Cardiovascular Disease Management Quiz

Cardiovascular Disease Management

• Leading Cause of Death: Cardiovascular disease is the leading cause of death in the US for all genders and ethnicities.
• Coronary Artery Disease (CAD): Most prevalent type of CVD in adults. CAD is most often caused by Coronary Atherosclerosis.
• Atherosclerosis: Abnormal accumulation of lipids and fibrous tissue in arterial walls. This begins with vascular endothelium injury and progresses over years. Potential causes include smoking, hypertension, and hyperlipidemia.

Pathophysiology of CAD

• Inflammation: Inflammation attracts inflammatory cells (like macrophages) after endothelium injury.
• Plaque Stability: Plaque can be stable or unstable. Unstable plaque has a thin fibrous cap and ongoing inflammation, increasing risk of acute MI (myocardial infarction).
• Risk Factors Elevated LDL: is a major risk factor. Elevated waist circumference, triglycerides, reduced HDL, and hypertension are also major risk factors

Prevention of CAD

• Lipid Management: Adults 20+ need fasting lipid profiles every 5 years.
• Lifestyle Interventions: Healthy diet ( Mediterranean), regular physical activity, and weight reduction.
• Medication: Lipid-lowering agents (statins) and smoking cessation aids (patches, lozenges).
• Hypertension Control: Early diagnosis and treatment are vital to prevent serious health implications.
• Gender Considerations: Women often present with symptoms 10 years later than men and have higher mortality rates.

Angina Pectoris

• Mechanism: Increased demand for blood flow in coronary arteries (physical exertion, cold, heavy meals).
• Types:
  • Stable: Predictable, relieved by rest or nitroglycerin.
  • Unstable: Not relieved by rest or nitroglycerin.
  • Variant (Prinzmetal): Thought to be caused by coronary artery spasm.

Geriatric Considerations

• Pain Presentation: Older adults may not exhibit typical pain profiles due to diminished pain transmission.

Assessment and Medical Management of CAD

• Diagnostic Tests: 12-lead ECG.
• Medical Management:
  • Goal: Decrease myocardial oxygen demand and increase supply.
  • Pharmacotherapy: Nitroglycerin (vasodilator), beta-blockers (e.g., metoprolol), antiplatelets (e.g., aspirin, warfarin, clopidogrel), calcium channel blockers (e.g., amlodipine, diltiazem).

Acute Coronary Syndrome (ACS) and Myocardial Infarction (MI)

• Definition: Acute onset of myocardial ischemia resulting in myocardial death. Includes unstable angina, Non ST Elevation MI (NSTEMI), and ST Elevation MI (STEMI).
• Mechanism: Reduced coronary blood flow, often due to plaque rupture, leading to clot formation.
• "Time is Muscle": Prompt intervention is crucial.
• Clinical Manifestations: Sudden chest pain (not relieved by rest and nitroglycerin), nausea, anxiety, cool, pale, moist skin.
• Laboratory Testing: Troponin, Creatine Kinase (CK), CK-MB, Myoglobin.

Medical Management of ACS/MI (MONA)

• Morphine: Pain relief and anxiety reduction.
• Oxygen: Supportive therapy.
• Nitroglycerin: Vasodilator.
• Aspirin: Blood thinner.
• Further Treatment: 12-lead ECG within 10 minutes, ACE inhibitors within 24 hours, anticoagulation with heparin, platelet inhibitors.

Percutaneous Coronary Intervention (PCI)

• Atherectomy: Removal of plaques using rotating shavers or lasers.
• Stents: Mesh-wire devices to keep arteries open.
• Types: Bare-metal and drug-eluting stents
• Angioplasty: Inflation of a balloon to widen arteries.

PCI Complications and Nursing Actions

• Artery Dissection/Perforation: Cardiac tamponade – fluid buildup in pericardium. Immediate provider notification, IV fluids, chest x-ray or echocardiogram, prepare for pericardiocentesis.
• Hematoma: Monitor insertion site, apply pressure, keep limb straight, provider notification.
• Allergic Reactions (Contrast Dye): Monitor for allergic reactions, have resuscitation equipment ready, administer diphenhydramine or epinephrine prn.
• External Bleeding: Monitor insertion site for bleeding or swelling, apply pressure, maintain limb position, notify provider.
• Embolism (Dislodged Plaque/Clot): Monitor for symptoms like flank pain and hypotension, inform the provider, initiate IV fluids, blood products.
• Retroperitoneal Bleeding: Assess for flank pain and hypotension, notify provider, administer IV fluids and blood products.
• Restenosis: Clot formation; potential for symptom recurrence.
• Acute Kidney Injury: Monitor urine output, BUN, creatinine, electrolytes and promote hydration.

Coronary Artery Bypass Graft (CABG)

• Procedure Goal: Restore myocardial vascularization.
• Indications: >50% blockage of left main coronary artery, significant two- or three-vessel disease, unstable angina
• Pre-op: Informed consent, chest x-ray, ECG, labs, baseline cognitive assessments and pre-op meds.
• Client Education (Pre & Post-op): Turn, cough, deep breathing, splinting, mechanical ventilation, incision care, heart-healthy diet, rest & recovery.

Post-CABG Complications & Nursing Actions

• Pulmonary Complications (Atelectasis, Pneumonia, Pulmonary Edema): Monitor vitals, encourage coughing, deep breathing, incentive spirometry.
• Hypothermia: Monitor temperature, provide warming measures, monitor BP and admin vasodilators (as directed)
• Decreased Cardiac Output & Hypovolemia: Monitor for hypotension, low urine output and treat as directed.
• Cardiac Tamponade: Bleeding with occluded chest tubes, leading to fluid accumulation.
• Electrolyte Imbalances: Potassium and magnesium loss possible. Do not push potassium, dilute as needed.
• Neurologic Deficits: Monitor pupils, level of consciousness etc. and maintain BP in prescribed limits.