Coronary Artery Disease and Acute Coronary Syndrome

Medications for Hyperlipidemia?

• Statins

• Omega-3 fatty acid

• Cholesterol Absorption Inhibitor

Define subtypes of Cardiovascular Disease

• Coronary Artery Disease (CAD) → most common CVD

• Asymptomatic CAD → stable chronic angina

• Acute Coronary Syndrome (ACS) → unstable angina (UA) or myocardial infarction (MI)

Define Atherosclerosis

Endothelial damage due to HTN → plaque accumulation → total or partial blockage

Non-modifiable CAD risk factors? (5)

• Age

• Gender

• Ethnicity

• Family history

• Genetic predisposition

Desired lipid levels to know? (4)

• Cholesterol < 200 mg/dL

• Triglycerides < 150 mg/dL

• HDL > 40 mg/dL

• LDL < 130 mg/dL

Key teaching for statins?

Take at night & avoid grapefruit juice; do not stop abruptly

Ethnic considerations for CAD?

White males → highest mortality from CAD

Native americans → due earlier than expected

Interventions to lower LDL cholesterol?

• Decrease saturated fat and cholesterol

• Increase omega-3 fatty acids

• Limit alcohol & red meats

Activity goals for cardiac health?

• Check tolerance & track activity

• 30 minutes at least 5 days per week

• Increase weight training (2 days a week)

Define Chronic Stable Angina

Clinical manifestation of reversible cardiac ischemia (remove trigger → pain goes away)

Key characteristics of Chronic Stable Angina? (3)

• Chest pain that occurs intermittently over a long period of time

• Same pattern of onset, duration, & intensity

• Pain at rest is unusual

Immediate interventions for Unstable Angina?

• Administer Asprin or Nitroglycerine

• 12-lead ECG within 10 minutes of admission

• Cardiac Catheterization within 90 minutes of administration

Key nursing interventions for Cardiac Catheterization?

• BLEED RISK → stay flat 4-6 hours

• Monitor access site & mark any bleeding

• Bloody dressing → apply pressure, DO NOT REMOVE

Stable Angina diagnostic studies? (4)

• CXR

• Echocardiogram (blood flow)

• Exercise stress test (must be able to tolerate activity)

• Coronary CT Angiography (contrast → assess for iodine allergy)

Define Cardiac Catheterization

Gold standard to identify & localize CAD

• Visualize blockages (diagnostic)

• Open blockages (interventional)

• Balloon angioplasty

Define subtypes of Acute Coronary Syndrome

• Unstable angina

• Non-ST-segment elevation MI (ischemia but some perfusion)

• ST-segment elevation MI (STEMI) → full infarction

Worst STEMI site?

Anterior STEMI: Usually caused by a blockage in the left anterior descending (LAD) artery, affecting the front (anterior) wall of the heart (often called a "widowmaker")

ACS etiology?

Deterioration of once stable plaque → rupture → platelet aggregation → thrombus

• Asprin blocks platelet aggregation

Clinical manifestations of unstable angina?

• New in onset

• Occurs at rest

• Pain lasting 10+ minutes

MI pain characteristics?

• Severe chest pain unrelieved by rest or nitrate administration

• Often occurs in early morning

• Atypical in women, elderly

SNS symptoms of MI?

• Diaphoresis

• Increased HR & BP

• Vasoconstriction of peripheral bvs → ashen, clammy, cool skin

Cardiovascular s/s of MI?

• Initial increase HR & BP then decrease BP (decreased CO)

• Decreased UOP (decreased renal perfusion)

• Crackles + JVD (CHF)

• Abnormal heart sounds (murmur, S3/S4)

ECG change in STEMI?

ST elevation (QRS doesn’t come back down)

ECG changes in NSTEMI?

ST depression or T inversion

MI treatment?

• Antiplatelet/anticoagulant

• Antianginals

• Antihypertensives

• Smoking cessation

• Cholesterol management

Serum cardiac biomarkers after MI? (3)

• Troponin → gold-standard diagnostic but up to 24h

• CK-MB → muscle damage but less specific

• Myoglobin → Nonspecific muscle damage (goes up first)

ACS treatment priorities?

• 12-lead ECG

• Upright position (increase perfusion)

• Oxygen (O2 > 93%)

• IV access

• Nitro & Aspirin (325 mg CHEWED)

• Statins & Morphine

ACS treatment of choice for confirmed STEMI?

• Emergent PCI

  • Goal: 90 minutes door to cath lab

  • Balloon angioplasty + stent(s)

When is thrombolytic therapy used for MI?

• Only for patients with a STEMI

  • Agencies that do not have cardiac catheterization resources

  • Given IV within 30 minutes of arrival to the ED

When is thrombolytic therapy contraindicated? Nursing intervention?

• Recent surgery, hx hemorrhagic stroke, aneurysm risk

  • Ask detailed questions to determine if patient is a candidate

Key nursing goals for MI?

• Preservation of heart muscle

• Resumption of sexual activity

• Cardiac rehabilitation participation

What can be delegated to UAPs? And LPNs?

• UAPs → VS, I/Os, report complications

• LPN → stable patient, NO thrombolytics