Cardiac Part II (PathoPharm Exam 2)

coronary artery disease (CAD)

Any vascular disorder that narrows or occlude the coronary arteries leading to myocardial ischemia

atherosclerosis

what is the most common cause of coronary artery disease?

atheroscleroatic plaque

narrows arteies, reducing oxygen delivery

endothelium

what usually prevents plaques?

1. BP

2. diabetes

3. high cholesterole

what three things cause damage to the endothelium?

endothelium becomes damaged -> becomes inflamed and very permeable

what causes a plaque to form?

when plaque starts to build up -> endothelium realizes it is damaged -> sends platelets to aggregate it (start of cascade effect) -> platelets adhere and form plug and eventually forms a clot -> can then block arteries

how are clots formed?

oxygen supply-demand mismatch

what causes myocardial ischemia?

ischemia

Lack of blood supply

dilate veins and arteries to relieve pain

what do nitrates (nitroglycerin, isosorbide) do to help treat coronary artery disease (CAD)?

lower low-density lipoprotein (LDL) and stabilize plaques

what do statins do to help treat coronary artery disease (CAD)?

1. stable

2. unstable

what are two types of plaques

stable plaque

plaque formed in the artery wall that remains in the wall (really secure)

-less likely to rupture (generally safer)

unstable plaque

plaque formed in the artery wall that can break away and obstruct blood flow or form a clot (not very secure)

-much higher risk of rupturing

contents of plaque rush into bloodstream -> clotting cascade happens and more clots form

what happens if a plaque ruptures?

95-99%

vessels need to be ___-___% blocked to experience chest pain

high

do low or high cholesterol level increase risk for coronary heart disease?

3, 4, greater

the risk of coronary heart disease in patients with cholesterol levels of 300 mg/dL is ___ to ___ time _________ than the patients with levels less than 200 mg/dL

below 100 mg/dL

what is a good LDL level for cholesterol?

above 40 mg/dL

what is a good HDL level for cholesterol

bad

is LDL good or bad?

good

is HDL good or bad?

exercise and diet

what is the first thing to try in a patient who has high cholesterol

stable angina pectoris

-predictable chest pain with exertion

-relieved by rest or nitrates

temporary ischemia

partial obstruction of coronary arteries causes...

reduce preload

for treatment of stable angina pectoris, what do nitrates do?

slow HR

for treatment of stable angina pectoris, what do beta blockers do?

lowers afterload

for treatment of stable angina pectoris, what do calcium-channel blockers do?

up to 3 doses, 5 minutes apart

what is the proper nitroglycerin use for stable angina pectoris?

phosphodiesterase inhibitors (sildenafil)

what should you avoid when taking nitrates

acute coronary syndrome (ACS)

sudden reduced blood flow to heart that leads to unstable angina

-plaque rupture and thrombus formation abruptly reduce flow

unstable angina

-unpredictable chest pain

-pain occurs at rest

-may not resolve with nitrates

1. oxygen

2. nitrates

3. antiplatelets (aspirin, clopidogrel)

4. anticoagulants (heparin)

5. morphine

what are 5 things you can treat unstable angina with?

infarction

beta blockers decrease _________ risk

1. monitor ECG

2. monitor troponin

3. prepare reperfusion therapy

what are three things nurses need to do when taking care of a pt. with unstable angina or acute coronary syndrome?

1. sublingual

2. oral spray

3. intravenously

what are three rapidly absorbable routes for angina?

1. transdermal patches

2. topical oinments

3. rectally

what are three long-term prevention routes for nitroglycerin for stable angina?

myocardial infarction (MI)

prolonged ischemia causes irreversible death of heart muscle

1. STEMI

2. NSTEMI

what are two types of MIs?

ST-Elevation Myocardial Infarction (STEMI)

heart attack that affects the full heart wall

Non-ST-Elevation Myocardial Infarction (NSTEMI)

heart attack that only affects part of the heart wall

-may not know you had one

1. quickly assess

2. call emergency services

3. give aspirin unless contraindicated

4. provide oxygen if O2 saturation is less than 90%

5. use nitrates for chest pain if safe

what are 5 immediate care steps for myocardial infarction (MI)?

percutaneous coronary intervention (PCI)

a procedure in which a catheter is placed in a coronary artery, and one of several methods is employed to reduce blockage within the artery

thrombolytic therapy

drugs to dissolve clots

-given if PCI is not available

90 minutes

PCI is preferred within ______ minutes

the heart works differently and drugs help prevent further remodeling and take extra workload off heart to prevent another heart attack

why are people placed on beta blocked and ACE inhibitors after heart attacks?

prevent new plaque formation

after a myocardial infarction (MI), statins are given to do what?

morphine

use _________ carefully to manage pain of a myocardial infarction (MI), watching for side effects

1. radiating chest pain

2. radiating pain in jaw to neck, and down left arm

3. nausea

4. dysnpea

5. cold sweat

6. feeling faint

7. tiredness

what are 7 symptoms of myocardial infarction (MI)?

1. heart failure

2. arrhythmias

damaged myocardium remodels after a myocardial infarction (MI), risking what two things?

1. beta blockers

2. aspirin

what two things do you continue indefinitely after a myocardial infarction (MI)?

heart failure

inability of the heart to pump enough blood to meet the body's demands

1. ischemia

2. high BP

3. valvular disease

what three things cause heart failure?

1. preload

2. afterload

3. contractility

heart failure is treated by targeting what three things?

pulmonary congestion

left-sided heart failure

1. crackles

2. dysnpea

3. fatigue

what are three symptoms/signs of left sided heart failure

systemic edema

right sided heart failure

1. ascites

2. jugular venous distention

what are two symptoms/signs of right sided heart failure?

1. weight

2. edema

3. O2 saturation

4. medication adherance

what four things should nurses track for when checking for heart failure?

loop diuretics

what treats congestion/left-sided heart failure?

ACE inhibitors

what lowers afterload in right/left heart failure?

1. output

2. perfusion

what two things do left and right sides heart failure decrease?

low output failure

pump weakness from ischemia or cardiomyopathy

HF medications

what is low output failure treated with?

high output failure

increased demand (anemia, sepsis, hyperthyroidism)

treating the cause

what is the high output failure treated with?

1. perfusion

2. mental status

3. urine output

4. skin temperature

what four things do you assess for when looking for high or low output failure?

1. systolic heart failure

2. diastolic heart failure

what are two types of left heart failure?

systolic heart failure

-inability of the heart to generate adequate cardiac output to perfuse tissues

-ventricular remodeling

ventricular remodeling

heart changes shape

1. myocardial infarction

2, myocarditis

3. cardiomyopathy

what are three causes of systolic heart failure?

diastolic heart failure

-pulmonary congestion despite normal stroke volume and cardiac output

-heart failure with preserved ejection fraction -> high ejection fraction

-left ventricle cannot relax completely

1. myocardial hypertrophy and ischemia

2. diabetes

3. valvular and paricardial disease

what are three causes of diastolic heart failure?

abdnormal impulse formation or conduction

what do dysrhythmias stem from?

1. decreased output

2. decreased perfusion

what two things do dysrhythmias cause?

1. ischemia

2. electrolyte imbalance

3. drug toxicity

what are three common causes of dysrhythmias?

1. restore rhythm

2. control rate safely

what two things do treatments for dysrhythmias aim to do?

bradycardia

<60 BPM

1. vagal tone

2. beta-blockers

2. MI

what are three causes of bradycardia?

tachycardia

>100 BPM

1. fever

2. anxiety

3. hypovolemia

what are three causes of tachycardia?

atropine

what do you treat bradycardia with if you are symptomatic?

1. correcting cause

2. using beta-blocker

what two things do you treat tachycardia with?

1. perfusion

2. oxygenation

what two things do you monitor for when dealing with bradycardia and tachycardia?

atrial fibrillation (A-Fib)

chaotic atrial activity -> irregularly rhythm, poor atrial contraction

P-wave due to atria quivering/not contracting

what wave is not shown on the ECG in atrial fibrillation (A-Fib) and why?

1. clot formation

2. stroke

3. heart failure

what are the three risks of atrial fibrillation (A-Fib)?

1. beta-blocker

2. calcium-channel blocker (verapamil, diltiazem)

what are the two rate controls for atrial fibrillation (A-Fib)?

1. amiodarone

2. sotalol

what are the two rhythm controls for atrial fibrillation (A-Fib)?

anticoagulants (warfarin or DOAC)

what drugs are used to prevent embolic events in atrial fibrillation (A-Fib)?

1. rate control

2. rhythm control

atrial fibrillation (A-Fib) management usually focuses on what two major goals?

rate control

slowing the ventricular response

rhythm control

restoring or maintaining normal sinus rhythm

1. metoprotolol

2. atenolol

3. bisoprolol

4. carvedilol

what are four examples of atrial fibrillation (A-Fib) beta blockers?

block beta receptors in the heart -> slow AV nodal conduction -> reduce HR

how do beta blockers work for atrial fibrillation (A-Fib)?

beta blockers

what drugs are rate control in AFib, especially when rapid ventricular response?

Afib + Heart failure (HFrEF)

what is the preferred choice when in atrial fibrillation (A-Fib) and beta blockers?

1. HR

2. BP

what are two things to check before giving beta blockers for atrial fibrillation (A-Fib)?

1. severe bradycardia

2. heart block

3. acute decompensated HF

what are three things to avoid beta blockers in when using them for atrial fibrillation (A-Fib)?

1. diltiazem (cardiazem)

2. verapamil

what are two examples of calcium channel blocker drugs for atrial fibrillation (A-Fib)?