platelets accumulate in large numbers leading to a thrombus
-leading to further narrowing or total occlusion of the artery

Back 5

-Complicated Lesion

Front 6

Do more women or men die of cardiovascular disease?

Back 6

-Women (African American women are at the highest rate)

Front 7

Name the 4 most modifiable risk factors for the development of CAD:

Back 7

1.) Elevated Serum Lipids
2.) HTN
3.) Tobacco Use
4.) Physical Inactivity

Front 8

The risk of CAD is associated with a serum cholesterol level of more than____ or a fasting triglyceride level of more than ______.

Back 8

-200 mg/dl

-150 mg/dl

Front 9

Are high serum HDL levels desirable or undesirable?

Back 9

-Desirable: HDLs carry lipids away from arteries and to the liver for metabolism

**Low HDLs levels are considered a risk factor for the development of CAD

Front 10

This lipoprotein contains both cholesterol and triglycerides and also are thought to deposit cholesterol directly on the wall of arteries:

Back 10

-VLDLs or very-low density lipoproteins

Front 11

A serum cholesterol level of ____ is at high risk for CAD and should be treated.

Back 11

- >200 mg/dl

Front 12

This class of medications is the widely used lipid-lowering drug:
-inhibit the synthesis of cholesterol in the liver which increases hepatic LDL receptors, this then allows the liver to remove more LDLs from the blood
-allows a small increase in HDLs

Back 12

-Statin drugs

**lovastatin (Mevacor), pravastatin (Pravachol), simvastatin (Zocor), fluvastatin (Lescol), atorvastatin (Lipitor), rosuvastatin (Crestor)

Front 13

Refers to chest pain that occurs intermittently over a long period with the same pattern of onset, duration, and intensity of symptoms
-Described as a pressure or an ache
-It usually does not change with position or breathing
-Usually lasts for only a few minutes (3-5 minutes) and commonly subsides when the precipitating factor is relieved
-Pain at rest is unusual
-Often predictable

Back 13

-Chronic Stable Angina

Front 14

Refers to ischemia that occurs in the absence of any subjective symptoms:

Back 14

-Silent Ischemia

Front 15

Describe what beta-blockers do:

Back 15

-Decrease myocardial contractility, HR, SVR, and BP which in return reduces myocardial O2 demand
-Decreases afterload
-Should be avoided in pts with asthma

Front 16

Describe what Ca-channel blockers do:

Back 16

-Systemic vasodilation with decreased SVR
-Decreased myocardial contractility
-Coronary vasodilation
-Cause smooth muscle relaxation and relative vasodilation of coronary and systemic arteries, thus increasing blood flow

Front 17

When ischemia is prolonged and not immediately reversible, this develops and encompasses the spectrum of unstable angina, NSTEMI, and STEMI:

Back 17

-Acute Coronary Syndrome (ACS)

Front 18

Artery partially occluded by a thrombus:

Back 18

-NSTEMI

Front 19

Artery completely occluded by a thrombus:

Back 19

-STEMI or "tombstone"

Front 20

Chest pain that is new in onset, occurs at rest, or has a worsening pattern
-Unpredictable and is considered an emergency
-Increasing frequency and is easily provoked by minimal or no exertion, during sleep, or even at rest

Back 20

-Unstable Angina

Front 21

Occurs as a result of sustained ischemia, causing irreversible myocardial cell death
-Secondary to thrombus formation
-Contractile function of the heart stops in the necrotic area(s)
-Most involve some portion of the LV

Back 21

-MI

Front 22

This common complication of MI is an inflammation of the visceral and/or parietal pericardium, may result in cardiac compression, decreased ventricular filling and emptying, and HF
-aggravated by inspiration, coughing, and movement of the upper body

Back 22

-Pericarditis

Front 23

These are released into the blood in large quantities from necrotic heart muscle after an MI:

Back 23

-Serum cardiac markers (CK and troponin)

Front 24

CK levels begin to rise approximately __ to ___ hours after an MI, peak in ____ hours, and return to normal within ___ to ____ days.

Back 24

-3-12 hours
-24 hours
-2-3 days

Front 25

Troponin levels increase __ to ___ hours after the onset of MI, peak at __ to ___ hours, and return to baseline over __ to ___ days.

Back 25

-3-12 hours
-24-48 hours
-5-14 days

Front 26

The goal of PCI is to open the affected artery within ____ minutes of arrival to the ED.

Back 26

-90 minutes

Front 27

What are the advantages to PCI:

Back 27

1.) Provides an alternative to surgical intervention
2.) Performed with local anesthesia
3.) Patient is ambulatory 24hrs after procedure
4.) Length of hospital stay is shorter than with CABG and reduces hospital costs (1-3 days instead of 4-6 days)
5.) Rapid return to work (5-7 days as opposed to 2-8 weeks)

Front 28

The goal for the administration of a fibrinolytic is within ___ minutes of the patient's arrival to the ED.

Back 28

-30 minutes

**Optimal outcomes can be achieved if the fibrinolytic is administered within 60 minutes of the onset of symptoms

Front 29

Names drugs used for both treatment and maintenance of MI:

Back 29

1.) IV nitroglycerin: used initially; goal is to reduce anginal pain and improve coronary blood flow; has an immediate onset of action and can be titrated to prevent, treat, and stop UA; decreases preload and afterload; increases myocardial O2 supply; BP is closely monitored

2.) Morphine Sulfate: given for chest pain that is unrelieved by nitroglycerin; decreases cardiac workload; reduces contractility, and decreasing BP and HR; helps reduce anxiety and fear

3.) Beta-blockers: used to decrease myocardial O2 demand by reducing HR, BP, and contractility; use if these drugs in the first hours of MI have shown to reduce the size of the infarction and incidence of complications

4.) ACE-inhibitors: recommended following anterior wall MIs or MIs that result in decreased left ventricular function or pulmonary congestion; can help prevent ventricular remodeling and prevent or slow the progression of HF

5.) Antidysrhythmia Drugs: only used if dysrhythmias are life-threatening

6.) Cholesterol-Lowering Drugs

7.) Stool Softeners

Front 30

The major nursing responsibilities for the care of the patient following PCI involves:

Back 30

*Monitoring for signs of recurrent angina
*Frequent assessment of VS, including HR and rhythm
*Evaluation of the groin site for signs of bleeding
*Maintenance of bed rest per institution policy

Front 31

Unexpected death from cardiac causes
-An abrupt disruption in cardiac function, producing an abrupt loss of CO and cerebral blood flow

Back 31

-Sudden Cardiac Death

Front 32

The most effective method of terminating ventricular fibrillation and pulseless VT
-most effective when the mycardial cells are not anoxic or acidotic
-accomplished by the passage of a DC electric shock through the heart that is sufficient to depolarize the cells of the myocardium
-intent is that subsequent repolarization of myocardial cells will allow the SA node to resume the role of pacemaker

Back 32

-Defibrillation

Front 33

Defibrillators that have rhythm detection capability and the ability to advise the operator to deliver a shock using hands-free defibrillator pads:

Back 33

-Automatic external defibrillators (AEDs)

Front 34

The therapy of choice for the patient with hemodynamically unstable ventricular or supraventricular tachydysrhythmias
-used to deliver a countershock that is programmed to occur on the R wave of the QRS complex of the ECG

Back 34

-Synchronized Cardioversion

Front 35

Describe the different between synchronized cardioversion and defibrillation:

Back 35

*Synchronized cardioversion:
-done on a nonemergency basis
-patient is sedated before the procedure
-used on a patient with superventricular tachycardia or VT with a pulse that is hemodynamically unstble
-energy needed is generally less than the energy needed for defibrillation

*Defibrillation:
-used when a patient is experiencing ventricular fibrillation and pulseless VT

Front 36

Describe how an implantable cardioverter-defibrillator works (ICD):

Back 36

-Approximately 25 seconds after the sensing system detects a lethal dysrhythmia, the defibrillating mechanism delivers a 25-joule or less shock to the pt's heart
-able to recycle and continue to deliver shock if needed
-equipped with antitachycardia and antibradycardia pacemakers
-spares pt painful defibrillator shocks

Front 37

An electric device used to pace the heart when the normal conduction pathway is damaged or diseased:

Back 37

-Pacemaker

Front 38

A pacemaker that has the power source outside the body:

Back 38

-Temporary Pacemaker

Front 39

This pacemaker consists of a lead or leads that are threaded transvenously to the right atrium and/or right ventricle and attached to the external power source:

Back 39

-Transvenous Pacemaker

Front 40

This is achieved by attaching an atrial and ventricular pacing lead to the epicardium during heart surgery:

Back 40

-Epicardial pacing

Front 41

This type of pacemaker is used to provide adequate HR and rhythm to the patient in an emergency situation
-one pad is positioned on the anterior part of the chest and the other pad is placed on the back
-warn patient about uncomfortable muscle contractions but reassure them it is temporary and whenever possible, analgesia and/or sedation should be provided

Back 41

-Transcutaneous pacemaker

Front 42

This form of therapy is new and used to "burn" or ablate areas of the conduction system as definitive treatment of tachydysrhythmias
-done after EPS has identified the source of the dysrhythmia
-an electrode-tipped ablation catheter is used to ablate accessory pathways or ectopic sites in the atria, AV node, and ventricles
-a successful therapy with a low complication rate

Back 42

-Radiofrequency Catheter Ablation Therapy

Front 43

Name ECG change(s) that are seen in myocardial ischemia:

Back 43

-ST segment depression
and/or
-T wave inversion

**these occur in response to the electrical disturbance in the myocardial cells due to an inadequate supply of blood and O2

Front 44

Name ECG change(s) that are seen in myocardial injury:

Back 44

-ST segment elevation

**If treatment is prompt and effective, it is possible to restore O2 to myocardium and avoid infarction and will be confirmed by the absence of serum cardiac markers
**If markers are present, infarction has occurred

Front 45

Name ECG change(s) that are seen in myocardial infarction:

Back 45

-ST segment elevation
-pathologic Q wave
-T wave inversion

**if pathologic Q wave appears, it indicates that at least half the thickness of the heart wall is involved, which is then referred to as a Q wave MI

Front 46

A brief lapse in consciousness accompanied by a loss in postural tone (fainting), is a common diagnosis of pats coming into the ED and hospital:

Back 46

-Syncope