CAD
Gender, race, heredity, and age
What is Nonmodifiable Risk Factors of CAD
-men have higher risk of heart disease that women and risk increase with a family hx of CAD and aging
MONA. Morphine, supplemental oxygen, nitroglycerin, and aspirin.
What is treatment of ACS in the acute care setting?
-*EBP
Lowers blood pressure and increases blood flow through the coronary arteries; also prevents coronary artery spasms in Prinzmetal’s/variant angina; used in patients who cannot tolerate beta-blockers or in patients with heart failure.
What is Calcium-Channel Blockers mechanism of action?
Nifedipine (Procardia) - Amlodipine (Norvasc)
Ischemia develops when there is an imbalance between the supply and demand of oxygen-rich blood to the heart, resulting in insufficient O2 to meet the demands of myocardial tissue.
What are clinical manifestations for CAD?
increase chest pain and blood pressure; vasodilators given watch out for hypotension, n/v, and HA
What is s/s of narrowing artery and treatment?
Obstruction of blood flow within the coronary arteries
What is obstuctive CAD?
Reduce cholesterol synthesis in the liver and increase the clearance of LDL from the blood; contraindicated in patients with acute liver disease or during pregnancy – risk of muscle myopathies and decreases in liver function.
What is Statins mechanism of action?
-Atorvastatin (Lipitor)
-Simvastatin (Zocor)
Reduces blood pressure, which decreases workload and oxygen demands.
What is ACE Inhibitors and ARBs mechanism of action?
Lisinopril (Zestril) - Losartan (Cozaar)
Infarction, or cell death, occurs when the imbalance is severe and prolonged, causing irreversible damage.
What are clinical manifestations for CAD?
Initial test performed when CAD is suspected. During anginal episodes or symptoms of ACS, ST-segment depression of greater than 0.5 mm or flat/inverted T waves may be present, indicative of ischemia. These changes return to normal when chest pain is relieved.
▪ Ischemia in some patients may be silent. Serial ECGs may be done with cardiac biomarkers to assist in ruling out an infarction (ST-segment impression).
What is ECG diagnosing CAD?
Potential plaque rupture, as platelets aggregate and initiate the coagulation cascade with eventual thrombus formation, further decreasing and eventually obstructing blood flow. One or the more of the following may occur:
unstable angina: chest pain occurring at ___? myocardial infarction: __? sudden cardiac death: ____?
What is the development of atherosclerosis?
1.chest pain occurring at _rest_. 2. _heart attack_. 3. _cardiac or cardiopulmonary arrest_.
Prevents intracoronary thrombosis in patients who are hospitalized with ACS.
What is Anticoagulants mechanism of action?
Enoxaparin (Lovenox), Heparin, Bivalirudin (Angiomax), Ticagrelor (Brilinta)
Dilates the coronary arteries to improve blood flow and oxygen supply to myocardial cells; also reduces afterload.
What is Vasodilators (potent) mechanism of action??
Nitroglycerin (Tridil-IV name)
Begins with an injury to the arterial endothelium that causes an inflammatory response, initiating a series of cellular and molecular reactions leading to the accumulation of atherosclerotic plaque. Plaque deposits increase in size over time, causing narrowing of the coronary arteries, which impedes oxygen-rich blood flow to the heart, causing associated myocardial ischemia.
What is Atherosclerosis patho/function in body?
Most common procedure performed to relieve symptoms caused by atherosclerotic changes within the coronary vessels.
a small balloon on the tip is advanced under fluoroscopy through a suitable artery, commonly the femoral or radial artery, to the area of atherosclerotic plaque. The balloon is inflated and deflated to open the lumen of the artery. During this time, patients may experience chest pain due to vessel occlusion. Once the lumen is open, a stent may be advanced to the proper location to hold the artery open and maintain adequate blood flow.
What is PTCA surgical management?
Coronary angiography (cardiac catheterization)
-left-sided, evaluate for blockage and to determine the location of plaque, the degree of occlusion, and whether the area can be treated with PTCA(____?).
What is the gold standard of diagnosing CAD?
-percutaneous transluminal coronary angioplasty (stent placement)
Converts more cholesterol into bile acids, which are excreted in stool, thereby lowering cholesterol; should not be used in individuals with baseline fasting triglyceride levels greater than or equal to 300, because severe triglyceride elevations can occur.
What is Bile Acid Sequestrants mechanism of action?
Cholestyramine (Questran)
Inhibits platelet aggregation to prevent clot development.
What is Antiplatelet Agents mechanism of action??
Aspirin (Ectorin) Clopidogrel (Plavix)
Reduced blood flow through the coronary artery microvasculature. Ischemic symptoms (e.g., chest pain) result from the microvascular system’s inability to dilate in response to myocardial demand for oxygen.
What is nonobstructive CAD?
Maintain a healthy body weight. ‒ Maintaining a body mass index (BMI) of less than 30 is critical. • Diet ‒ Low in saturated fat and sodium; high in fruits, whole grains, and vegetables • Physical activity ‒ Moderate-intensity ‒ At least 30 minutes a day, five days a week is recommended • Smoking cessation • Refrain from excessive alcohol use.
What are lifestyle modifications for CAD?
CK, CK-MB, and Troponin
What is cardiac biomarkers used to rule out a myocardial infarction (MI)?
Inhibits the absorption of cholesterol through the small intestine.
What is Cholesterol Absorption Inhibitors mechanism of action?
Ezetimibe (Zetia)
Performed if cardiac biomarkers and ECGs are normal. Done to assess the function of the heart during exercise.
Pharmacological agents, such as Dobutamine, may be administered to increase the heart rate if patients cannot use a treadmill or stationary bike, mimicking the effects of exercise on the heart.
Dobutamine: ___? Epinephrine: ___? Norepinephrine (Levophed): ___? Dopamine: __?
What is exercise stress test?
1. increase heart rate (mimicking the effects of exercise). 2. used to give when heart stop 3. support low blood pressure 4. blood pressure increasing
Increased total cholesterol, hypertension (HTN), diabetes mellitus (DM), obesity, smoking, and physical activity Stress and excessive alcohol consumption can also contribute to CAD development.
What are modifiable risk factors?
When to call emergency services: ‒ Unrelieved chest pain. ‒ Chest pain at rest requiring early intervention. ‒ For PCI (PTCA) patients, uncontrolled bleeding, swelling, redness, purulent discharge, pain at the insertion site(s), and/or fever requiring immediate treatment. • Encourage cardiac rehabilitation. ‒ Reduces morbidity and mortality.
What is teaching for CAD?