1. pathophys of CAD
    • Endothelial cells are injured
    • --Become permeable to circulating lipoproteins
    • --Fatty streak formsRepeated injury causes streak to grow to a plaque
    • --Complicated lesion compromises vessel wall
    • Atherosclerotic plaque may obstruct a coronary vessel
    • Plaque may rupture, forming a thrombus
    • Vessel may become partially or totally occluded
    • --May occur anywhere in the vessel
  2. Risk factors for CAD

    • Non-changeable
    • --age, family history, sex, and race
    • Changeable
    • --hypertension, tobacco, high LDL, diabetes, obesity, sedentary life, stress
    • Contributing
    • --DM
    • --Metabolic Syndrome (DM is a subset of of metabolic syndrome)
    • --Hcy (homocystien, enflammatory marker).
  3. SnSs of CAD
    • The classic symptom of CAD is angina, the direct result of inadequate flow of oxygen to the myocardium (ischemic).
    • P = Provocative
    • Q = Quality
    • R = Region/Radiation/Relief
    • S = Severity/Other Symptoms
    • T = Timing
  4. Types of Angina
    • Stable Angina: is predictable in frequency and durationhas not changed over a period of months
    • Unstable Angina: increases in frequency and duration. Is more easily induced. Does not necessarily subsite with rest. Progressively gets worse, does not respond to nitrates.
    • Prinzmetal’s Angina: results from unpredictable coronary artery spasmmay occur at rest or sleep. Not technically considered CAD.Look over this one for the test.
  5. What does an ECG look like for angina?
    • Image Upload 1
    • Often read while stressing heart via pt on treadmill.
    • This is a normal one. With aschemic heart, ST segment will be below baseline, like this:
    • Image Upload 2
  6. Treatment for Angina
    • Nitrates
    • --short-acting
    • --long-acting
    • Beta-adrenergic blockers
    • Calcium channel blockers
    • ACE inhibitors
  7. What are some invasive treatments for CAD?
    • Cardiac Catheterization
    • --Angiogram: photos taken via floroscapy (information gathering)
    • --Angioplasty: the actual surgical procedure to correct blockage.
    • Image Upload 3
    • --PCI: percutaneous cardiac intervension
  8. Coronary Artery Bypass Graft (CABG)
    • Image Upload 4
    • Coronary Artery Bypass Graft (CABG)
    • --Graft circumvents the occluded artery entirely. Occluded artery stays in place and is simply not used due to blood flow originating above the site of original artery insertion.
    • --For obstructive lesions
    • --Uses vein and/or artery grafts
  9. Nursing intervensions for angina/any cath-lab patient.
    • Explain all procedures (education)
    • Pain control. Sometimes nitro can help with this.
    • Hemodynamic Monitoring
    • Rest and comfort to keep cardiac demand down.
    • Monitor insertion site for bleeding; check distal pulses and movement
    • Instruct about fluids and bed rest
    • Instruct about treatment

    Increase 02 supply, decrease 02 demand.
  10. Prevension of CAD/Angina
    • Diet and Exercise
    • Tobacco Cessation
    • Stress Reduction
    • Control of Hypertension, Serum Cholesterol, and Triglycerides
    • Minimization of Platelet Aggregation (antithrombolytic)
Card Set
Coronary artery disease and acute coronary syndrome