What is the final and most dangerous stage of atherosclerosis?
Complicated Lesion: Here s where a thrombus can be formed as the artery's inner wall has been compromised and platelets accumulate in large numbers.
What is considered HTN for a person who has diabetes or chronic kidney disease?
130/80
What is ischemia?
An organ, particularly the heart, that is not getting enough O2. It is reversible.
ST elevation in an zone of hypoxic injury to the heart will be in how many continuous leads?
2 or more
The nurse determines that teaching about implementing dietary changes to decrease the risk of CAD has been effective when the patient says,
B.
List the 3 labs that look at damage to the heart?
Myoglobin
Creatine Kinase (CPK)
Troponin
What lab tests will you look at concerning the patient's heart and their diet?
Trigllycerides
Cholesterol
LDL and HDL
Match:
These labs will rise within a range of time
1. CK-MB ____
2. Troponin ____
3. Myoglobin ____
a. This will begin to rise within 2 hours and peaks in 3 to 1 hours.
b. This will be detectable within 4 to 6 hours, and peaks at 10-24 hours. It can be detected up to 10-14 days.
c. This begins to rise about 6 hours after symptoms onset, peaks in 18 hours, and returns to baseline within 24-36 hours.
1. c
2. b
3. a
Two risk factors for coronary artery disease that increase the workload of the heart and increase myocardial oxygen demand are:
D.
An elevated blood pressure and cigarette smoking (causes vasoconstriction)
increase the rate of atherosclerosis; atherosclerosis increases the workload of
the heart and increases myocardial oxygen demand.
T or F: HTN increases the rate of atherosclerosis
True
List 3 symptoms when O2 demand is greater than supply?
Tachycardia
Higher respiration
Mild anxiety
What is this term:
Chest pain that goes away with rest
Chronic stable angina
This term is a variant of angina: occurs at rest, usually in response to reversible, severe spasm of a major coronary artery
Prinzmetal angina
This is a type of angina where chest pain occurs in the absence of significant coronary atherosclerosis or coronary spasm.
Angina occurs d/t abnormalities of the coronary microcirculation (small branches of distal coronary arteries.
Microvascular angina (Microvascular disease)
What are indications for short-acting nitrates vs. long-acting ones?
Short-acting: first-line therapy for tx of angina
Long-acting: used to reduce the incidence of anginal attacks
Which drugs are the preferred for the management of chronic stable angina? Why?
Beta-Adrenergic blockers: they reduce the myocardial oxygen demand by decreasing contracitility, HR, SVR, and BP
Which class of drug is used to manage prinzmetal's angina?
Calcium channel blockers
What are the 3 primary effects of calcium channel blockers?
1. systemic vasodilation with decreased SVR
2. decreased myocardial contractility
3. coronary vasodilation
What are the antidotes for classical anticoagulant toxicity? (UFH and Warfarin)
UFH: protamine sulfate
Warfarin: Vitamin K
How is MI defined?
Sustained ischemia (>20 mins), causing irreversible myocardial cell death
List interventions you would do when suspecting MI, in order of highest priority
If not already, sit or lay down
O2, IV, Crash cart
12 lead
Labs for cardiac markers (Troponin, CKMB)
Portable Chest XR (PCXR)
What is the first line of tx for patients with confirmed MI? Why?
Emergent PCI: the goal is to open the affected artery within 90 minutes of arrival to a facility with an interventional cardiac cath lab
What is the contraindication for nonspecific betablockers?
Asthma or COPD patients
If a patient is bleeding when on a newer anticoagulant where vitamin K won't reverse the effect, what could be given?
Platelets: helps with starting clotting process
What are big side effect of statin drugs?
Rhabdo: s/s of achy muscles, usually in calves when they're walking
This med interferes with the synthesis of cholesterol and triglycerides. What is its primary side effect that people dislike?
Niacin (Vitamin B): sun sensitivity
This drug primarily affects triglyceride levels and decreases synthesis of lipids.
Atromid
This drug lowers VLDL levels and increases HDL.
Fibric Acid
This drug binds cholesterol with bile into stool. It tastes awful.
