med/surg ch. 34: acute coronary syndrome
pericarditis with effusion and fever that develops 4-6 weeks after MI
dressler syndrome
what are modifiable risk factors of CAD?
elevated serum lipids, elevated BP, tobacco use, physical inactivity obesity, diabetes, metabolic syndrome, psychologic states, and elevated homcysteine level
what is the first line of treatment for patients with confirmed MI?
emergent PCI
once NTG tablets have been opened, how often should the be replaced?
every 6 months
what diagnostic tests are used when a patient has abnormal but non diagnostic baseline ECG?
exercise or pharmacologic stress testing and echocardiogram
what is the most effective drug for lowering triglycerides and increases HDLs?
fabric acid derivatives (have no effect on LDLs)
when is CABG surgery recommended?
for patients who: fail medical management, have left main coronary artery or 3 vessel disease, are not candidates for PCI and continue to have chest pain, have diabetes mellitus, or are expected to have longer term benefits with CABG than with PCI
what side effects can NTG cause?
headache, dizziness, or flushing
what is the leading cause of death in women?
heart disease
a complication that occurs when the heart's pumping action is reduced?
heart failure
nicotine in tobacco smoke causes catecholamines to be released resulting in?
increased HR, peripheral vasoconstriction, and increased BP
if when taking an NTG tablet a patient doesn't feel tingling, what does this mean?
that it may be outdated
what does the MET determine?
the energy costs of various exercises
what two factors contribute to the growth and extent of collateral circulation?
the inherited predisposition to develop new blood vessels and the presence of chronic ischemia
anterior wall infarctions result from blockages in?
the left anterior descending artery
what are the most widely used lipid-lowering drugs?
the statin drugs
what effect do bile-acid sequestrates have on the body?
they decrease total cholesterol and LDLs
why do you give a patient who just had an MI stool softeners?
to prevent straining and vagal stimulation from the valsalva maneuver that could lead to bradycardia and provoke dysrhythmias
what are long-acting nitrates used for?
to reduce the incidence of anginal attacks
if a patient has taken nitroglycerin and symptoms are unchanged or worse after five minutes, what do you tell the patient to do?
to repeat the NTG every 5 minutes for a maximum of three doses and contact EMS if symptoms have not resolved completely
where is a sublingual NTG tab administered?
under the tongue
chest pain that is new in onset, occurs at rest, or has a worsening pattern
unstable angina
what results when the infarcted myocardial wall is thin and bulges out during contraction?
ventricular aneurysm
during the initial period after MI, what is the most common lethal dysrhythmia to occur?
ventricular fibrillation
what are example of isotonic activities?
walking, jogging, swimming, bicycling, and jumping rope
should a patient have a high fiber diet?
yes
are high serum HDL levels desirable?
yes, because they lower the risk of CAD
The nurse teaches a student nurse about diagnostic studies used for acute coronary syndrome. Which statement made by the student nurse indicates effective learning? "A pathogenic Q wave is seen in patients with unstable angina." "Serum cardiac markers are released from necrotic heart muscle." "A nitroprusside stress echocardiogram is used for patients with acute pericarditis." "Coronary angiography is the only way to confirm the diagnosis of unstable angina."
"Serum cardiac markers are released from necrotic heart muscle." Serum cardiac markers such as myoglobin, creatine kinase, cardiac-specific troponin I (cTnI), and cardiac-specific troponin T (cTnT) are released in patients with myocardial infarction (MI) into the blood from necrotic heart muscle. These markers are important to diagnose MI. A patient with a pathologic Q wave and ST-elevated MI has prolonged coronary occlusion, because the MI evolves with time. Pharmacologic stress echocardiogram testing with dobutamine, dipyridamole, or adenosine simulates the effects of exercise and is performed on patients who are unable to exercise or have abnormal, nondiagnostic baseline echocardiograms. A coronary angiography is used for patients with stable or high-risk unstable angina.
The nurse notes that the patient was taking clopidogrel (plavix) at home. The nurse knows that this medication belongs to which drug class? Vitamin K antagonist Nonsteroidal antiinflammatory drug (NSAID) Opioid analgesic Antiplatelet
Antiplatelet Plavix is an antiplatelet medication, used commonly in patients with cardiovascular disease. Plavix is not an opioid analgesic, NSAID, or vitamin K antagonist.
Postoperative care of a patient undergoing coronary artery bypass graft (CABG) surgery includes monitoring for what common complication? Dehydration Paralytic ileus Atrial dysrhythmias Acute respiratory distress syndrome
Atrial dysrhythmias Postoperative dysrhythmias, specifically atrial dysrhythmias, are common in the first three days following CABG surgery. Although dehydration, paralytic ileus, and acute respiratory distress syndrome could occur, they are not common complications.
patients who have left ventricular dysfunction, elevated BP, or have had an MI should start and continue what?
B-adrenergic blockers indefinitely
what has been shown to lower blood levels of homocysteine?
B-complex vitamins (B6, B12, folic acid)
what is the BP of someone who has stage 2 HTN?
BP greater than 160/100
what is prehypertension classified as?
BP of 120 to 139/80 to 89
what is a nonspecific marker of inflammation?
C-reactive protein (CRP)
which surgery consists of the placement of conduits to transport blood between the aorta, or other major arteries, and the myocardium distal to the blocked coronary artery or arteries
CABG, coronary artery bypass graft
what marker is specific to myocardial cells and also helps quantify myocardial damage?
CK-MB
The nurse is providing teaching to a patient recovering from a myocardial infarction (MI). How should resumption of sexual activity be discussed? Delegated to the health care provider Discussed along with other physical activities Avoided because it is embarrassing to the patient Accomplished by providing the patient with written material
Discussed along with other physical activities Although some nurses may not feel comfortable discussing sexual activity with patients, it is a necessary component of patient teaching. It is helpful to consider sex a physical activity and to discuss or explore feelings in this area when other physical activities are discussed. The discussion of sexual activity should not be delegated to the health care provider or avoided because of embarrassment.
what are the initial drug treatments of choice for ACS?
IV NTG, dual antiplatelet therapy, and systemic anticoagulation with either LMWH given subQ or IV UH
A patient experienced sudden cardiac death (SCD) while hospitalized and survived. What should the nurse expect to be used as a preventive treatment for this patient while at home? External pacemaker An electrophysiologic study (EPS) Medications to prevent dysrhythmias Implantable cardioverter-defibrillator (ICD)
Implantable cardioverter-defibrillator (ICD) An ICD is the most common approach to preventing recurrence of SCD. An external pacemaker may be used in the hospital, but will not be used for the patient living daily life at home. An EPS may be done to determine if a recurrence is likely and determine the most effective medication treatment. Medications to prevent dysrhythmias are used, but are not best for prevention of SCD.
The nurse provides a student nurse with information related to management of a patient following cardiac catheterization. Which intervention should the nurse explain is the specific responsibility of the nurse, rather than that of Unlicensed Assistive Personnel (UAP)? Asking the patient about comfort measures Recording vital signs Monitoring neurovascular changes Assisting with oral hygiene, hydration, meals, and toileting
Monitoring neurovascular changes
The nurse is preparing a care plan for a patient with chest pain. The patient's assessment findings include peripheral edema, blood pressure of 100/60 mm of Hg, pulse rate of 68/minute, and dyspnea. What is the priority nursing intervention? Monitoring the patient's neurologic function Discussing the losses associated with chronic illness Advising the patient to avoid heavy meals and extreme weather conditions Encouraging verbalization of feelings, perceptions, and fears
Monitoring the patient's neurologic function A patient with chest pain, peripheral edema, blood pressure of 100/60 mm Hg, pulse rate of 68 beats/minute, and dyspnea may have acute coronary syndrome. In order to avoid further complications, the nurse should regularly monitor neurologic, liver, and renal function to evaluate blood perfusion to the vital organs. The nurse should help the patient with anxiety and stress to work on the losses due to chronic illness to prevent sudden depression-related cardiac workload. A patient with chronic stable angina is advised to avoid heavy meals and extreme weather to reduce the probability of symptoms. The nurse should encourage verbalization of feelings, perceptions, and fears that increases workload on heart.
what can patients use prophylactically before starting an activity that is known to cause an anginal attack?
NTGm 5-10 minutes before starting the activity
When planning emergent care for a patient with a suspected myocardial infarction (MI), what should the nurse anticipate administrating? Oxygen, nitroglycerin, aspirin, and morphine Oxygen, furosemide, nitroglycerin, and meperidine Aspirin, nitroprusside, dopamine, and oxygen Nitroglycerin, lorazepam, oxygen, and warfarin
Oxygen, nitroglycerin, aspirin, and morphine The American Heart Association's guidelines for emergency care of the patient with chest pain include the administration of oxygen, nitroglycerin, aspirin, and morphine. These interventions serve to relieve chest pain, improve oxygenation, decrease myocardial workload, and prevent further platelet aggregation. Furosemide, meperidine, nitroprusside, dopamine, lorazepam, and warfarin may be used later in the patient's treatment.
A nurse is caring for a patient with chest pain that began 10 days ago. Which serum cardiac marker should the nurse review to determine if a myocardial infarction occurred 10 days ago? Troponin Myoglobin Homocysteine Creatine kinase
Troponin Troponin is a serum cardiac marker that is detectable in the blood up to two weeks after myocardial injury and is used to diagnose a myocardial infarction. Troponin has two subtypes: cardiac-specific troponin T (cTnT) and cardiac-specific troponin I (cTnI). Serum levels of cTnT and cTnI begin to increase 4 to 6 hours after the onset of myocardial injury, peak at 10 to 24 hours, and return to normal over 10 to 14 days.
A patient is admitted to the ICU with a diagnosis of unstable angina. Which medications would the nurse expect the patient to receive? (select all that apply) a. ACE inhibitor b. antiplatelet therapy c. thrombolytic therapy d. prophylactic antibiotics e. IV NTG
a. ACE inhibitor b. antiplatelet therapy e. IV NTG
After teaching about ways to decrease risk factors for CAD, the nurse recognizes that additional instruction is needed when the patient says? a. I would like to add weight lifting to my exercise program b. I can only keep my BP normal with meds c. I can change my diet to decrease my intake of saturated fats d. I will change my lifestyle to reduce activities that increase my stress
a. I would like to add weight lifting to my exercise program
complications of stent placement?
abrupt closure, vascular injury, acute MI, stent embolization, coronary spasm, and emergent coronary artery bypass graft surgery, and dysrhythmias
when ischemia is prolonged and not immediately reversible, what develops?
acute coronary syndrome develops and encompasses the spectrum of unstable angina
an inflammation of the visceral and/or parietal pericardium
acute pericarditis
elevated LDL correlates with?
an increased incidence of atherosclerosis and CAD
what is the clinical manifestation of reversible myocardial ischemia?
angina (chest pain)
chest pain that occurs only while the person is lying down and is usually relieved by standing or sitting?
angina decubitus
when a coronary artery spasm occurs, what does the patient experience?
angina, and transient ST segment elevation
for patients who can not tolerate ACE inhibitors, what should you give them?
angiotensin II receptor blockers
if patients are intolerant to ACE-inhibitors what is used?
angiotensin II receptor blockers
life threatening dysrhythmias occur most often with ?
anterior wall infarction, HF, or shock
how long can cardiac cells handle ischemic conditions before cell death begins?
approximately 20 minutes
how does morphine sulfate work on the body?
as a vasodilator, it decreases cardiac workload by lowering myocardial oxygen consumption, reducing contractility, and decreasing BP and HR
hardening of the arteries
atheroscelrosis
what is characterized by deposits of lipids within the intima of the artery?
atheroscelrosis
what is the major cause of CAD?
atherosclerosis
where should NTG tablets be stored?
away from the light and heat
In teaching a patient about coronary artery disease, the nurse explains that the changes that occur in this disorder include: (select all that apply) a. diffuse involvement of plaque formation in coronary veins b. abnormal levels of cholesterol, especially low-density lipoproteins c. accumulation of lipid and fibrous tissue within the coronary arteries d. development of angina due to decreased blood supply to heart muscle e. chronic vasoconstriction of coronary arteries leading to permanent vasospasm
b. abnormal levels of cholesterol, especially low-density lipoproteins c. accumulation of lipid and fibrous tissue within the coronary arteries d. development of angina due to decreased blood supply to heart muscle
The nurse is caring for a patient who is 2 days post MI. The patient reports she is experiencing chest pain. She states, "It hurts when I take a deep breath". Which action would be a priority? a. notify the physician STAT and obtain a 12 lead ECG b. obtain vital signs and auscultate for pericardial friction rub c. apply high-flow oxygen by face mask and auscultate breath sounds d. medicate the patient with PRN analgesic and reevaluate in 30 minutes
b. obtain vital signs and auscultate for pericardial friction rub
A hospitalized patient with a history of chronic stable angina tells the nurse that she is having chest pain. The nurse bases his actions on the knowledge that ischemia... a. will always progress to MI b. will be relieved by rest, NTG, or both c. indicates that irreversible myocardial damage is occurring d. is frequently associated with vomiting and extreme fatigue
b. will be relieved by rest, NTG, or both
why should serum digoxin levels be closely monitored in patients taking calcium channel blockers?
because calcium channel blockers potentiate the action of digoxin by increasing serum digoxin levels
why does the use of tobacco place postmenopausal women at a higher risk for developing CAD?
because it decreases estrogen levels
why are B-adrenergic blockers used cautiously in patients with diabetes?
because it masks the signs of hypoglycemia
why should patients with prolonged QT intervals or taking meds that prolong QT intervals avoid Ranolazine?
because it prolongs the QT interval
why should ephedrine alkaloids be avoided?
because they can cause high BP, MI, and stroke
side effects of bile-acid sequestrants?
belching, heartburn, nausea, abdominal pain, and constipation
what should you focus your care on when when assessing a CABG patient?
bleeding, hemodynamic monitoring, checking fluid status, replacing electrolytes as needed, and restoring temperature
A patient is recovering from an uncomplicated MI. Which rehabilitation guideline is a priority to include in the teaching plan? a. refrain from sexual activity for a minimum of 3 weeks b. plan a diet program that aims for a 1-2 pound weight loss per week c. begin an exercise program that aims for at least five 30 minute sessions per week d. consider the use of erectile agents and prophylactic NTG before engaging in sexual activity
c. begin an exercise program that aims for at least five 30 minute sessions per week
The most common finding in individuals at risk for sudden cardiac death is? a. aortic valve disease b. mitral valve disease c. left ventricular dysfunction d. atherosclerotic heart disease
c. left ventricular dysfunction
if B-adrenergic blockers are contraindicated, poorly tolerated, or do not control anginal symptoms, what is used?
calcium channel blockers
what is used to control prinzmetal's angina?
calcium channel blockers and or nitrates
when a patient gets a chest x-ray, what are you looking for?
cardiac enlargement, aortic calcifications, and pulmonary congestion
what might acute pericarditis result in?
cardiac tamponade, decreased ventricular filling and emptying, and HF
these markers are highly specific indicators of MI and have greater sensitivity and specificity for myocardial injury than creatine kinase
cardiac-specific troponin
what are the S/S of major bleeding due to thrombolytic therapy?
drop in BP, increase in HR, a sudden change in the patient's LOC, blood in the urine or stool
for patients with ongoing angina and negative cardiac markers what is recommended?
dual antiplatelet therapy and heparin
why do patients with diabetes have in increased prevalence of silent ischemia?
due to the diabetic neuropathy affecting the nerves that innervate the cardiovascular system
what signs and symptoms are evidence of early HF?
dyspnea, tachycardia, pulmonary congestion, distended neck veins
what is the most common complication after an MI?
dysrhythmias
what is the most prominent symptom of unstable angina?
fatigue
what are the stages of development in atherosclerosis?
fatty streak, fibrous plaque, and complicated lesion
which stage of atherosclerosis is the beginning of progressive changes in the endothelium of the arterial wall?
fibrous plaque
when do cardiac-specific troponin levels increase, peak, and return to baseline?
increase 4-6 hours after the onset of MI, peak at 10-24 hours, and return to baseline over 10-14 days
what are signs of rhabdomyolysis?
increased creatine kinase levels, muscle tenderness
what are the benefits of robotic surgery?
increased precision, smaller incisions, decreased blood loss, less pain, and shorter recovery time
blockage of the right coronary artery results in an?
inferior wall MI
most common artery used for a bypass graft?
internal mammary artery
what type of activities involve the development of tension during muscle contraction but produce little or no change in muscle length or joint movement
isometric activities
what type of activities involve changes in muscle length and joint movement with rhythmic contractions at relatively low muscular tension
isotonic activities
what happens when you inhibit cholesterol synthesis?
it increases hepatic LDL receptors making the liver able to remove more LDLs from the blood, and it produces an increase in HDLs and lower CRP levels
what does Niacin do?
it lowers LDL and triglyceride levels by interfering with their synthesis and increases HDL levels
what does ezetimibe (zetia) have on the body?
it selectively inhibits the absorption of dietary and biliary cholesterol across the intestinal wall (reduces LDLs by decreasing cholesterol absorption)
remodeling of normal myocardium can lead to the development of?
late HF
blockages in the left circumflex artery usually cause what MIs?
lateral and/or posterior wall MIs
crackles, if present, suggest?
left ventricular dysfunction
the LDL level goal is?
less than 160 mg/dl
what is an example of an isometric activity?
lifting, carrying, and pushing heavy objects
are high or low LDL levels desirable?
low LDL levels
what are the goals of therapy for cariogenic shock?
maximize oxygen delivery, reduce oxygen demand, and prevent complications
how might the patient's skin look/feel during an MI?
may be ashen, clammy, and cool to touch
a cluster of risk factors for CAD whose underlying pathophysiology may be related to insulin resistance
metabolic syndrome
chest pain that occurs in the absence of significant coronary atherosclerosis or coronary spasm, especially in women?
microvascular angina
what are subtle signs of HF?
mild dyspnea, restlessness, agitation, or slight tachycardia, pulmonary congestion on X-ray, S3 and S4, crackles, jugular venous distention
people with stage 1 or 2 HTN usually require what to reach therapeutic goals?
more than one drug
what is the drug of choice for chest pain that is unrelieved by NTG?
morphine sulfate
occurs because of sustained ischemia, causing irreversible myocardial cell death?
myocardial infarction
when the demand for myocardial oxygen exceeds the ability of the coronary arteries to supply the heart with oxygen, what occurs?
myocardial ischemia
what is released into the circulation within 2 hours after an MI and peaks in 3-15 hours
myoglobin
the most common therapeutic interventions for the management of chronic stable angina are the use of?
nitrates, ACE inhibitors, B-adrenergic blockers, and calcium channel blockers to optimize myocardial perfusion
how would you treat papillary muscle dysfunction?
nitroprusside (nipride) and/or IABP therapy, and immediate cardiac surgery with mitral valve repair or replacement
should patients with asthma take B-adrenergic blockers?
no
occurs only at night, but not necessarily when the person is in the recumbent position or during sleep
nocturnal angina
how should you treat a patient that presents to the ED with acute coronary syndrome?
obtain a 12-lead ECG, position the patient in an upright position, initiate oxygen by nasal cannula to keep Osats above 93, establish an IV route, give SL NTG and chewable aspirin, morphine sulfate is given for pain unrelieved by NTG), maintain bedrest and limit activity for 12-24 hours
where should translingual NTG be sprayed?
on the tongue
how often should you monitor I&O ?
once a shift
what drugs are given within the first 24 hours of a STEMI if there are no contraindications?
oral B-adrenergic blockers
what is a complication of all nitrates?
orthostatic HTN
what may occur if the infarcted area includes or is near the papillary muscle that attaches to the mitral valve
papillary muscle dysfunction
what should you suspect if you auscultate a new murmur at the cardiac apex?
papillary muscle dysfunction
patient with this illness have an increased prevalence of silent ischemia?
patients with diabetes
what increases HDL levels?
physical activity, moderate alcohol consumption, and estrogen administration
a rare form of angina frequently seen in patients with a history of migraine headaches and Raynaud's phenomenon
prinzmetal's angina
often occurs at rest, usually in response to spasm of a major coronary artery
prinzmetal's angina (variant angina)
patients with STEMI tend to have a more extensive MI that is associated with ?
prolonged and complete coronary occlusion; a pathologic Q wave is seen on ECG
what should you do to help with pain management in a patient with ACS?
provide NTG, morphine, and supplemental oxygen as needed to eliminate or reduce chest pain
what are the advantages of PCI?
provides an alternative to surgical intervention, is performed with local anesthesia, the patient is ambulatory shortly after the procedure, and the length of hospital stay is approx. 1-3 days compared to the 4-6 day stay with CABG surgery, the patient can also return to work earlier
for patients with STEMI or NSTEMI with positive cardiac markers what therapy is recommended?
reperfusion therapy
if a patient eats a heavy meal, what should you instruct them to do?
rest for 1-2 hours after the meal because blood is shunted to the GI tract to aid digestion and absorption
jugular venous distention, hepatic engorgement, and peripheral edema may indicate?
right ventricular dysfunction
when do CK levels begin to rise, peak, and return to normal?
rise about 6 hours after an MI, peak at about 18 hours, and return to normal within 24-36 hours
when the initial 12-lead ECG is non diagnostic what do you do?
serial 12-lead ECGs are done because the ECG may change to reflect the infarction process
proteins released into the blood from necrotic muscle after an MI
serum cardiac markers
what are the side effects of niacin?
severe flushing, pruritis, GI symptoms, and orthostatic HTN
what is the first line therapy treatment for angina?
short-acting nitrates
when a patient is taking morphine sulfate, what should you monitor for?
signs of bradypnea or hypotension, conditions to avoid in myocardial ischemia and infarction
ischemia that occurs in the absence of any subjective symptoms?
silent ischemia
people admitted to the ED with drug-induced chest pain usually have what symptoms?
sinus tachycardia, high BP, angina, and anxiety
an expandable meshlike structure designed to keep the vessel open by compressing the arterial wall
stent
what does a dobutamine (dobutrex), dipyridamole (persantine), or adenosine (adenocard) stress echocardiogram do?
stimulates the effects of exercise and is used in patients unable to exercise
if S/S of major bleeding occur, what do you do?
stop the thrombolytic therapy and notify the physician
what is the earliest tissue to become ischemic?
subendocardium (inner most layer)
what are the 3 primary effects of calcium channel blockers?
systemic vasodilation with decreased SVR, decreased myocardial contractility, and coronary vasodilation
when clinical reperfusion occurs, what clinical markers might you see?
the return of ST segment to baseline on the ECG, resolution of chest pain, and early rapid rise of serum cardiac markers within 3 hours of therapy
what is a benefit of the matrix system for transdermal controlled-release nitrates?
there can be no dose dumping
what does it mean if a person's serum cholesterol level is great than 200 mg/dl?
they are at risk for CAD
how do B-adrengergic blockers work on the body?
they decrease myocardial contractility, HR, SVR, and BP, all of which reduce the myocardial oxygen demand
how do statin drugs work?
they work by inhibiting cholesterol synthesis in the liver
what causes 80-90% of all MIs?
thrombus formation
since tolerance is a side effect of NTG therapy, what can you do to help avoid this?
titrate the dose down at night during sleep and titrate the dose up during the day
what is the goal of an emergent PCI?
to open the blocked artery within 90 minutes of arrival to a facility that has an interventional cardiac catheterization laboratory
what does treatment of MI with thrombolytic therapy aim to do?
to stop the infarction process by dissolving the thrombus in the coronary artery and reperfusing the myocardium
patients with UA or NSTEMI usually have?
transient thrombosis or incomplete coronary occlusion and usually do not develop pathologic Q waves
what may reverse the fatty streak process?
treatment that lowers LDL cholesterol may reverse this process
the incidence of CAD and MI is highest among who?
white, middle-aged men
what are the major nursing responsibilities for patient care after PCI?
1. monitoring for signs of recurrent angina 2. frequent assessment of vitals 3. evaluation of catheter insertion site for signs of bleeding 4. neurovascular assessment of the involved extremity 5. maintenance of bed rest per institution policy
what are the priority nursing interventions in the initial phases of ACS?
1. pain assessment and relief 2. physiologic monitoring 3. promotion of rest and comfort 4. alleviation of stress and anxiety 5. understanding of the patient's emotional and behavioral reactions
if your patient experiences angina, what measures are you going to implement?
1. position the patient upright and administer O2 2. assess vitals 3. obtain a 12-lead ECG 4. provide pain relief with a nitrate followed by an opioid if needed 5. auscultate heart and breath sounds
if a patient has chronic kidney disease or diabetes, what is the highest their BP can be before it is considered hypertension?
130/80
what is the BP of someone who has stage one HTN?
140 to 159/90 to 99 mm Hg
the risk of CAD is associated with a fasting triglyceride level greater than?
150 mg/dl
the risk of CAD is associated with a serum cholesterol level greater than?
200 mg/dl
obesity is defined as a BMI greater than ?
30 kg/m
when does v-fib most often occur?
4 hours after onset of pain
if ischemia persists, approximately how long does it take for the entire thickness of the heart to become necrosed?
4-6 hours
when is it generally safe to resume sexual activity after an uncomplicated MI?
7-10 days
what should be started and when in patients that are recovering from STEMI of the anterior wall, with HF, or an EF of 40% or less?
ACE inhibitors should be started within the first 24 hours and continued indefinitely
what should be started ASAP after CABG surgery?
B-adrenergic blockers to reduce incidence of AF
carries lipids away from the arteries and to the liver for metabolism
HDL
for patients having CABG surgery, where is the care provided for the first 24-36 hours?
ICU
A teenage girl survived an episode of sudden cardiac death (SCD) and is recovering in the intensive care unit (ICU). The nurse anticipates which intervention to prevent a recurrence? Drug therapy with beta-blocker Coronary artery bypass graft (CABG) Percutaneous coronary intervention (PCI) Implantable cardioverter-defibrillator (ICD)
Implantable cardioverter-defibrillator (ICD) The most common approach to preventing a recurrence is the use of an ICD. It has been shown that an ICD improves survival compared with drug therapy alone. Drug therapy and a PCI will not prevent a recurrence of SCD. A coronary artery bypass graft is not necessary.
severe, immobilizing chest pain not relieved by rest, position change, or nitrate administration is the hallmark of an?
MI
The nurse observes a student nurse who is providing thrombolytic therapy to a patient three hours after the patient's report of chest pain. Which action performed by the student nurse indicates the need for the nurse to intervene? Monitors the patient for gingival bleeding Assesses the patient regularly for neurologic status changes Draws blood samples from the patient before initiation of the therapy Reduces the dose of the thrombolytic agent during episodes of chest pain
Reduces the dose of the thrombolytic agent during episodes of chest pain Thrombolytic therapy helps stop the infarction process by dissolving the thrombus in the coronary artery and reperfusing the myocardium. In order to be effective, the entire dose of a thrombolytic agent must be administered as soon as possible after the onset of symptoms.
what does a 12 lead electrocardiogram usually show with chronic stable angina?
ST segment depression and/or T wave inversion indicating ischemia
The nurse provides a list of activities that are considered to be moderate energy to a patient with acute coronary syndrome. Which activity is appropriate to be included on the list? Painting while seated Performing carpentry Walking at four miles per hour (mph) Running at seven miles per hour (mph)
Walking at four miles per hour (mph) Physical activity improves the physiologic functioning and psychologic well-being of a patient with acute coronary syndrome. Therefore, the nurse should encourage the patient to walk at a rate of three to four miles per hour. Painting while seated is a low-energy activity. Carpentry and running at seven miles per hour are high-energy activities for a patient with acute coronary syndrome.
are omega-3 fatty acids good for the body in relation to CAD?
YES
should red meat, egg yolks, and whole milk products be reduced or eliminated from diets?
YES, these products are major sources of saturated fat and cholesterol
for patients with increasing symptoms or with a significant amount of myocardium that is ischemic under stress, what is ordered?
a cardiac catheterization
what is the main side effect of all nitrates?
a headache form the dilation of cerebral blood vessels
a loud holosystolic murmur may develop and may indicate?
a septal defect , papillary muscle rupture, or valve dysfunction
patients who are typically candidates for OPCAB have?
a very low EF rate, severe lung disease, acute or chronic kidney disease, a high risk for stroke, or a calcified aorta
what should patients take with nitrates to relieve headaches?
acetminophen
what are some side effects of B-adrenergic blockers?
bradycardia, hypotension, wheezing, and GI complaints, weight gain, depression, and sexual dysfunction
how is minor bleeding controlled?
by applying a pressure dressing or ice packs
what is the major route of elimination of cholesterol?
by conversion to bile acids in the liver
occurs when oxygen and nutrients supplied to tissues are inadequate because of severe left ventricular failure
cardiogenic shock
when having an MI, what might an older patient experience?
change in mental status, shortness of breath, pulmonary edema, dizziness, or a dysrhythmia
inclusion criteria for thrombolytic therapy includes?
chest pain typical of acute MI 6 hours or less in duration, 12-lead ECG findings consistent with acute MI, and no absolute contraindications
chest pain that occurs intermittently over a long period of time with the same pattern of onset, duration, and intensity of symptoms?
chronic stable angina
what is often described as a squeezing, heavy, choking, or suffocating sensation?
chronic stable angina
for high risk women who are intolerant of aspirin, what can be substituted?
clopidogrel (plavix)
what is the only way to confirm the diagnosis of prinzmetal's angina?
coronary angiography
most common type of cardiovascular disease?
coronary artery disease
what does cardiac catheterization and coronary angiography provide images?
coronary circulation and identifies the location and severity of any blockage
if a coronary blockage is amenable to an intervention, what is done?
coronary revascularization with an elective percuatenous coronary intervention
how do B-adrenergic blockers work on the body?
decrease myocardial oxygen demand by reducing HR, BP, and contractility
the treatment of chronic stable angina aims to?
decrease oxygen demand and/or increase oxygen supply
how does IV NTG work on the body?
decreases preload and after load while increasing the myocardial oxygen supply
what is ACS associated with?
deterioration of a once stable atherosclerotic plaque
nitrates produce their principal effects by which mechanisms?
dilating peripheral blood vessels, and dilating coronary arteries and collateral vessels
what is the most serious complication of PCI?
dissection of the newly dilated coronary artery, if the damage is extensive the coronary artery could rupture causing cardiac tamponade, ischemia and infarction, decreased CO, and possible death
what are common side effects of ranolazine?
dizziness, nausea, constipation, and generalized weakness
what is a disadvantage of the reservoir system for transdermal controlled-release NTG?
dose dumping if the reservoir seal is punctured or broken
