CAD, Angina, and Acute Coronary Syndrome

Coronary artery disease (CAD)

Atherosclerosis affecting the coronary arteries that supply oxygen and nutrients to the heart muscle

Soft fat deposits that harden over time

CAD pathophysiology

Collateral circulation

Arterial connections within the coronary circulation that increase with chronic ischemia

Age, sex, ethnicity, family history

Nonmodifiable CAD risk factors

Hyperlipidemia, hypertension, diabetes, sedentary lifestyle, high-fat diet, tobacco and substance abuse

Major modifiable CAD risk factors

Obesity, increased triglycerides, decreased HDL, hypertension, increased fasting blood sugar

Metabolic syndrome features associated with CAD risk

Reduced saturated fat, cholesterol, and triglyceride intake

CAD dietary changes

Complex carbohydrates, fiber, omega-3 fatty acids

Foods encouraged for CAD

150 minutes per week

Recommended moderate- to low-intensity aerobic exercise listed for CAD

Smoking cessation, exercise, dietary changes

CAD lifestyle management

Statins, aspirin, nitrates

CAD medication management

Atorvastatin, simvastatin, rosuvastatin

Statins used for hyperlipidemia, CAD, and heart attack prevention

HMG-CoA reductase inhibitors

Statin medication category

GI upset, elevated liver enzymes, myopathy, myalgia, rhabdomyolysis

Statin adverse effects

Monitor lipid panel, liver enzymes, and muscle pain or weakness

Statin nursing considerations

LDL below 70 mg/dL

Lipid goal

Angina

Chest pain caused by myocardial ischemia

Pressure, heaviness, squeezing, tightness; may radiate to neck, jaw, shoulder, arm, or back

Typical angina description

Nitroglycerin and isosorbide mononitrate

Nitrates used to relieve or prevent angina

Vasodilation of coronary arteries and peripheral veins; decreased myocardial oxygen demand and increased oxygen supply

Nitrate mechanism of action

Sublingual nitroglycerin tablets or spray

Rapid-relief treatment for acute angina

1-5 minutes

Expected time for sublingual nitroglycerin to relieve pain

One tablet sublingually or 1-2 sprays; repeat every 5 minutes, up to 3 total doses

Sublingual nitroglycerin instructions

Call EMS if symptoms have not improved after the first dose

Sublingual nitroglycerin patient education

Dark, airtight container; short shelf life of 6 months after opening

Nitroglycerin storage

Sit or lie down when taking nitroglycerin

Patient education to reduce risk from decreased BP

Headache, dizziness, flushing

Nitroglycerin adverse effects

Erectile dysfunction medications

Medications that must not be combined with nitrates because of life-threatening hypotension

Chronic stable angina

Angina with predictable onset, shorter episodes, and relief with rest or nitroglycerin

Physical exertion, stress, cold weather, emotional upset

Chronic stable angina triggers

Unstable angina

Angina that is unpredictable, occurs at rest or with minimal exertion, and lasts longer

Unstable angina

Angina without permanent damage but with high risk of progression to MI

Acute coronary syndrome (ACS)

Acute coronary conditions associated with reduced blood flow to the heart, including unstable angina and MI

No permanent damage; predictable symptoms relieved by rest or nitroglycerin

Chronic stable angina

No permanent damage; unpredictable symptoms and increased duration

Unstable angina

Permanent myocardial damage and necrosis

Myocardial infarction