Coronary Heart Disease and Acute Coronary Syndrome

During a routine health examination, a 48 year old patient is found to have a total cholesterol level of 224 and a LDL of 140. What does the nurse teach the patient based on the Therapeutic Lifestyle Changes diet (select all that apply): a. use fat free milk b. abstain from alcohol use c. reduce red meat in diet d. eliminate intake of simple sugars e. avoid egg yolks and foods prepared with whole eggs

a, c, e Therapeutic Lifestyle Changes diet recommendations emphasize reduction in saturated fat and cholesterol intake. Red meats, whole milk products, and eggs as well as butter, stick margarine, lard, and solid shortening should be reduced or eliminated from diets. If triglyceride levels are high, alcohol and simple sugars should be reduced.

The nurse is encouraging a sedentary patient with major risk factors for CAD to perform physical exercise on a regular basis. In addition to decreasing the risk factor of physical inactivity, the nurse tells the patient that exercise will also directly contribute to reducing which risk factors? a. hyperlipidemia and obesity b. diabetes mellitus and hypertension c. elevated serum lipids and stressful lifestyle d. hypertension and elevated serum homocysteine

a. Increased exercise without an increase in calorie intake will result in weight loss, reducing the risk associated with obesity. Exercise increases lipid metabolism and increases HDL, thus reducing CAD risk. Exercise may also indirectly reduce the risk of CAD by controlling hypertension, promoting glucose metabolism in diabetes, and reducing stress. Although research is needed to determine whether a decline in homocysteine can reduce the risk of heart disease, it appears that dietary modifications are indicated for risk reduction.

To which patient should the nurse teach the Therapeutic Lifestyle Changes diet to reduce the risk of CAD? a. all patients to reduce CAD risk b. patients who have experienced an MI c. individuals with 2 or more risk factors for CAD d. individuals with a cholesterol level >200

a. The Therapeutic Lifestyle Changes diet includes recommendations for all people, not just those with risk factors, to decrease for CAD.

What accurately describes the patho of CAD/ a. partial or total occlusion of the coronary artery occurs during the stage of raised fibrous plaque b. endothelial alteration may be caused by chemical irritants such as hyperlipidemia or by tobacco use c. collateral circulation in the coronary circulation is more likely to be present in the young patient with CAD d. the leading theory of atherogenesis proposes that infection and fatty dietary intake are the basuc underlying causes of atheroscerosis

b The etiology of CAD includes atherosclerosis as the major cause. The patho of atherosclerosis development is r/t endothelial chemical injury and inflammation, which can be the result of tobacco use, hyperlipidemia, hypertension, toxins, diabetes mellitus, hyperhomocysteinemia, and infection causing local inflammatory response in inner lining of the vessel walls. Partial or total occlusion occurs in the complicated lesion stage. Extra collateral circulation occurs in the presence of chronic ischemia. Therefore it is more likely to occur in an older patient.

While obtaining patient histories, which patient does the nurse ID as having the highest risk for CAD? a. white man, age 54, who is a smoker and has a stressful lifestyle b. a white woman, age 68, with a bp of 172/100 and who is physically active c. an Asian woman, age 45, with a cholesterol level of 240, and a bp of 130/74 d. an obese African American man, age 65, with a cholesterol level of 195, and a bp of 128/76

b This white woman has one unmodifiable risk factor (age) and 2 major modifiable risk factors (hypertension and physical inactivity). Her gender risk as a man's because she is over 65 years of age. The white man has one unmodifiable risk factor (gender). One major modifiable risk factor (smoking), and one minor modifiable risk factor (stressful lifestyle). The Asian woman has only one major modifiable risk factor (hyperlipidemia) and Asians in the US have fewer MI than do whites. The African American man has an unmodifiable risk factor r/t age and one major modifiable risk factor (obesity).

What characteristics describe unstable angina (select all that apply)? a. usually precipitated by exertion b. unpredictable and unrelieved by rest c. characterized by progressive severity d. occurs only when the person is recumbent e. usually occurs in response to coronary artery spasm

b, c Unstable angina is unpredictable and unrelieved by rest and has progressively increasing severity. Chronic stable angina is usually precipitated by exertion. Angina decubitus occurs when the person is recumbent. Prinzmental's angina is frequently caused by a coronary artery spasm.

Which characteristics are associated with LDLs (select all): a. increases with exercises b. contains the most cholesterol c. has an affinity for arterial walls d. carries lipids away from arteries to liver e. high levels correlate most closely with CAD f. the higher the level, the lower the risk for CAD

b, c, e LDLs contain more cholesterol than the other lipoproteins, have an attraction for arterial walls, and correlate most closely with increased incidence of atherosclerosis and CAD. HDLs increase with exercise AND carry lipids away from arteries to the liver for metabolism. A high HDL is associated with a lower risk of CAD.

MI occurs as a result of increased oxygen demand and decreased oxygen supply. What factors and disorders result in increased oxygen demand (select all that apply)? a. hypovolemia or anemia b. increased cardiac workload and aortic stenosis c. narrowed coronary arteries from atherosclerosis d. angina in the patient with atherosclerotic coronary arteries e. left ventricular hypertrophy caused by chronic hypertension f. sympathetic nervous system stimulation by drugs, emotions, or exertion

b, d, e, f Increased oxygen demand is caused by increasing the workload of the heart, including left ventricle hypertrophy with hypertension, sympathetic nervous stimulation, and anything precipitating angina. Hypovolemia, anemia, and narrowed coronary arteries contribute to decreased oxygen supply.

Which serum lipid elevation, along with elevated LDL, is strongly associated with CAD? a. apolipoproteins b. fasting triglycerides c. total serum cholesterol d. high-density lipoprotein (HDL)

b. Elevated fasting triglyceride levels are associated with cardiovascular disease and diabetes. Apolipoproteins are found in varying amounts on the HDLs and activate enzyme for receptor cites that promote removal of fat from plasma, which is protective. The Apolipoproteins A and Apolipoproteins B ratio must be done to predict CAD. Elevated HDLs are associated with a lower risk of CAD. Elevated total serum cholesterol must be calculated with HDL or a ration over time to determine an increased risk of CAD.

Which patient is most likely to be in the fibrous stage of development of coronary heart disease? a. age 40 thrombus adhered to coronary artery wall b. age 50 rapid onset of disease with hypercholesterolemia c. age 32 thickened coronary arterial walls with narrowed vessel lumen d. age 19 elevated LDL, lipid filled smooth muscle cells

c the fibrous plaque stage has progressive changes that can be seen at age 30. Collagen covers the fatty streak and forms a fibrous plaque in the artery. The thrombus adheres to the arterial wall in the complicated lesion stage. Rapid onset of coronary artery disease with hypercholesterolemia may be r/t familial hypercholesterolemia, not a stage CAD development. The fatty streak stage is the earliest stage of atherosclerosis and can be seen by age 15.

What types of angina can occur in the absence of CAD (select all that apply)? a. silent ischemia b. nocturnal angina c. prinzmental's angina d. microvascular angina e. chronic stable angina

c, d Prinzmental's angina and microvascular angina may occur in the absence of CAD but with arterial spasm in prinzmental's angina or abnormalities of coronary microcirculation. Silent ischemia is prevalent in persons with DM and contributes to asymptomatic myocardial ischemia. Nocturnal angina occurs only at night. Chronic stable angina refers to chest pain that occurs with the same pattern of onset, duration, and intensity intermittently over a long period of time.

What are manifestations of acute coronary syndrome (select all that apply)? a. dysrhythmia b. stable angina c. unstable angina d. ST segment elevation myocardial infarction e. non ST segment elevation myocardial infarction

c, d, e Unstable angina, STEMI, NSTEMI are conditions that are manifestations of acute coronary syndrome (ACS). The other options are NOT manifestations of ACS.

A 62 year old woman has prehypertension and smokes a pack of cigarettes per day. She has no symptoms of CAD but a recent LDL was 154. Based on these findings, the nurse would expect that what treatment plan would be used first for this patient? a. diet and drug therapy b. exercise instructions only c. diet therapy and smoking cessation d. drug therapy and smoking cessation

c. Diet therapy and smoking cessation are indicated for a patient without CAD who has prehypertension and an LDL level > or equal to 130. When the patient's LDL level is > or equal to 160 drug therapy would be added to diet therapy. Because tobacco use is related to increased bp and LDL level, the benefit of smoking cessation is almost immediate. Exercise is indicated to reduce risk factors throughout treatment.

What causes the pain that occurs with MI? a. death of myocardial tissue b. dysrhythmias caused by cellular irritability c. lactic acid accumulation during anaerobic metabolism d. elevated pressure in the ventricles and pulmonary vessels

c. When the coronary arteries are occluded, contractility ceases after several minutes, depriving the myocardial cells of glucose and oxygen for aerobic metabolism. Anaerobic metabolism begins and lactic acid accumulates, irritating mycardial nerve fibers that then transmit a pain message to the cardiac nerves and upper thoracic posterior roots. The other factors may occur during vessel occlusion but are not the source of pain.

The lab tests for 4 patients show the following results. Which patient should the nurse teach first about preventing CAD because the patient is at greatest risk for CAD even without other risk factors? a. total cholesterol: 152, triglycerides: 148, LDL: 148, HDL: 52 b. total cholesterol:160, triglycerides: 102, LDL: 138, HDL: 56 c. total cholesterol:200, triglycerides:150, LDL: 160, HDL: 48 d. total cholesterol:250, triglycerides: 164, LDL: 172, HDL: 32

d. All of this patient's results are abnormal. The patient in option C is close to being at risk, as all of that patient's results are at or near the cutoff for being acceptable. If this patient is a woman, the HDL is too low. The other patients' results are at acceptable levels.

Tachycardia that is a response of the sympathetic nervous system to the pain of ischemia is detrimental because it increases oxygen demand and: a. increases cardiac output b. causes causes reflex hypotension c. may lead to atrial dysrhythmias d. impairs perfusion of the coronary arteries

d. An increased heart rate decreases the time the heart spends in diastole, which is the time of greatest coronary blood flow. Unlike other arteries, coronary arteries are perfused when the myocardium relaxes and blood back flows from the aorta into the sinuses of Valsalva, which have openings to the R and L coronary arteries. Thus the heart has a decreased oxygen supply at a time when there is an increased oxygen demand. Tachycardia may also lead to ventricular dysrhythmia. The other options are incorrect.

While teaching a woman about the risks and incidence of CAD, what does the nurse emphasize? a. smoking is not a significant risk factor for CAD in women as it is in men b. women seek treatment sooner then men when they have symptoms of CAD c. estrogen replacement therapy in postmenopausal women decreases the risk for CAD d. CAD is the leading cause of death in women with a higher mortality rate after MI then in men

d. CAD is the numba 1 killa of American women and women have a much higher mortality rate within one year following MI than do men. Smoking carries specific problems for women because smoking has been linked to a decrease in estrogen levels and to early menopause and it has been ID'd as the most powerful contributor to CAD in women under the age of 50. Fewer woman than men present with classic manifestations and women delay seeking care longer than men. Recent research indicates that estrogen replacement does not reduce the risk for CAD, even though estrogen lowers LDL and raises HDL.