Podcast
Questions and Answers
What is the most common cause of cardiovascular disease in the United States?
What is the most common cause of cardiovascular disease in the United States?
Which of the following is NOT a risk factor for coronary artery disease?
Which of the following is NOT a risk factor for coronary artery disease?
What is the purpose of a stent in a percutaneous coronary intervention (PCI)?
What is the purpose of a stent in a percutaneous coronary intervention (PCI)?
What is the term for chest pain that occurs when the heart muscle does not receive enough oxygen?
What is the term for chest pain that occurs when the heart muscle does not receive enough oxygen?
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Which type of angina is unpredictable and may not be relieved by rest or nitroglycerin?
Which type of angina is unpredictable and may not be relieved by rest or nitroglycerin?
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Which of the following is a potential complication of a coronary angiogram procedure?
Which of the following is a potential complication of a coronary angiogram procedure?
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Which of the following is a possible explanation for client experiencing chest pain after a coronary angiogram?
Which of the following is a possible explanation for client experiencing chest pain after a coronary angiogram?
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Which of the following medications is NOT typically used in the medical management of coronary artery disease?
Which of the following medications is NOT typically used in the medical management of coronary artery disease?
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Which of the following nursing actions is appropriate for a patient experiencing a cardiac tamponade following a coronary angiogram?
Which of the following nursing actions is appropriate for a patient experiencing a cardiac tamponade following a coronary angiogram?
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What is the acronym MONA used to describe the initial medical management of acute coronary syndrome?
What is the acronym MONA used to describe the initial medical management of acute coronary syndrome?
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Which of the following nursing actions is most appropriate for a client experiencing an allergic reaction to the contrast dye used in a coronary angiogram?
Which of the following nursing actions is most appropriate for a client experiencing an allergic reaction to the contrast dye used in a coronary angiogram?
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What is the primary reason for obtaining a 12-lead ECG within 10 minutes of an acute coronary syndrome?
What is the primary reason for obtaining a 12-lead ECG within 10 minutes of an acute coronary syndrome?
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Which of the following is an indication for coronary artery bypass graft (CABG) surgery?
Which of the following is an indication for coronary artery bypass graft (CABG) surgery?
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Which of the following is NOT a common complication of a myocardial infarction?
Which of the following is NOT a common complication of a myocardial infarction?
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Which of the following medications is commonly administered pre-operatively for a CABG procedure?
Which of the following medications is commonly administered pre-operatively for a CABG procedure?
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What is the purpose of a drug-eluting stent compared to a bare-metal stent?
What is the purpose of a drug-eluting stent compared to a bare-metal stent?
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Which of the following is a potential postoperative complication of CABG surgery?
Which of the following is a potential postoperative complication of CABG surgery?
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Which of the following is a characteristic of stable angina?
Which of the following is a characteristic of stable angina?
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Which of the following nursing actions is most appropriate for a client experiencing hypothermia after CABG surgery?
Which of the following nursing actions is most appropriate for a client experiencing hypothermia after CABG surgery?
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Which of the following nursing actions is most appropriate for a client experiencing decreased cardiac output after CABG surgery?
Which of the following nursing actions is most appropriate for a client experiencing decreased cardiac output after CABG surgery?
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Which of the following client education points is most important for a client undergoing a coronary angiogram?
Which of the following client education points is most important for a client undergoing a coronary angiogram?
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Study Notes
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).
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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.
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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.
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Description
Test your knowledge on cardiovascular disease management and the pathophysiology of coronary artery disease. This quiz covers key concepts such as the leading causes of CVD, atherosclerosis, inflammation, and risk factors related to CAD. Dive into the details and see how much you know about this critical health issue.
