s/sx of CAD/MI
meds used to treat CAD/MI
education for pt diagnosed with CAD/MI
labs and radiology dx used for CAD/MI
complications and interventions for CAD/MI
100

ischemia vs. infarction

ischemia: insufficient oxygen supply to meet requirements of myocardium

infarction: necrosis or cell death that occurs when severe ischemia is prolonged and decreased perfusion causes irreversible damage to tissue 

100

medications used to treat CAD 

- statins: inhibit cholesterol synthesis, decrease LDL and increase HDL. Monitor for liver damage and myopathy 

- niacin: lowers LDL and triglycerides, increases HDL. SE: flushing, pruritus, GI s.e, orthostatic hypotension 

- antiplatelets: ASA, clopidogrel 

*HTN & DM2 should be well managed* 

100

modifiable risk factors

- physical activity (30min daily for 5 days) 

- obesity (BMI of 30kg/m2) 

- diabetes (A1c should be <7%)

- psychologic state, homocysteine, substance abuse

100

ways CAD is diagnosed & what the tests look for

- chest xray to look for cardiac enlargement, pulmonary congestion

- 12 lead ecg obtained to compare to previous tracing

- echocardiogram confirms CAD 

- calcium score screening: locates calcium deposits in atherosclerotic plaque

- exercise stress test: to know the impact of the lesion on coronary blood flow

100

what is the most common complication of an MI 

- dysrhythmias are present in 80% of MIs. They are the most common cause of death. 

- can be caused by ischemia, electrolyte imbalances or SNS stimulation

- life threatening seen most often with anterior MI, heart failure or shock

200

what occurs during angina and define the s/sx between unstable and stable

- reversible ischemia when 75% of arteries are blocked. They become hypoxic within 10 seconds of occlusion and are viable for ~20minutes. 

- chronic: transient lasting 5-15min, ST segment depression and/ or T-wave inversion

- unstable: easily provoked (can occur at rest), may last longer than chronic, rest/medicine do not help, can lead to heart attack 

200

medications for ACS

- ASA to make platelets slippery 

- nitrates: dilate peripheral blood vessels and coronary arteries/ collateral vessels (coronary perfusion) 

- morphine: helps reduce pain, promote comfort, relax smooth muscle, decrease myocardial oxygen demand and reduces circulating catecholamines 

- beta blockers: decrease heart rate, force of contraction, blood pressure, o2 myocardial demand 

- ACEs, IV heparin to prevent reocclusion 

- thrombolytic/ fibrinolytics: directly targets clot in coronary arteries, restores blood flow since fibrinolytics dissolves the clot

- calcium channel blockers: vasodilation and myocardial perfusion, not given for acute emergent situation 

200

give examples of saturated fats and cholesterol to reduce and complex carbs to increase for prevention/ early treatment of CAD 

- reduce saturated fats and cholesterol such as red meat, egg yolks and whole milk 

- increase complex carbs such as whole grains, fruit and vegetables

- if triglyceride levels are elevated, reduce/ eliminate intake of simple sugars and alcohol

200

laboratory studies for CAD 

- cardiac enzymes 

- lipid profile 

- C reactive protein

200

what are other complications of MIs 

- heart failure: when the pumping power of the heart has diminished, can occur with signs of mild dyspnea, restlessness, agitation or tachycardia

- cardiogenic shock: when oxygen and nutrients supplied to tissues are inadequate due to LV failure

- acute pericarditis 


300

CAD vs. ACS

CAD: blood vessel disorder which is progressive of plaque in the lining of coronary arteries 

ACS: includes unstable angina and MI (NSTEMI/STEMI). When ischemia is prolonged and not immediately reversible. Deterioration of a once stable atherosclerotic plaque > ruptures > platelet aggregation > thrombus 

*Medical Emergency* 

300

if a patient lives in a rural area and a PCI is not available, what are other options? (non-surgical) 

- thrombolytic therapy: stops infarction process by dissolving thrombus. Ideal to start within first hour, given IV. 

- monitor closely for signs of bleeding

- assess for signs of reperfusion (return of ST segment to baseline) 

300

management for ACS 

- semi fowler's 

- supplemental oxygen >90%

- ASA, nitroglycerin (SL), morphine 

- 12 lead ecg (watch for changes in QRS, ST, and T wave to distinguish between NSTEMI/STEMI

- IV access, labs, cath lab 

300

what is a PCI and when is it indicated?

- first line of treatment for patients with confirmed MI (ECG changes and positive cardiac markers). It visualizes and opens blockages. 

- goal is 90min from door of ER to cath lab

- balloon angioplasty + drug eluting stents

300

nursing interventions for MI 

- continuous cardiac monitoring 

- heart/ lung sounds

- VS, I/O, rest, cardiac rehab

- anxiety reduction

400

define MI and its s/sx 

- most serious ACS, result from irreversible sustained ischemia >20min, necrosis, hypoxia, ischemia starting in sub endocardium 

- necrosis of entire myocardium takes 4-6 hours, losing contractile function

- s/sx: chest pain not relieved by rest/ nitrates. Heaviness, crushing tight pain. Substernal, retrosternal, epigastric (indigestion) that radiates to neck, jaw and arms

- atypical in women/ elderly, no pain if pt has cardiac neuropathy (DM)

400

modifiable risk factors for CAD

- elevated serum lipids (cholesterol >200, triglycerides >150, HDL, LDL) 

- hypertension: the second major risk factor

- tobacco use 

400

what do we monitor post cardiac cath? 

- monitor recurrent angina

- frequent VS/ cardiac rhythm

- monitor site for bleeding/ hematoma 

- neurovascular assessment (perfusion/pulses)

- bedrest per policy

- foley care 

400

what occurs after CABG surgery? 

- ICU for 24-36 hours 

- pulmonary artery cath (measures CO) 

- intraarterial line (measures BP cont.), pleural/mediastinal chest tubes (drainage) 

- ET tube w/ mechanical vent, epicardial pacing wires (emergency pacing of the heart) 

- urinary cath/ NG tube (monitor urine output/ gastric decompression) 

400

when are surgical options recommended for MI? 

- when patient has failed medical management, not a candidate for PCI, failed PCI with ongoing chest pain, hx of DM, long term benefits of CABG are superior to PCI 

- CABG: uses arteries and veins for grafts, requires sternotomy and cardiopulmonary bypass. 

-MIDCAB: alternative to CABG 

500

assessment findings for MI 

- initially increased HR and BP, then decreased BP 2ndary to decrease in CO

- crackles, JVD, N/V with severe pain, vasovagal reflex

- elevated temp in the first 24 hours (inflammatory process by cell death) 

500

difference between STEMI/NSTEMI 

- STEMI: coronary artery is completely blocked resulting in severe damage to the heart muscle. ST segment elevation 

- NSTEMI: coronary artery is partially blocked

500

post op care after CABG 

- assess for bleeding

- monitor hemodynamic status, pain, fluid status

- pulmonary hygiene, cognitive dysfunction

- restore temperature, monitor afib 

500

what labs are increased during/after an MI 

- troponin

- CK-MB

- myoglobin 

* serum cardiac markers are important in the diagnosis of MI 

500

what is SCD? 

- unexpected death with sudden disruption in cardiac function, producing abrupt loss of CO and cerebral blood flow. 

- most commonly caused by ventricular dysrhythmias

- no warning sugns

- prodromal symptoms associated with MI (chest pain, palpitations, dyspnea) death within 1 hour of onset of symptoms