FOUNDATIONS: CORONARY ATHEROSCLEROTIC HEART DISEASE, ANGINA PECTORIS, MYOCARDIAL INFARCTION and HEART FAILURE Flash Cards

Questions and Answers

What is the primary cause of coronary artery disease (CAD)?

Atherosclerosis (correct)

Arrhythmia

Hypertension

Hemorrhage

What happens when the myocardial oxygen demand exceeds the supply delivered by the coronary arteries?

Angina is alleviated

Hypertension occurs

Ischemia results (correct)

Cardiac arrest happens

What is a characteristic change in the artery walls due to atherosclerosis?

Increased plasticity

Widening of the lumen

Enhanced responsiveness to blood flow

Hardened and less elastic walls (correct)

What is angina pectoris primarily associated with?

Decreased oxygen flow to the myocardium Signup and view all the answers

What is the significance of an obstruction exceeding 75% in the coronary arteries?

It increases the risk of death Signup and view all the answers

What does the term 'lumen' refer to in the context of blood vessels?

The cavity within the artery Signup and view all the answers

What is typically a symptom of myocardial ischemia?

Chest pain Signup and view all the answers

Which statement is true regarding the coronary arteries?

They are responsible for oxygenating the heart muscle. Signup and view all the answers

What should be done if pain has not subsided after a third nitroglycerin tablet?

Call the health care provider. Signup and view all the answers

What is the preferred blood vessel for coronary artery bypass grafting (CABG)?

Internal mammary artery Signup and view all the answers

What is the main purpose of percutaneous transluminal coronary angioplasty (PTCA)?

To widen narrowed coronary arteries. Signup and view all the answers

What are stents used for after PTCA?

To maintain vessel patency. Signup and view all the answers

How long do saphenous vein grafts typically last?

5 to 10 years Signup and view all the answers

What type of consent must patients undergoing PTCA be prepared to sign?

Consent for CABG surgery Signup and view all the answers

What is one major nursing intervention to ensure comfort for patients with angina?

Assess and manage pain factors Signup and view all the answers

What should a patient with angina do if they experience chest pain during activity?

Stop the activity immediately Signup and view all the answers

What is the typical hospitalization duration after CABG surgery?

4 to 6 days Signup and view all the answers

What are common complications associated with stent placement?

Vascular injury and hemorrhage Signup and view all the answers

What nursing intervention promotes tissue perfusion for patients with angina?

Instruct to stop activities if symptoms occur Signup and view all the answers

What can be a psychological intervention for managing angina symptoms?

Utilizing music therapy Signup and view all the answers

What type of activity is typically tolerated by most individuals with angina pectoris?

Mild exercise such as walking Signup and view all the answers

What is a key characteristic of stents used in coronary procedures?

They are thrombogenic. Signup and view all the answers

What typically triggers angina episodes?

Exposure to intense cold Signup and view all the answers

Which of the following best describes unstable angina?

An unpredictable episode of severe discomfort at rest Signup and view all the answers

What symptom is commonly associated with angina pectoris?

Tightness in the chest Signup and view all the answers

How does nitroglycerin help relieve angina symptoms?

By dilating coronary arteries Signup and view all the answers

Which of the following is a common sign of myocardial infarction (MI) in patients with diabetes?

Chest discomfort or nausea Signup and view all the answers

What is a primary treatment for managing angina symptoms?

Reducing cardiac ischemia Signup and view all the answers

Which medication is considered the first-line anti-platelet therapy for angina?

Aspirin Signup and view all the answers

How is pain from an MI typically experienced compared to anginal pain?

Usually more intense than anginal pain Signup and view all the answers

What is a common characteristic of angina pain?

It may radiate to other areas like the jaw Signup and view all the answers

Which of the following is NOT a usual precipitating factor for angina?

Deep breathing exercises Signup and view all the answers

Which diagnostic test is commonly used to correlate activity with precipitating factors for angina symptoms?

Holter monitoring Signup and view all the answers

What is a common subjective symptom reported by patients with angina?

Feeling of impending death Signup and view all the answers

What mechanism leads to angina pectoris pain?

Temporary lack of oxygen and blood supply Signup and view all the answers

Which intervention is crucial for long-term management of CAD and angina?

Identifying and correcting risk factors Signup and view all the answers

What is the main purpose of troponin I as a cardiac marker?

To detect ischemic myocardial injury. Signup and view all the answers

What white blood cell count range is associated with severe myocardial infarcts?

12,000 to 15,000/mm3 Signup and view all the answers

Which ECG finding is commonly associated with an acute myocardial infarction (MI)?

ST-segment elevation. Signup and view all the answers

What is the primary goal of medical management during an acute myocardial infarction?

To prevent further tissue injury. Signup and view all the answers

Which medication is typically used to alleviate pain and anxiety in MI patients?

Diazepam (Valium). Signup and view all the answers

What is a STEMI characterized by?

Complete interruption of blood flow causing ST elevation. Signup and view all the answers

What is an important consideration regarding thrombolytic therapy?

Must be administered within 3 to 5 hours of symptoms. Signup and view all the answers

Which type of surgery is considered when less invasive interventions fail?

CABG surgery. Signup and view all the answers

What complication is commonly associated with myocardial infarction?

Ventricular fibrillation. Signup and view all the answers

What effect do beta-adrenergic blockers have when used early in an MI?

Decrease morbidity and mortality. Signup and view all the answers

Which of the following is NOT a contraindication for thrombolytics?

History of myocardial infarction. Signup and view all the answers

During which time frame is the effectiveness of reperfusion most significant?

3 to 5 hours post onset. Signup and view all the answers

Which medication is contraindicated for the treatment of acute MI according to guidelines?

Lidocaine. Signup and view all the answers

What is the cause of cardiogenic shock in myocardial infarction?

Low cardiac output and vascular system collapse. Signup and view all the answers

What level of BNP suggests a patient may have heart failure?

Between 100 and 700 pg/mL Signup and view all the answers

Which medication is most commonly used to improve cardiac efficiency in heart failure management?

Digoxin Signup and view all the answers

What is the primary function of ACE inhibitors in heart failure treatment?

Decrease peripheral vascular resistance Signup and view all the answers

What role do beta blockers play in heart failure management?

They inhibit the sympathetic nervous system. Signup and view all the answers

Which drug is used intravenously for acute decompensated heart failure?

Nesiritide Signup and view all the answers

What simple measure can help reduce myocardial oxygen demand in heart failure patients?

Elevating the head of the bed Signup and view all the answers

What is a common symptom associated with left-sided heart failure?

Shortness of breath Signup and view all the answers

How should fluid retention be monitored in heart failure patients?

Daily weight monitoring Signup and view all the answers

What effect do angiotensin II receptor blockers have on the body in heart failure treatment?

Block vasoconstrictor effects Signup and view all the answers

Which device may improve symptoms and function in heart failure patients with conduction disorders?

Biventricular pacemaker Signup and view all the answers

What is a recommended intervention for patients with heart failure and depression?

Using a combination of therapies Signup and view all the answers

What can a decrease in oxygen supply lead to in heart failure patients?

Worsening tissue and organ function Signup and view all the answers

Which of the following is NOT a key component of care for heart failure patients?

Administering high doses of diuretics Signup and view all the answers

What can be indicated by an increase in abdominal girth in heart failure patients?

Fluid retention Signup and view all the answers

Which intervention is recommended at discharge for patients with left ventricular systolic dysfunction?

Institute optional beta blocker therapy Signup and view all the answers

What is a significant complication of heart failure that can lead to life-threatening conditions?

Pulmonary edema Signup and view all the answers

What should patients discuss with their healthcare providers regarding end-of-life care?

Treatment preferences and advance directives Signup and view all the answers

What clinical manifestation is commonly associated with pulmonary edema?

Frothy blood-tinged sputum Signup and view all the answers

What factors are monitored in patients with pulmonary edema as part of nursing interventions?

Arterial blood gases and vital signs Signup and view all the answers

What is the prognosis for patients diagnosed with heart failure in terms of mortality?

10% die in the first year, 50% within five years Signup and view all the answers

What nursing intervention helps alleviate dyspnea in patients with pulmonary edema?

Having the patient sit upright with legs down Signup and view all the answers

Which diagnostic tests support the diagnosis of pulmonary edema?

Chest radiograph and arterial blood gas studies Signup and view all the answers

In patients with heart failure, what is one of the most important discussions to have regarding their future care?

End-of-life care options and preferences Signup and view all the answers

What symptom indicates severe respiratory distress due to pulmonary edema?

Frothy sputum production Signup and view all the answers

What is the primary risk factor for patients with diabetes in the context of myocardial infarction?

Nerve damage causing missed symptoms Signup and view all the answers

Which of the following is NOT a part of patient education for managing angina pectoris?

Engaging in high-intensity exercise immediately Signup and view all the answers

What symptom is characteristic of a myocardial infarction compared to angina pectoris?

Severe pain lasting longer than 30 minutes Signup and view all the answers

What is collateral circulation in the context of myocardial infarction?

The development of new blood vessels Signup and view all the answers

Which of the following is a common initial treatment recommendation for chest pain?

Chew an aspirin Signup and view all the answers

In women, what are early signs of a myocardial infarction?

Unusual fatigue and shortness of breath Signup and view all the answers

What type of obstruction typically leads to myocardial infarction?

Atherosclerotic plaque or embolus Signup and view all the answers

What indicates the presence of myocardial necrosis in lab tests?

Increased serum cardiac markers Signup and view all the answers

Which of the following signs may indicate a serious myocardial event?

Persistent chest heaviness Signup and view all the answers

Pain associated with myocardial infarction is often described as:

Crushing or viselike Signup and view all the answers

What can help reduce the mortality rate associated with angina pectoris?

Early and aggressive management Signup and view all the answers

What is the primary physiological effect of an occlusion in a coronary artery?

Tissue ischemia due to oxygen deprivation Signup and view all the answers

What is the role of phagocytes following a myocardial infarction?

To clear necrotic debris Signup and view all the answers

Which of the following best describes the process of tissue damage after prolonged ischemia?

Necrosis occurs after 35 to 45 minutes Signup and view all the answers

What is the primary goal when detecting shock in patients?

To initiate immediate treatment Signup and view all the answers

Which complication is least likely to occur in a patient experiencing cardiogenic shock?

Blood vessel rupture Signup and view all the answers

What should be done if a patient shows symptoms of chest pain after a myocardial infarction?

Encourage them to rest and take deep breaths Signup and view all the answers

What role do lipid-lowering agents serve in the treatment of patients post-myocardial infarction?

To prevent elevated cholesterol levels Signup and view all the answers

Why should food generally be withheld from patients until their condition stabilizes?

To prepare for potential surgical interventions Signup and view all the answers

Which of the following is a sign of heart failure?

Dyspnea Signup and view all the answers

What is a common consequence of the left ventricle failing to pump effectively?

Pulmonary congestion Signup and view all the answers

What is a potential psychological impact on patients following a myocardial infarction?

Denial and anxiety Signup and view all the answers

Which factor is NOT associated with the development of heart failure?

Exercise deprivation Signup and view all the answers

How does the body compensate during heart failure?

By reducing blood flow to non-essential organs Signup and view all the answers

What is the typical management for patients experiencing anxiety and restlessness post-myocardial infarction?

Use of sedation to promote sleep Signup and view all the answers

What dietary modifications are recommended for heart failure patients?

Low-fat, low-sodium diet Signup and view all the answers

What symptom is typically associated with right ventricular failure?

Decreased cardiac output Signup and view all the answers

What role do antiembolic stockings play for heart failure patients?

They prevent blood clots Signup and view all the answers

What is a common symptom of right ventricular failure?

Pitting edema Signup and view all the answers

What does cardiac rehabilitation primarily focus on?

Exercise training and education Signup and view all the answers

Which of the following can lead to right ventricular failure?

Increased pulmonary pressure Signup and view all the answers

Which method is used for noninvasive assessment of heart function?

Echocardiogram Signup and view all the answers

What weight gain signifies a gain of 1L of body fluid?

1 kg Signup and view all the answers

What is the expected outcome of participating in cardiac rehabilitation?

Improved stamina and strength Signup and view all the answers

What symptom may indicate fluid retention in heart failure patients?

Orthopnea Signup and view all the answers

What laboratory study is elevated due to decreased glomerular filtration in heart failure?

Creatinine Signup and view all the answers

What does a patient experience in paroxysmal nocturnal dyspnea?

Breathlessness during sleep Signup and view all the answers

What can happen as right ventricular failure progresses?

Increased peripheral edema Signup and view all the answers

Which condition indicates right ventricular failure due to chronic lung issues?

Cor pulmonale Signup and view all the answers

What does jugular vein distention indicate?

Fluid overload Signup and view all the answers

What is one common psychosocial effect of heart failure?

Major depression Signup and view all the answers

How long can cardiac rehabilitation potentially last?

6 weeks to 6 months or longer Signup and view all the answers

What is the role of education in cardiac rehabilitation?

To assist understanding of heart conditions Signup and view all the answers

What is the primary condition that obstructs blood flow in the coronary arteries?

Atherosclerosis Signup and view all the answers

Angina pectoris is caused by an increase in oxygen supply to the myocardium.

False Signup and view all the answers

What term describes the decreased blood supply to the heart muscle, often marked by pain?

ischemia Signup and view all the answers

The __________ of the coronary arteries narrows as atherosclerosis progresses, obstructing blood flow.

lumen Signup and view all the answers

Match the following terms with their definitions:

Angina pectoris = Chest pain due to insufficient oxygen Atherosclerosis = Buildup of plaques in arteries Ischemia = Reduced blood supply to an organ Myocardium = Muscle tissue of the heart Signup and view all the answers

Study Notes

Coronary Arteries and Disease

Coronary arteries originate at the base of the aorta, supplying oxygen and nutrients to the heart muscle.
Coronary artery disease (CAD) encompasses conditions obstructing blood flow in these arteries.
Atherosclerosis, a major factor in CAD, is marked by cholesterol plaques narrowing the artery lumen and reducing blood flow.

Angina Pectoris

Angina pectoris is thoracic pain caused by decreased oxygen supply to the heart muscle, primarily due to coronary atherosclerosis.
Symptoms include a spasmodic sensation in the chest, often described as heaviness or tightness, potentially radiating to the left arm and jaw.
Angina generally occurs during physical exertion, emotional stress, or extreme temperature changes and is often relieved by rest or nitroglycerin.
Unstable angina is a severe form that occurs unpredictably, signaling an increased risk of myocardial infarction (MI).

Risk Factors and Clinical Manifestations

CAD is the leading cause of death in the United States, with many fatalities related to unstable angina episodes.
Symptoms may vary by sex; women may report more generalized discomfort rather than classic chest pain, leading to misdiagnosis.
Common symptoms accompanying angina include dyspnea, anxiety, diaphoresis, and nausea. In diabetics, neuropathy may mask classic pain.

Assessment and Diagnosis

Diagnosis is based on patient history, characterizing the pain, and conducting ECG or other stress tests to assess myocardial ischemia.
Objective data collected includes vital signs, behavior (e.g., rubbing the chest or arm), and signs of anxiety or diaphoresis.

Medical Management

Treatment focuses on symptom control and reducing cardiac ischemia through risk factor modification.
Antiplatelet therapy, primarily with low-dose aspirin, is recommended for those at increased cardiovascular risk.
Vasodilators (e.g., nitrates), beta-blockers, and calcium channel blockers are used to manage symptoms.
Nitroglycerin is administered sublingually for rapid relief during angina episodes.

Surgical Interventions

Coronary artery bypass grafting (CABG) addresses severe coronary artery blockages by rerouting blood flow through grafts from other vessels.
Percutaneous transluminal coronary angioplasty (PTCA) widens narrowed arteries using balloon catheters and may involve stent placement to maintain patency.
Stents are thrombogenic, requiring anticoagulation therapy for several months post-placement.

Nursing Interventions

Comfort measures include reducing stress and anxiety, assessing pain tolerance, and optimizing rest periods.
Patients should increase activity gradually, being cautious of symptoms indicating low tissue perfusion.
Education on medication adherence, lifestyle modifications, triggers of angina, and recognizing MI signs are crucial for patient management.
Continuous support can help improve quality of life and long-term management of disease.

Prognosis

Prognosis for those with angina pectoris can be serious, especially in individuals with diabetes due to nerve damage affecting symptom recognition.
Early intervention and lifestyle adjustments are vital for reducing mortality risks associated with CAD.
Myocardial infarction (MI) occurs when significant obstruction of coronary arteries leads to tissue ischemia, with cardiac tissue necrosis potentially following as ischemia persists beyond 35-45 minutes.### Risk Factors and Diagnostic Tests for Myocardial Infarction (MI)
Respiratory assessment is crucial for patients with suspected MI.
Serum cardiac markers such as CK-MB, myoglobin, and troponin I indicate myocardial cell death.
Troponin I is highly specific for MI detection, making it a critical marker.
An elevated white blood cell count (12,000-15,000/mm³) arises hours after pain onset and persists for 3-7 days.
Erythrocyte sedimentation rate (ESR) rises during the first week and can remain elevated for weeks.
Diagnosis supported by ECG findings: ST-segment elevation and Q-wave development.
STEMI (ST-Elevation Myocardial Infarction) results from complete blood flow interruption and has a higher mortality rate than NSTEMI (Non-ST-Elevation Myocardial Infarction).
ECG changes differ between genders; women are less likely to exhibit ST-segment elevation during MI.
Advanced tests may include cardiac fluoroscopy, myocardial imaging, echocardiograms, PET, and MUGA scanning for diagnosing and assessing coronary artery disease (CAD).

Medical Management of Myocardial Infarction

Focus on preventing further tissue injury and preserving cardiac muscle.
Rapid diagnosis and treatment are essential to restore tissue perfusion and reduce heart workload.
Pain relief is provided with morphine and diazepam; amiodarone may be administered for frequent PVCs.
Beta-adrenergic blockers decrease morbidity and mortality if administered during acute MI and the following year.
ACE inhibitors may help prevent progression to heart failure (HF).
Oxygen therapy enhances cardiac tissue perfusion; attention to respiratory issues and fluid management is vital.
Thrombolytic agents like streptokinase and alteplase are standard treatment to restore blood flow and minimize heart muscle damage.
Intervention efficacy declines past the 3-5 hour window from symptom onset, emphasizing the principle of “time is muscle.”

Complications and Nursing Interventions

Complications include ventricular fibrillation, cardiogenic shock, heart failure, and dysrhythmias; prompt detection is crucial.
Medical interventions may aim to limit injury size and support recovery through various medications.
Monitor vital signs, enable rest, and provide reassurance to mitigate anxiety and improve patient outcomes.
Nutritional support progresses from clear liquids to a low-fat, low-sodium diet as tolerated.
Cardiac rehabilitation supports lifestyle adjustments and monitored physical activity following discharge from the hospital.

Heart Failure: Etiology and Pathophysiology

Heart failure (HF) represents the heart's inability to meet the body's blood supply needs, leading to circulatory congestion.
Chronic neurohormonal activation contributes to disease progression; sympathetic nervous system hormones can exacerbate cardiac dysfunction.
HF can arise from MI, prolonged hypertension, diabetes, and other conditions.
It significantly affects older adults, leading to numerous hospitalizations and deaths.

Clinical Manifestations and Diagnosis of Heart Failure

Symptoms include dyspnea, orthopnea, weight gain, fatigue, and peripheral edema.
Physical signs reveal respiratory distress, jugular vein distention, and heart murmurs.
Chest radiographs may indicate pulmonary congestion and cardiomegaly.
Echocardiography aids in assessing heart structure and function.
Blood tests, including BNP levels, provide insight into HF severity: less than 100 pg/mL indicates no HF, over 700 pg/mL indicates worsening HF.

Medical Management of Heart Failure

Treatment focuses on improving cardiac output through digoxin and vasodilators.
ACE inhibitors are vital for reducing vascular resistance and improving quality of life.
Beta blockers (e.g., carvedilol, metoprolol) help manage symptoms and reduce mortality rates.
Angiotensin II receptor blockers offer alternative treatment for patients intolerant to ACE inhibitors.### Nesiritide (Natrecor) and Heart Failure Management
Nesiritide is administered intravenously for acutely decompensated heart failure (HF) characterized by dyspnea at rest or with minimal exertion.
It is the first human BNP (B-type Natriuretic Peptide), which reduces pulmonary capillary pressure, enhances breathing, and promotes vasodilation, thus increasing stroke volume and cardiac output.
Therapeutic strategies include elevating the head of the bed or having the patient sit upright to lower oxygen demand and reduce circulating volume to the heart.

Additional Heart Failure Treatments

Diuretics manage edema and pulmonary congestion, while sodium restriction and fluid intake limitation are advised.
Daily weight monitoring is essential to track fluid retention.
Medication therapy usually includes digoxin, ACE inhibitors, thiazide diuretics, and loop diuretics.
Improving heart workload and reducing tissue engorgement leads to increased patient activity levels.

Device Interventions

Biventricular pacemakers can alleviate symptoms, enhance function, and improve quality of life in patients with HF and conduction disturbance.
Implantable cardioverter-defibrillators decrease sudden cardiac death risks in patients with ejection fractions below 30% and specific risk factors.

Oxygen and Anxiety Management

Oxygen therapy and pharmacologic treatments are priorities in acute HF management.
Reducing oxygen needs through rest helps slow heart rate and enhances cardiac reserves.
Reassurance can mitigate the anxiety stemming from symptoms, helping to prevent serious complications like embolus and MI.

Nursing Interventions for HF

Monitoring vital signs and signs of respiratory distress or pulmonary edema is critical.
Assess urinary output, edema characteristics, and abdominal girth as indicators of fluid retention.
Lung auscultation for abnormal sounds (crackles, wheezes) is necessary, along with monitoring for cough and dyspnea.
Assess for signs of depression in HF patients and discuss treatment options, including therapy and rehabilitation.

Key Components of Care in Heart Failure

Assessment of left ventricular systolic function is critical, particularly before discharge if ejection fraction is below 40%.
Initiate ACE inhibitor therapy and anticoagulants if chronic atrial fibrillation is present.
Emphasize smoking cessation, discharge education on medications, activity, diet, and follow-up.
Immunizations like influenza and pneumococcal vaccines are recommended at discharge.
Discuss end-of-life preferences, including advance directives and health care decisions, while patients can actively participate.

Prognosis and Progression of Heart Failure

Approximately 10% of HF patients die within the first year; 50% within five years.
HF is a chronic condition, but advancements in treatment allow many patients to live longer with improved quality of life.
New insights into prescribed exercise benefits have contributed to overall patient well-being.

Pulmonary Edema

Pulmonary edema, mainly caused by HF, is a severe complication resulting from left ventricular dysfunction leading to fluid accumulation in lung tissues.
Clinical signs include severe respiratory distress and blood-tinged, frothy sputum, indicating fluid in the alveoli.

Diagnostic and Medical Management

Diagnosis relies on symptomatic observation, supported by imaging and blood gas analyses.
Medical interventions aim to enhance oxygenation, cardiac output, and decrease pulmonary congestion, requiring prompt emergency treatment.

Nursing Care for Pulmonary Edema

Administer oxygen and position the patient upright to aid breathing and relieve congestion.
Continuous monitoring of arterial blood gases, vital signs, and fluid balance is crucial.
Provide emotional support and keep the patient informed about care procedures.
Pulmonary edema requires aggressive interventions and is a life-threatening condition, emphasizing its urgency in management.