Coronary Artery Disease and Acute Coronary Syndrome

Study Notes

Etiology and Pathophysiology of Coronary Artery Disease (CAD)

CAD leads to reduced blood flow and oxygen to the heart, potentially resulting in Acute Coronary Syndrome (ACS).
Risk factors include hypertension, hyperlipidemia, diabetes, smoking, and a sedentary lifestyle.
Plaque rupture in atherosclerosis provokes thrombus formation, obstructing coronary arteries and contributing to angina or myocardial infarction.

Angina Types

Chronic Stable Angina: Triggered by exertion or stress, resolves with rest or nitroglycerin; characterized by predictable frequency.
Prinzmetal’s Angina: Caused by coronary artery spasms, often occurring at rest; typically transient and triggered by stress or cold.
Unstable Angina: Occurs at rest, unpredictable, prolonged, and exacerbated by physical or emotional stress; indicates significant coronary artery obstruction and risk for myocardial infarction.

Clinical Manifestations of Angina

Typical complaints include chest discomfort, pressure, or pain; may radiate to the arms, neck, jaw, or back.
Patients with unstable angina may present with severe, sudden onset of symptoms distinguishing it from chronic stable angina.
Health disparities exist: minority communities may experience delayed diagnosis and access to care, leading to worse outcomes.

Differentiating Unstable Angina, NSTEMI, and STEMI

Unstable Angina: No cardiac enzyme elevation, ST-segment depression or T-wave inversion on EKG; transient ischemia.
NSTEMI: Cardiac enzyme elevation (e.g., troponin), ST-segment depression or T-wave inversion on EKG; signifies partial occlusion.
STEMI: Elevated ST segments on EKG indicate complete occlusion of a coronary artery; cardiac enzyme elevation essential for diagnosis.

Diagnostic Tests and Labs

Initial EKG changes help differentiate between unstable angina, NSTEMI, and STEMI.
Cardiac biomarkers (troponins, CK-MB) are critical; serial lab tests may indicate continuous damage in NSTEMI and STEMI.

Nursing Management and Acute Chest Pain

Monitor vital signs, administer oxygen if hypoxic, and provide aspirin and nitroglycerin.
EKG should be done immediately for initial assessment; assess pain characteristics and response to nitroglycerin.
Provide patient education on lifestyle changes and medication adherence post-discharge.

HEART Score

Categories: History, EKG, Age, Risk factors, and Troponin levels.
Utilized to evaluate risk of major adverse cardiac events; informs treatment decisions and discharge pathway.

Cath Lab and tPA Considerations

Patients with high risk for myocardial infarction are prioritized for cath lab intervention; goal is within 90 minutes of arrival.
tPA (thrombolytics) is indicated for STEMI patients if within the treatment window and no contraindications exist.

Follow-Up and Monitoring

Post-MI follow-up should include assessing for complications, medication adherence, and lifestyle modifications.
Evaluating treatment effectiveness through symptom relief and functional capacity improvement.

Complications of STEMI

Potential complications include arrhythmias, heart failure, and cardiogenic shock.
Physical exam may reveal abnormal heart sounds, signs of fluid overload, and vital sign instability.

Takotsubo Cardiomyopathy

A stress-induced condition primarily affecting women, presenting with symptoms similar to myocardial infarction.
HPI typically involves a recent emotional or physical stressor, dyspnea, and chest pain; heart function usually normalizes over time.

Hypertensive Crisis

Causes include poorly controlled hypertension, medications, or adrenal causes.
Clinical manifestations include severe headache, anxiety, chest pain, and altered mental status.
Nursing management involves immediate BP reduction, assessment of end-organ damage, and continuous monitoring.

Treatment Goals

Rapidly lower blood pressure to prevent complications while maintaining organ perfusion.
Assess effectiveness by monitoring BP trends and resolving symptoms.

Description

This quiz covers the etiology and pathophysiology of coronary artery disease, its implications on developing acute coronary syndrome, and differentiating angina types. It also explores clinical manifestations and health disparities.