Cardiac Nursing: CAD, Angina, MI, and Reperfusion Therapy

What is atherosclerosis?

Plaque builds up inside arteries, causing inflammation, hardening, and reduced blood flow.

How does CAD cause ischemia?

Narrowed coronary arteries cannot supply enough oxygen for the heart's demand.

When does the heart receive most coronary blood flow?

During diastole.

What is stable angina?

Predictable chest pain with exertion, usually relieved by rest or nitroglycerin.

What is unstable angina?

New, worsening, or unpredictable chest pain that is not reliably relieved by rest.

What chest pain findings suggest ACS rather than stable angina?

Pain at rest, lasting over 15 minutes, worsening, or accompanied by sweating and dyspnea.

What is myocardial infarction (MI)?

Irreversible heart muscle death due to sustained lack of coronary blood flow.

Why can myocardial ischemia cause chest pain?

Low oxygen leads to anaerobic metabolism and lactic acid production.

What conditions are included in ACS?

Unstable angina, NSTEMI, and STEMI.

What is the difference between NSTEMI and STEMI?

STEMI has ST elevation on ECG; NSTEMI lacks ST elevation but has myocardial injury.

What are classic MI symptoms?

Crushing chest pain, diaphoresis, dyspnea, nausea, palpitations, and anxiety.

Who may have atypical or silent MI symptoms?

Older adults, women, patients with diabetes, and heart transplant recipients.

What are possible atypical MI symptoms?

Fatigue, unease, mild back discomfort, palpitations, or no chest pain.

What is the nursing priority for suspected MI?

Assess ABCs, promptly obtain a 12-lead ECG, and activate urgent evaluation.

What does a 12-lead ECG help identify?

Electrical changes suggesting myocardial ischemia or infarction.

What does an echocardiogram assess?

Heart structure, wall motion, and ejection fraction.

What does a cardiac stress test assess?

Cardiac response to exercise or medication-induced stress.

Which medications may be used for pharmacologic stress testing?

Dobutamine, adenosine, or dipyridamole.

What does coronary angiography identify?

Location and severity of coronary artery blockages.

What is troponin used to detect?

Heart muscle injury; it is a key marker for MI.

When does troponin I rise and peak according to the slides?

Rises in 4-6 hours and peaks in 10-24 hours after MI onset.

What troponin I normal value is listed on the slides?

Less than 0.1 ng/mL; laboratory reference ranges vary.

What does CK-MB help indicate?

Muscle injury; it is more cardiac-specific than total CK.

What labs besides cardiac markers matter in MI?

Electrolytes, BUN/creatinine, CBC, PT/INR, and PTT.

Why monitor electrolytes after an MI?

Abnormal electrolytes increase the risk of dysrhythmias.

What is the main goal of CAD management?

Prevent progression and MI while controlling symptoms.

What diet changes are taught for CAD?

Reduce saturated fats and sodium and support healthy weight.

What lifestyle changes help reduce CAD risk?

Exercise, smoking cessation, weight management, and BP/lipid screening.

How does nitroglycerin help angina?

Vasodilation decreases cardiac workload and myocardial oxygen demand.

What nitroglycerin instructions are emphasized on the slides?

Carry it, protect it from light, and take prescribed doses 5 minutes apart.

What should a patient do with possible heart attack symptoms?

Call 911 immediately; do not delay emergency care to finish nitroglycerin doses.

How do beta blockers help CAD and MI patients?

Lower heart rate and contractility to reduce cardiac workload.

How do ACE inhibitors or ARBs help cardiac patients?

Lower BP and cardiac workload; used when indicated.

How do calcium channel blockers help angina?

Promote vasodilation; some also reduce contractility and heart rate.

Why are aspirin and clopidogrel given for CAD?

They inhibit platelet aggregation and lower clot risk.

Why are statins prescribed for CAD?

Lower lipids and help prevent progression of atherosclerosis.

What are major CAD complications?

MI, heart failure, dysrhythmias, and sudden cardiac death.

What are serious MI complications?

Dysrhythmias, heart failure, cardiogenic shock, rupture, and sudden death.

What does 'time is muscle' mean?

Rapid reperfusion can save ischemic myocardium from irreversible damage.

What is PCI?

Percutaneous coronary intervention to reopen narrowed or blocked coronary arteries.

What is balloon angioplasty?

Inflating a balloon in a narrowed coronary artery to improve blood flow.

What is a coronary stent?

A mesh tube placed in an artery to help keep it open.

What STEMI PCI time goal appears in the slides?

Within 90 minutes of hospital arrival.

What is reperfusion therapy's goal?

Restore blood flow through coronary arteries to ischemic tissue.

What do fibrinolytics do?

Break down blood clots to restore blood flow.

Which fibrinolytics appear in the slides?

Alteplase, tenecteplase, and streptokinase.

What fibrinolytic treatment window is listed in the slides?

Within 4 hours of symptom onset.

What is the most important complication of fibrinolytics?

Major bleeding, including intracranial hemorrhage.

What findings after fibrinolytics demand immediate assessment?

Altered consciousness, stroke signs, hematuria, or GI bleeding.

What fibrinolytic cautions are listed?

Recent surgery/trauma, stroke history, active bleeding, uncontrolled HTN, and peptic ulcer.

Why is antiplatelet therapy important after a stent?

Stents can form clots; antiplatelets help prevent stent thrombosis.

What may sudden recurrent chest pain after PCI indicate?

Possible stent occlusion or recurrent ischemia; report immediately.

What does left heart catheterization use for access?

An artery; contrast angiography visualizes coronary blockages.

What does right heart catheterization use for access?

A vein; it measures heart pressures and may use a Swan-Ganz catheter.

What should the nurse check before cardiac catheterization?

NPO status, allergies, IV access, labs, ordered medications, and education.

What should the nurse monitor after catheterization?

Vital signs, pain, rhythm, ECG, access site, bleeding, and circulation.

What are major cardiac catheterization complications?

Bleeding, embolism, dissection, tamponade, contrast injury, and stent occlusion.

What findings suggest retroperitoneal bleeding after femoral access?

Back/flank pain, hypotension, tachycardia, or falling hemoglobin.

What should the nurse do for active catheter-site bleeding?

Apply pressure per protocol, assess stability, and notify the team promptly.

Why is bedrest ordered after femoral catheterization?

To reduce bleeding from the arterial puncture site.

What is CABG?

Bypass surgery that reroutes blood around blocked coronary arteries.

When may CABG be needed?

When medications or PCI cannot adequately manage CAD or PCI complications occur.

What are serious CABG complications?

Stroke, infection, heart failure, respiratory or kidney failure, and tamponade.

What nursing interventions matter after CABG?

Hemodynamic monitoring, deep breathing, incentive spirometry, early ambulation, and infection prevention.

Does CABG cure atherosclerosis?

No; long-term medications and lifestyle changes remain essential.

What is primary hypertension?

High BP without a single identifiable cause.

What is secondary hypertension?

High BP caused by an identifiable medical problem.

What raises BP during sympathetic activation?

Increased heart rate, contractility, and vasoconstriction.

How does RAAS increase BP?

Angiotensin II constricts vessels; aldosterone promotes sodium/water retention.

What is the MAP formula?

(Systolic BP + 2 × diastolic BP) ÷ 3.

Why is MAP important?

It estimates average arterial pressure and helps evaluate organ perfusion.

What MAP concern appears in the slides?

MAP below 60 mmHg risks tissue ischemia; goal is generally above 65.

Why is hypertension sometimes called silent?

Organ damage can occur without obvious symptoms.

What organs can uncontrolled hypertension damage?

Heart, brain, kidneys, eyes, and peripheral vessels.

What are possible hypertension symptoms?

Headache, dizziness, vision changes, dyspnea, palpitations, or no symptoms.

What is the overall medication goal in hypertension?

Reduce circulating volume and/or systemic vascular resistance.

What thiazide diuretics appear in the slides?

Chlorthalidone and hydrochlorothiazide.

How do diuretics lower BP?

Increase sodium and water excretion, lowering circulating volume.

What are examples of ACE inhibitors and ARBs?

Lisinopril or ramipril; losartan or valsartan.

What are examples of calcium channel blockers?

Amlodipine, nifedipine, diltiazem, and verapamil.

What are examples of cardioselective beta blockers?

Metoprolol, atenolol, esmolol, and nebivolol.

What antihypertensive adverse effects require teaching?

Dizziness, orthostatic hypotension, fatigue, and sexual dysfunction.

What home teaching helps manage hypertension?

Monitor BP, take medications consistently, reduce sodium, exercise, and stop smoking.

What is hypertensive urgency?

Severely elevated BP without acute target-organ damage.

What is hypertensive emergency?

Severely elevated BP with acute target-organ damage requiring prompt treatment.

What differentiates hypertensive emergency from urgency?

Evidence of acute target-organ damage, not BP number alone.

What are warning signs of hypertensive emergency?

Confusion, seizures, chest pain, dyspnea, or signs of kidney injury.

What initial MAP reduction is described for hypertensive emergency?

About 20%, followed by gradual lowering over the next 24 hours.

What is pharyngitis?

Inflammation of the pharynx, commonly causing sore throat.

What causes most pharyngitis according to the slides?

Viruses; these usually resolve with supportive care.

What organism causes classic bacterial strep pharyngitis?

Group A beta-hemolytic Streptococcus.

What findings suggest strep pharyngitis?

Fever, tender cervical nodes, tonsillar exudate, and absence of cough.

What signs may also occur with strep throat?

Strawberry tongue, palatal petechiae, rash, and halitosis.

What finding suggests fungal pharyngitis?

White patches, often after antibiotics or inhaled corticosteroids.

How is suspected strep pharyngitis tested?

Rapid antigen testing with a posterior pharynx/tonsil swab.

How is viral pharyngitis managed?

Supportive care: rest, analgesics, fluids, and soothing gargles.

What antibiotics are listed for strep pharyngitis?

Penicillin V or amoxicillin; azithromycin if penicillin-allergic per slides.

What treatment is listed for fungal pharyngitis?

Nystatin swish and swallow.

What complications can untreated strep cause?

Rheumatic fever, nephritis, and local spread of infection.

What teaching prevents spread of pharyngitis?

Hand hygiene, no shared utensils, cough etiquette, and appropriate antibiotic use.