Chapter 28: Coronary Artery Disease (CAD) Exam 2

What do the coronary arteries do?

Supply blood and oxygen to the heart during diastole (ventricular relaxation).

What is Coronary Artery Disease (CAD)?

Narrowing or blockage of the coronary arteries.

What usually causes CAD?

Atherosclerosis

What is atherosclerosis?

Build-up of cholesterol plaque on the inner walls of arteries.

How does plaque affect the heart?

Reduces blood flow and oxygen delivery to the heart.

What can severe CAD lead to?

Angina and myocardial infarction (heart attack).

What are the risk factors for CAD?

• Smoking

• Abnormal cholesterol

• Hypertension

• Obesity

• Diabetes/prediabetes

• Age

• Genetics

• Ethnicity

• History of preeclampsia

How can CAD be managed without medications?

• Exercise

• Stop smoking

• Control BP

• Control cholesterol

• Control glucose

• Lifestyle changes

What procedures may be used to treat CAD?

• CABG

• Cardiac catheterization

• PCI/Stent

What is angina?

Chest pain caused by an imbalance between oxygen supply and oxygen demand.

Why does angina occur in CAD?

The heart's oxygen demand is greater than the oxygen supply.

How may women present differently with CAD?

GI symptoms rather than classic chest pain.

What conditions are included in Acute Coronary Syndrome (ACS)?

• Unstable angina

• NSTEMI

• STEMI

What is NSTEMI?

Ischemia caused by inadequate blood flow to the heart.

Is NSTEMI urgent or emergent?

Urgent.

What is STEMI?

ST-elevation myocardial infarction.

Why is STEMI more serious?

Heart muscle is dying.

Is STEMI urgent or emergent?

Emergent.

What is the goal of antianginal therapy?

• Increase oxygen supply

• Decrease oxygen demand

How do antianginal drugs decrease oxygen demand?

By reducing preload, afterload, heart rate, and/or contractility.

What do nitrates do?

Relax and dilate veins, arteries, and capillaries.

How do nitrates improve angina?

• Increase oxygen supply

• Decrease oxygen demand

How do nitrates affect preload and afterload?

Decrease preload and afterload.

Examples of nitrates?

• Nitroglycerin

• Isosorbide dinitrate

• Isosorbide mononitrate

How is nitroglycerin commonly given for acute angina?

Sublingually

How many doses of sublingual nitroglycerin can be given?

Up to 3 doses.

How long should the patient wait between nitroglycerin doses?

5 minutes

What should a patient do after the third nitroglycerin dose?

Call 911.

Major adverse effects of nitroglycerin?

• Severe headache

• Hypotension

• Reflex tachycardia

When should nitroglycerin NOT be used?

• Right-sided MI

• Head injuries

• Recent erectile dysfunction medication use

Which erectile dysfunction medications cannot be taken with nitrates?

• Sildenafil

• Vardenafil

What should the nurse monitor closely when administering nitroglycerin?

Blood pressure.

How do beta blockers help angina?

Decrease heart rate and contractility, reducing oxygen demand.

What receptor do selective beta blockers block?

Beta-1

Major adverse effects of beta blockers?

• Bradycardia

• Hypotension

• Masked hypoglycemia

Contraindications for beta blockers?

• Liver impairment

• Heart block

• AV block

How do calcium channel blockers help angina?

Vasodilation decreases afterload and reduces cardiac oxygen demand.

Calcium channel blockers end in?

-pine

Memory trick for calcium channel blockers?

Pine tree = wide = widen arteries.

What type of calcium channel blockers are amlodipine, nicardipine, and nifedipine?

Dihydropyridines.

Major adverse effects of calcium channel blockers?

• Flushed skin

• Muscle cramps

• Peripheral edema

• Headache

• Dizziness

• Hypotension

• Sexual dysfunction

Which calcium channel blocker can be given IV?

Nicardipine.

What should patients avoid while taking calcium channel blockers?

Grapefruit juice.

What is Ranolazine?

An anti-ischemic metabolic modulator used as first-line treatment for chronic angina.

How does morphine help patients with CAD?

Relieves pain and decreases preload and afterload.

What antiplatelets were mentioned for CAD?

• Aspirin

• ADP receptor antagonists

• GP IIb/IIIa receptor antagonists

Goals of CAD therapy?

• Relieve angina

• Reduce angina attacks

• Improve exercise tolerance

• Delay CAD progression

• Prevent MI

• Prevent sudden cardiac death