NURS 321: CAD, MI, and Angina (patho) PART 1

What is CAD?

The disease process; plaque buildup

What is ANGINA?

warning pain; temporary ischemia

What is MYOCARDIAL INFARCATION?

heart muscle death; permanent damage

What is CAD used for?

Prevent progression

What is ANGINA used for?

Relieve ischemia

What is MYOCARDIAL INFARCTION used for?

Save heart muscle NOW

What occurs during CAD?

narrowed arteries NOT fully blocked; focus on worsening

What is ATHEROSCLEROSIS?

Plaque buildup that happens over time on the blood vessel walls, causing the vessels to narrow and limit blood supply to the heart

What happens when PLAQUE RUPTURES in CAD?

cause clots and obstruct blood flow which can lead to MI

What is the GOAL of CAD TREATMENT?

long-term protection; Slow plaque buildup, prevent clot formation, reduce cardiac workload

What are SYMPTOMS of CAD?

asymptomatic, chest pain can occur

What are the THREE medication TREATMENTS of CAD?

1.) Statin

2.) Blie acid sequestrants

3.) Antiplatelets

What is the EFFECT of STATINS?

lower cholesterol; stabilize plaque

What is the EFFECT of ANTIPLATELETS?

prevent clot formation

What are EXAMPLES of BAD CHOLESTEROL?

LDL, triglycerides, total cholesterol

What are EXAMPLES of GOOD CHOLESTEROL?

HDL

What is the APPROPRIATE RANGE for LDL?

< 100 mg/dL

What is the APPROPRIATE RANGE for TRIGLYCERIDES?

< 150 mg/dL

What is the APPROPRIATE RANGE for TOTAL CHOLESTEROL?

< 200 mg/dL

What is the APPROPRIATE RANGE for GOOD CHOLESTEROL MALE?

> 40 mg/dL

What is the APPROPRIATE RANGE for GOOD CHOLESTEROL FEMALE?

> 50 mg/dL

What is MYOCARDIAL INFARCTION?

condition that involves

complete blockage of one

or more large coronary

arteries, leading to

myocardial cell death and

necrosis

What happens when the ARTERY is BLOCKED?

heart muscle is actively dying

What is the MOST COMMON CAUSE of MI?

underlying coronary artery disease (CAD) in which atherosclerotic plaques form in the coronary arteries

Describe the PROCESS leading to MI.

rupture of atherosclerotic plaques, which triggers

thrombotic occlusion of the artery, causing ischemia; lead to irreversible structural changes in the myocardium

What is ISCHEMIA PERSISTS?

permanent necrosis spreads through several layers of the heart muscle

Can HEART TISSUE REGENERATE?

no, infarcted area heals by forming scars leading to remodeling

What are the EFFECTS of an ACUTE EVENT of MI?

vary depending on how quickly reperfusion can take place and the amount of muscle injured

What is MOST IMPORTANT in MI recovery?

reperfusion

What are LONG TERM EFFECTS of MI?

angina, repeat MI, dysrhythmias, heart failure, shock, cardiac rupture, blood clots, and swelling or fluid around the heart

What is the ORDER of MI?

1.) Atherosclerosis: Coronary arteries become narrower because of plaque build up

2.) Angina: because of low oxygen

3.) Myocardial Infarction: Plaque ruptures, which becomes a

blood clot that blocks arteries of the heart

What S/S of MI?

pain, SOB, n/a, sweating

What type of PAIN occurs in MI?

Substernal chest pain (crushing or radiating)

Jaw pain

Left arm pain

Mid back/shoulder pain

Heartburn (epigastric)

What is STEMI?

ST Elevation Myocardial Infarction; ST segment is elevated

What is NSTEMI?

Non-ST Elevation Myocardial Infarction; No ST elevation

What is the CAUSE of STEMI?

Complete coronary artery blockage

What is the CAUSE of NSTEMI?

Partial blockage of coronary artery

What is the TROPONIN LEVEL of STEMI?

ELEVATED

What is the TROPONIN LEVEL of NSTEMI?

ELEVATED

When is TROPONIN RELEASED?

When cells are die due to lack of oxygen they release troponin proteins

What does ELEVATED TROPONIN cause?

trauma to the heart, heart muscle death

What are examples of CARDIAC BIOMARKERS?

Myoglobin & CK-MB

What is MYOGLOBIN?

NOT a specific indicator of an acute MI, but a negative result is a good way to rule out an acute MI

What is CK-MB?

LESS reliable than troponin; An enzyme that is released into the bloodstream when the heart, muscle, or brain is damaged

What is the TREATMENT for MI? MNEMONIC?

MONA

Morphine: decrease workload and pain

Oxygen: increase oxygen

Nitroglycerin: opens up vessels

Antithrombotic

What is ANGINA?

CHEST PAIN, due to the narrowing of at least one major coronary artery

When does ANGINA occur?

when there is a mismatch between oxygen supply and demand in the heart

What does INCREASED PAIN from ANGINA indicate?

more tissue death

What occurs in STABLE ANGINA?

metabolic mismatch typically requires a trigger, such as

exercise, stress, or exposure to low temperatures, to cause these manifestations.

What occurs in UNSTABLE ANGINA?

manifestations may occur at rest, indicating a more severe and

potentially dangerous situation that could lead to further cardiac ischemia if not resolved

What occurs in VARIANT ANGINA?

occurs at rest or night, vessel is spasming/cramping

What is the PRIMARY EFFECT of ANGINA?

experience of chest discomfort or pain resulting in distress and may lead to a reduction in activities and possible anxiety

What are the INCREASED RISK FACTORS in ANGINA?

myocardial infarction and sudden cardiac death

How does ANGINA PRESENT?

present differently in males vs. females

What is STABLE ANGINA?

Predictable chest pain

What is UNSTABLE ANGINA?

Dangerous and unpredictable

What is VARIANT ANGINA?

Prinzmetal - spasm

What CAUSES STABLE ANGINA?

Artery is narrow but stable (like a clogged pipe)

What CAUSES UNSTABLE ANGINA?

Artery suddenly gets worse plaque breaks → clot

What CAUSES VARIANT ANGINA?

Artery squeezes tight (spasms)

WHEN does STABLE ANGINA occur?

During activity (walking)

WHEN does UNSTABLE ANGINA occur?

Anytime (even at rest)

WHEN does VARIANT ANGINA occur?

At rest or at night

How is PAIN MANAGED for STABLE ANGINA?

Goes away with rest and nitro

How is PAIN MANAGED for UNSTABLE ANGINA?

DOES NOT go away easily

How is PAIN MANAGED for VARIANT ANGINA?

Goes away with nitro

What is the DANGER LEVEL for STABLE ANGINA?

Lower risk

What is the DANGER LEVEL for UNSTABLE ANGINA?

Higher risk → can become a heart attack

What is the DANGER LEVEL for VARIANT ANGINA?

Moderate

Why does STABLE ANGINA OCCUR?

Heart needs more oxygen

Why does UNSTABLE ANGINA OCCUR?

Blood flow is getting blocked

Why does VARIANT ANGINA OCCUR?

Artery is cramping

What are the MANIFESTATIONS of ANGINA?

• Pain, pressure

• Tightness

• Heaviness in the chest, which may radiate to the jaw or left arm

• Shortness of breath

• Anxious behaviors

• Diaphoresis (sweating)

• Nausea