CAD nursing
acute coronary syndrome
-when myocardial ischemia is prolonged and not immediately reversible -encompasses the spectrum of unstable angina & acute infarction
MI psychosocial assessment
-denial -fear -anxiety
CAD diagnosis
-12 lead EKG -exercise stress test -nuclear stress test
statins adverse effects
-GI disturbance such as dyspepsia, cramps, flatulence, constipation, abd. pain -hepatotoxicity -myopathy -rhabdomylosis
Nonmodifiable risk factors for CAD
-age -gender -ethnicity -family history -genetics
CAD clinical manifestations
-asymptomatic for many years -chronic stable angina -acute coronary syndome
acute coronary syndrome patho
-atherosclerotic plaque in coronary artery ruptures resulting in platelet aggregation, thrombus formation, and/or vasoconstriction
statins examples
-atorvastatin (lipitor) -rosuvastatin (crestor) -simvastatin (zocor) -pravastatin (pravachol)
antianginal controller drugs
-beta blockers, calcium channel blockers, & long acting nitrates -provide baseline prophylaxis or protection against acute angina attacks
cardiac tamponade
-compression of the heart by an accumulation of fluid in the pericardial sac
coronary artery bypass graft (CABG)
-coronary surgical revascularization -failed medical management -presence of left main coronary artery or three vessel disease -not a candidate for PCI -failed PCI w/ ongoing chest pain
statins drug effects
-decrease LDL cholesterol by 25-63%
Therapeutic lifestyle changes
-decrease cholesterol -decrease saturated fat -increase soluble fiber -increase plant stanols & sterols -weight control -greater than 30 min of mod intensity greater than 5 days -smoking cessation
statins MOA
-decrease the rate of cholesterol production in the liver by inhibiting HMG-CoA reductase -decrease inflammation
chronic stable angina
-due to myocardial ischemia begins to occur when myocardial O2 demand exceeds the ability of the coronary artery to supply the heart with O2
Modifiable risk factors for CAD
-elevated serum lipids -HTN -tobacco use -physical inactivity -diabetes -obesity stress
MI treatment
-emergency: place on continuous EKG, BP, & O2 sat monitoring & start 2 large bore IVs -semi fowlers position -Morphine, Oxygen, Nitroglycerin, Aspirin, Beta blocker -get to cardiac cath lab for PCI
women w/ atypical cardiac chest pain
-extreme fatigue -SOB -pain in back/ abd -indigestion -anxiety -dizziness
LDL
-goal is LDL less than 100 mg/dL
total cholesterol
-goal is less than 200mg/dL
HDL
-greater than 40 mg/dL in men -greater than 50 mg/dL in women
statins nursing implications
-initial effects 2 wks, maximal effects 4-6 wks, reversal of effects upon withdrawal -monitor LFT, CPK levels -assess for CO weakness, muscle aches
CABG post op care
-monitor vitals -manage fluid & electrolyte for imbalance -monitor incision, chest tube, etc. -watch out for hypothermia, hypotension, cardiac temponade, sternal infection, pain
statins patient education
-most effective when taken at bedtime -educate patient to immediately report muscle pain/weakness -keep follow up appts.
myocardial infarction (MI)
-most serious acute coronary syndrome -myocardial tissue abruptly & severely deprived of O2 resulting in myocardial cell death & necrosis
patho for atherosclerosis
-narrowing of arteries -endothelial lining altered as a result of inflammation & injury -injury allows deposit of cholesterol & lipid within internal wall of the artery -begins as soft deposits of fat that harden w/ age -plaque becomes unstable, ruptures, platelets aggregate leads to thrombus formation
infarction
-necrosis or cell death that occurs when severe ischemia is prolonged and decreased perfusion causes irreversible damage to tissue
acute infarction
-non ST segment myocardial infarction -ST segment elevation myocardial infarction
MI physical assessment
-pain -BP & HR -heart rhythm & sounds -peripheral pulses -skin temp
unstable angina
-patient presents w/ ST changes on 12-lead ECG, but will not have changes in troponin or CK levels
s/s of MI
-persistent chest pain (crushing, pressure, heaviness, constriction, tightness) -chest pain may radiate neck, jaw, arm, back -shortness of breath -nausea/vomiting -ashen skin -cool clammy skin -fatigue -diabetes = no symptoms
statins contraindication
-pregnancy category X
antianginal rescue drugs
-sublingual, translingual spray, & IV nitroglycerin -used to treat acute anginal pain
ischemia
-temp imbalance b/w coronary artery's ability to supply oxygen and cardiac muscle's demand for oxygen -insufficient oxygen supply to meet requirements of myocardium -ischemia limited in duration and does not cause permanent damage to myocardial tissue
diagnosing MI
-troponin Q6H x 3 -12 lead EKG -cardiac catheterization
collateral circulation
-when plaque blocks the normal flow of blood through a coronary artery and the resulting ischemia is chronic increased collateral circulation develops
coronary artery disease (CAD)
-when the arteries that supply blood to heart muscle become hardened and narrowed -due to the buildup of cholesterol and plaque on their inner walls -atherosclerosis -leading cause of death in the US
percutaneous coronary intervention (PCI)
balloon angioplasty and stent -stents are thrombogenic so pt. treated w/ oral antiplatelet agents such as Plavix and aspirin until intimal lining can grow over the stent & provide a smooth vascular surface
