CAD/Angina/Acute Coronary Syndrome/AMI/HF/Inflammatory heart disease

what is CAD

progressive narrowing of the arteries by atherosclerosis

cholesterol and thickening

coronary heart disease

athersclerotic heart disease

non-modifiable risk factors of CAD

age

men over 45

women once they get near menopause

family hx

modifiable risk factors

smoking

inactivity

overweight

cholesterol

increased LDL

decreased HDL

HTN

what is the first diagnostic test that should be done with CAD

12 lead EKG

dx studies of CAD

12 lead EKG-1st

holter monitor- outpatient

stress test w/ adenosine(hold beta blockers)

monitor VS and ECG

pharmacological stress testing

nuclear stress testing

chest x-ray

echo

TEE

multigated blood pool study

PET scan

MRI

what is nuclear stress testing

isotopes that glow

MUGA scan

looks at the hearts pumping ability and uses a tracer(radioactive isotopes)

medical hx and physical exam of CAD

risks

prior hospitalizations

SOB, chest pain

meds for erectile dysfunction

psychosocial hx

include stressors

labs for CAD

CBC

hgb

hct

sodium

potassium

calcium

mag

cholesterol- HDL and LDL

Troponin I and T

what is a normal amount of troponin I

less than .5

normal amount of troponin T

less than .1

cardiac cath and arteriography

electrophysiology study

catheter R. or L.

heart pressures (similar to PA cath)

Cardiac output

ateriography

uses contrast

ateriography

contrast used to visualize the blood vessels

if they are not 100% occluded, use balloon pump

post-catheterization

bed-rest

monitor bleeding

new collagen agents for hemostasis can be used

monitor pulses

check for bleeding and hematomas

antiplatelet drugs after the procedure

2 check nurse check below the catheter to check for pulses

what should the bed be at after catheterization for CAD

no higher than 30 degrees or

reverse trendelenburg

when are antiplatelet drugs normally given in regards to CAD

after a PCI when they place a balloon

why are antiplatelets used after PCI

to prevent clotting cascade

when can antiplatelet drugs be discontinued after PCI

6-8 hrs

what are the extreme tx options for CAD

stent

CABG

medically managed

which meds are used for CAD

statins

medications affecting platelets- ASA, dipyridamole, ticlopidine, clopidogrel

what is HMG-CoA reductase

a class of medications that lower cholesterol in the blood

tx for CAD

diet: low cholesterol

low sodium

DASH diet

excersise

wt loss

smoking cessation

management of HTN of DM

statins

which medications are bile acid resins bind and are excreted via bowel

cholestyramine

colestipol

ezetimbe

blocks the absorption of cholesterol in the digestive tract

stable angina

chronic

exertional

what does stable angina look like on an ECG

T wave inversion

what is the tx for stable angina

rest

nitro

unstable angina

more often and more severe

less relief

activity does not always trigger it

what does unstable angina look like on an ECG

may have ST elevation

what is the tx for unstable angina

rest

nitro

drugs affecting platelets

revascularization

Prinzmental’s variant angina

spasms in the coronary arteries

chest pain will occur at rest

when does ST elevation occur with variant angina

with pain

what is the tx for variant angina

calcium channel blocker

nitro

common SE is HA-take tylenol

vasodilator- gets more o2 to the heart

can take 3; one every 5 mins; call 911 after third one

watch BP

how long does it take to put in stents

60-90 mins

if a stent is placed for angina and the pt is experiencing pain right after what does that indicate

failed stent

clotting cascade

difference of occlusion of unstable angina vs stable angina

unstable angina is more occluded and worse

what angina are stents used for

stable angina

what are the pt care outcomes for angina

pt will verbalize relief of chest discomfort

pt will appear relaxed and comfortable

verbalize understanding of angina and its management

pt will describe cardiac risk factors and strategies to reduce them

perform activities within limits of the disease aeb no pain or discomfort and no ECG changes reflecting ischemia

acute coronary syndrome

irreversible

ischemia w myocaridal death

imbalance of o2 supply and demand

includes stable angina, unstable angina, or AMI

causes of acute coronary syndrome

atherosclerosis

emboli

blunt trauma

spasm

types of MIs

NSTEMI

STEMI

what is collateral cirrculation

when there is blockages in the main vessels so the little vessels dilate to create another pathway for bloodflow

sx of MI

midsternal chest pain

severe crushing and squeezing pressure

may radiate

unrelieved with nitrates

pale and diaphoretic

dyspnea, tachypnea, and/or hypotension

females=shoulder and neck pain

syncope

feeling of impending doom

NV
dysrythmias

nursing goals of MI

maintain CO

treat pain

assess for complications

increase activity tolerance

relieve anxiety

dx of MI

signs and symptoms

12 lead EKG

ST elevation followed by a Q wave

ST depression=non-q wave

elevated troponin

increased trop and normal EKG

NSTEMI

increased trop and ST elevation

STEMI

tx of MI

CABG

MICABG

transmyocardial revascularization

interventional cardiology

percutaneous transilluminal coronary angioplasty

stent

60% occulsion or less

stent

60% occlusion or more

CABG

what are the ED meds for MI

MONA

morphine

O2

nitro

aspirin

who would PCI be contraindicated for

someone with issues in the L main artery

medical management of MI

pain relief: morphine and nitro

o2

prevention of platelet aggregation- pt is given aspirin in the ambulance then put on a heparin drip

PCI

fibrinolytic therapy

autologous bone marrow tx to the damaged myocardium

balloon pump

improves diastolic filling time and improve contractility

used for a few days until someone can get surgery

used for cardiogenic shock

improves cardiac output

what is heart failure

the inability of the heart to generate adequate flow and meet the metabolic demands of the body

systolic HF

impaired contractility dt cardiomyopathy

diastolic HF

impaired filling dt hypertrophy

left sided HF

decreased pumping action

fluid backup from the lungs

backflow can lead to R sided failure

sometimes uses the renin-angiotensin-aldosterone system

right sided HF

systemic sx

lab to check HF and its normal

BNP

normal=100

BNP

cardiac hormone secreted that is a good marker for differentiating between pulmonary and cardiac causes of dyspnea

what happens to BNP as HF is treated

lowers

dx testing for HF

echo

ABG

electroltyes

BUN/creatnine

CBC

BNP

hepatic function

ECG

HF interventions

LVAD

improve pump function

improve cardiac workload

optimization of gas exchange

what are the HF interventions that improve pump function

diuertics

ACEi

angiotensin receptor blockers

BB

digoxin

nesiritride citrate

what are the HF interventions to reduce cardiac workload

balloon pump

rest, cardiac rehab

mechanical circulatory support devices

optimization of gas exchange

airway assessment

semi-fowler

supplemental o2

CPAP

diuersis

control sodium and fluid retention

daily wts

VTE prophylaxis

inflammatory heart disease

either pericarditis or endocarditis

what are the causes of pericarditis and endocarditis

pericarditis:

infection

autoimmune disorder

trauma

endocarditis:

IV drug use

mechanical valve

what can inflammatory heart disease lead to

tamponade

scarring

pericarditis sx

friction rub

pulsus paradoxus-change in BP during inspiration

initial ST elevation

chest hurts with inspiration or while moving forward

fever

dysrythmias

dyspnea

what are the interventions for pericarditis

pericardiocentesis to remove fluid

pericardial window

pericardectomy

NSAIDS

steroids- dec inflammation

antibiotics for bacterial

what are the symptoms of endocarditis

high fever

shaking chills

night sweats

cough

wt loss

general malaise, weakness, fatigue, HA, musculoskeletal complaints

new murmurs

JVD

skin abnormalities

Janeway Leisons- red/blue spots on palms and soles

osler nodes- red/purple nodules found on fingers and toes

petechiae

splinter hemorrhages

dx of endocarditis

echo

TEE

blood cultures

interventions of endocarditis

antibiotics

rest abx before dental appointments

heart valve replacement

what does endocarditis cause

microvascular pressure w/ regurgitation and a floppy valve

what is a PCI

putting in a stent in the cath lab for a partial blockage (under 60%)

what is cardiac catheterization/angiogram

uses contrast and catheter to look for blockages

angioplasty

clears blockages with a balloon that opens the blood vessel

stent may be placed

what to do before cardiac cath

NPO

sedation

assess allergies to shellfish and iodine

give diphenhydramine

give prednisone

what to do before a stress test

NPO

hold beta blockers

adenosine

what lab is important for CAD and what are the instructions before it is drawn

lipids

HDL

LDL

NPO 12 hours prior to blood draw

what does atorvastatin treat

LDL only

normal LDL=under 100

when is plavix/clopigodrel used

when a stent is placed so that clots do not form around the stent

Plavix/clopidogrel needs to be stopped before any surgeries

managing the progression of CAD

aspirin

diet and lifestyle changes

what should be watched for with stent placement

Thrombotic thrombocytopenic papura- little clots all over the body that cause neuro changes and renal failure

how is nitro taken

sublingually or spray

if a pt presents to the ED with chest pain what should always be asked before giving nitro

if they take phosphodiasterase

erectile dysfunction meds

can cause life-threatening hypotension

normal LDL

under 100

when should someone notify their physician when taking a statin

if they develop muscle pain or tenderness

which labs are monitored when taking statins

CPK- shows potential damage or injury to the skeletal or muscle tissues in the body

liver function

what should be monitored with taking beta blockers

hypoglycemia

breathing issues- not prescribed for pts with COPD or asthma

do not take with grapefruit juice

what do ACEi end in and what is a common SE

“pril”

dry cough

when does each angina occur

stable- on exertion

unstable-rest or exertion

variant- at rest

what is indicative that someone is having an MI and not just having angina

chest pain that lasts more than 30 mins

unrelieved by rest and nitro

MI also has SOB and N/V and diaphoresis

when do you call 911 when taking nitro

after the 3rd dose

what are the sx women experience for an MI

jaw pain

back pain

NV

tx for AMI

MONA

morphine

O2

nitro

aspirin

how does an angioplasty widen the artery

with a balloon that pushes the plaque to the side