CAD
What is Coronary Artery Disease?
A type of blood vessel disorder in the general category of atherosclerosis
What is Chronic Stable Angina?
Pain that comes in a predictable pattern, it is the same each time, this chest pain will get better with medication use.
What is acute coronary syndrome (ACS)?
Prolonged ischemia, that is not immediately reversible.
There are a few subtypes: MI: NSTEM or STEMI, and unstable angina
What are STEMI manifestations?
STEMI causes ST-elevation in ECG leads facing the infarction
ST segment elevation must be 1 mm or more above the isoelectric line in 2 contiguous leads
In leads V2 and V3, ST must be 2 mm or higher
Medical emergency
What are the clinical manifestations of an MI?
Severe chest pain that is not relieved by rest, position change, or nitrate admin.
The patient feels heaviness, pressure, tightness, burning, constriction, or crushing with the chest pain.
The chest pain doesn't tend to show up in women and older adults/ It is atypical.
The SNS is activated causing diaphoresis, increased HR & BP, vasoconstriction of peripheral blood vessels, and makes the skin appear ashen, clammy, and cool to the touch.
Jugular vein distention can occur, crackles, decreased renal perfusion, and so on.
Nausea and vomiting is common.
A fever may also develop.
What are modifiable risk factors for CAD?
Smoking, BP >120/80 mm Hg, Diabetes, Total cholesterol >200 mg/dL, Triglycerides ≥150 mg/dL, LDL cholesterol >130 mg/dL, HDL cholesterol <40 mg/dL in men or <50 mg/dL in women, Metabolic syndrome, Obesity, Physical inactivity, & Tobacco use
What medication classes are used to help chronic stable angina?
There are various medications that can treat this, these include vasodilators, ACE inhibitors, ARBs, calcium channel blockers, and beta blockers.
What is unstable angina?
A form of chest pain that is new onset; occurs at rest; or with increasing frequency, duration, or less effort than chronic stable angina pattern, may be first clinical sign of CAD, Pain lasting > 10 minutes, Unpredictable; needs immediate treatment, ECG may show ST depression and/or T wave inversion = ischemic changes
What are the clinical manifestations of an NSTEMI?
ST depression & T wave inversion
Pt has positive biomarkers
What are some complications of an MI?
Cardiogenic shock, papillary muscle dysfunction or rupture, left ventricular aneurysm, ventricular septal wall rupture, left ventricular free wall rupture, pericarditis, & dressler syndrome.
What are nonmodifiable risk factors for CAD?
increasing age, ethnicity, gender, genetic predisposition, family hx
What other things can nurses do to help patients with this condition?
Give O2 as needed, put on 12 lead ECG, give nitro, help calm patient down, position patient upright, obtain chest x-ray, obtain cardiac biomarkers, and so on.
What is a myocardial infarction (MI)?
AKA heart attack
ST-elevation and Non-ST-elevation MI, Result of abrupt stoppage of blood flow through a coronary artery with a thrombus caused by platelet aggregation, causing irreversible myocardial cell death (necrosis)
Two types: STEMI & NSTEMI
How long do you have to get to the Cath. lab with a STEMI?
You have 90 minutes. This is a medical emergency.
Treatment for NSTEMI?
Acute intensive drug therapy with nitro, antiplatelet meds, and anticoagulation therapy.
Coronary angiography and CABG surgery.
They are usually put on a heparin drip to help as well.
What can you do for the patient as a nurse to lower risk of CAD?
Encourage eating lean protein, stay away from red meats, educate patient of exercise, encourage patient to take BP meds if on, encourage stress reduction activites, and so on.
What other measures can be done to treat chronic stable angina besides medication therapy?
Cardiac catheterization, Percutaneous Coronary Intervention (PCI), CABG, MIDCAB, OPCAB, TECAB, and so on.
What is a STEMI?
This is an occlusive thrombus,
ST-elevation
How long do you have to get to the cath. lab with NSTEMI?
You have 12-72 hours to get to the cath. lab
Treatment for STEMI?
Emergent reperfusion therapy: PCI, thrombolytic therapy, CABG surgery.
Concurrent Drug Therapy: antiplatelet therapy and anticoagulant therapy.
What medications can help reduce the risk of CAD?
Drugs that restrict lipoprotein production:
- HMG-CoA reductase inhibitors: Statins, Rosuvastatin (Crestor)
- Niacin
- Fibric acid derivatives
Drugs that decrease risk of cholesterol absorption:
-Ezetimibe (Zetia)
Antiplatelet Therapy:
-Low-dose Aspirin
What is one of the most important cardiac biomarkers to look at?
Troponin
What is a NSTEMI?
This is a nonocclusive thrombus,
Non-ST-elevation
What can a nurse do to help a patient with ACS/MI?
Help reduce anxiety, teach preventative measures, encourage rest and comfort, monitor ECG, monitor cardiac biomarkers, ambulate them, and so on.