Coronary Atherosclerosis Overview

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Questions and Answers

What primarily characterizes coronary atherosclerosis?

Accumulation of calcium deposits in the arterial wall

Abnormal accumulation of lipid and fibrous tissue in vessel walls (correct)

Rupture of small vessels leading to hemorrhage

Formation of large blood clots within the coronary arteries

Which inflammatory cells are involved in the development of atherosclerosis?

Macrophages and platelets

Neutrophils and basophils

T lymphocytes and monocytes (correct)

B lymphocytes and eosinophils

Which statement differentiates angina from myocardial infarction?

Myocardial infarction is typically characterized by transient episodes of chest pain.

Both conditions are due to severe coronary artery disease only.

Angina occurs due to complete blockage of a coronary artery.

Angina is a reversible condition, while myocardial infarction results in permanent heart damage. (correct)

What is the role of macrophages in atherogenesis?

To ingest lipids and die, contributing to plaque formation Signup and view all the answers

What is a major consequence of lipid accumulation in the intima of arteries?

Narrowing of arterial lumen and reduced blood flow Signup and view all the answers

Which lifestyle change is most effective in preventing atherosclerosis?

Engaging in regular physical activity Signup and view all the answers

What type of lesion is formed as a result of lipid accumulation in atherosclerosis?

Fatty-fibrous plaque or atheroma Signup and view all the answers

What is a common risk factor for both angina and acute myocardial infarction?

High blood cholesterol levels Signup and view all the answers

Which medication therapy is often utilized for the management of angina?

Nitrates Signup and view all the answers

What is the primary purpose of the nursing process in managing patients with angina?

To assess and intervene in patient care effectively Signup and view all the answers

What triggers myocardial ischemia by increasing the myocardial oxygen demand?

Physical exertion Signup and view all the answers

Which type of angina is characterized by unpredictable episodes that may occur at rest?

Variant angina Signup and view all the answers

What major factor is involved in thrombus formation leading to acute myocardial infarction?

Thrombus rupture Signup and view all the answers

Which of the following lipid profile values should be aimed for in very high-risk patients?

LDL cholesterol less than 70 mg/dL Signup and view all the answers

What is not a physical manifestation of angina pectoris?

Increased appetite Signup and view all the answers

What risk factor is considered modifiable in the context of coronary artery disease?

Obesity Signup and view all the answers

Which of the following is the best practice for monitoring cholesterol abnormalities?

Every 6 weeks until desired levels are achieved Signup and view all the answers

During an unstable angina episode, which characteristic is likely to be observed?

Pain unrelieved by nitrates Signup and view all the answers

What is a common cause for silent ischemia, particularly in patients with diabetes?

Autonomic neuropathy Signup and view all the answers

Which of the following is a significant clinical manifestation of myocardial ischemia?

Chest pain with radiation to the left arm Signup and view all the answers

What distinguishes NSTEMI from unstable angina based on diagnostic findings?

Elevated cardiac biomarkers without ECG changes Signup and view all the answers

How quickly must thrombolytic therapy be administered after the onset of AMI symptoms for maximum effectiveness?

Within 6 hours Signup and view all the answers

Which cardiac enzyme is primarily found in cardiac cells and indicates myocardial damage when elevated?

Troponin T and I Signup and view all the answers

What is the main purpose of cardiac rehabilitation for a patient who has experienced an MI?

To extend life and improve quality of life Signup and view all the answers

Which of the following accurately describes the nursing diagnosis of 'acute pain' in patients with acute coronary syndrome?

Related to insufficient myocardial oxygen supply Signup and view all the answers

In the context of an MI, when do creatine kinase (CK) levels typically rise?

3-12 hours post-MI Signup and view all the answers

Which of the following is not a typical clinical manifestation of coronary ischemia?

Severe headache Signup and view all the answers

Which phase of cardiac rehabilitation begins with the diagnosis of atherosclerosis?

Phase I Signup and view all the answers

What is a potential consequence of failing to restore oxygen supply to the heart during an acute coronary event?

Myocardial tissue hypoxia Signup and view all the answers

What is a common sign that must be monitored after administering cardiac medications?

Signs of bleeding Signup and view all the answers

What is a major indication for the use of nitrates in patients with angina pectoris?

Vasodilation that reduces myocardial oxygen consumption Signup and view all the answers

Which medication class is indicated for patients unresponsive to beta-blockers due to vasospasm?

Calcium channel blockers Signup and view all the answers

What characterizes Acute Coronary Syndrome (ACS)?

Acute onset of myocardial ischemia that may lead to myocardial death Signup and view all the answers

What common misconception about myocardial infarction is incorrect?

The patient often experiences localized pain in a specific area. Signup and view all the answers

Which statement accurately describes the pathophysiology of myocardial infarction?

Coronary artery thrombosis is a leading cause of most infarctions. Signup and view all the answers

What symptom is least likely associated with acute myocardial infarction?

Radiating pain to the lower back Signup and view all the answers

In the context of angina pectoris management, what is the primary goal of using beta-blockers?

Block beta-adrenergic stimulation to reduce heart rate Signup and view all the answers

Which of the following statements regarding myocardial ischemia is true?

It represents an imbalance between oxygen supply and demand. Signup and view all the answers

What nursing diagnosis is related to a patient's understanding of their cardiac condition?

Deficient knowledge about the underlying disease Signup and view all the answers

When myocardial injury occurs, which of the following best describes the timeframe for irreversible cell damage?

Myocardial necrosis starts within 20-40 minutes after blood flow loss. Signup and view all the answers

Study Notes

Coronary Atherosclerosis

Characterized by lipid and fibrous tissue accumulation within the vessel wall, narrowing coronary vessels and reducing blood flow to the myocardium.
Lipids accumulate in the intima of the artery, triggering an inflammatory response with T lymphocytes and monocytes infiltrating the area.
Lipid accumulation develops into a fatty-fibrous lesion, often containing a lipid core covered by a fibrous cap, known as an atheroma or plaque, protruding into the artery's lumen.
Thin fibrous caps can rupture, releasing lipids into the bloodstream, promoting clot formation and potentially leading to sudden death or acute myocardial infarction.

Clinical Manifestations

Symptoms and complications depend on location and severity of narrowing, thrombus formation, and obstruction of blood flow to the myocardium.
Myocardial ischemia can manifest with acute chest pain, shortness of breath, and nausea.

Risk Factors

Non-modifiable:
- Family history of Coronary Artery Disease (CAD)
- Increasing age
- Gender
- Lack of estrogen in women
Modifiable:
- High blood cholesterol level
- Hypertension
- Cigarette smoking, tobacco use
- Diabetes mellitus
- Obesity
- Physical inactivity

Prevention

Controlling Cholesterol Abnormalities:
- Dietary Measures: Limit saturated and trans fats, increase soluble fiber intake
- Physical Activity: At least 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous-intensity aerobic activity per week.
- Medications:
  - Statins: Examples include atorvastatin (Lipitor)
Promoting Cessation of Tobacco Use
Managing Hypertension
Controlling Diabetes

Myocardial Ischemia

Occurs due to an imbalance between the myocardium's metabolic needs and oxygenated blood flow.
Increased Myocardial O2 Demand: Exercise, smoking, heavy meals, fever, heart failure, dysrhythmias, stress, hypertension, cold weather, aortic stenosis
Reduced Myocardial O2 Supply: Coronary artery narrowing caused by a thrombus, vasospasm, or rapid progression of atherosclerosis

Angina Pectoris

Clinical syndrome characterized by episodes of chest pain or pressure caused by insufficient coronary blood flow, leading to decreased oxygen supply to the myocardium.
Pain can occur in the chest, neck, arms, or back.
Often described as pain or pressure behind the sternum, radiating to the left arm.

Pathophysiology of Angina

Usually caused by atherosclerosis with a significant obstruction of a major coronary artery.
Associated factors include physical exertion, exposure to cold, eating heavy meals, and stress.

Types of Angina

Stable angina: Predictable, consistent pain during exertion, relieved by rest and/or nitroglycerin.
Unstable angina: More intense than stable angina, may not be relieved by rest or nitroglycerin. It can wake the person from sleep, requiring more than nitrates for pain relief. Changes in frequency or severity require immediate medical evaluation.
Variant angina (Prinzmetal's angina): Occurs at rest, often cyclic, occurring at the same time each day. Associated with smoking, alcohol use, and stimulant drug use. May involve coronary artery spasm, leading to ST-segment elevation and chest pain.
Silent ischemia: Objective evidence of ischemia (ECG changes on stress test) without reported symptoms.

Clinical Manifestations of Angina

Chest pain, discomfort, tightness, or a heavy sensation.
Pain may radiate to the neck, jaw, shoulders, and upper arm (often the left arm).
Apprehension and a feeling of impending death.
Weakness or numbness in the arms, wrists, and hands.
Shortness of breath.
Pallor.
Diaphoresis.
Dizziness.
Nausea and vomiting.

Assessment & Diagnostic Findings for Angina

Patient history and pain assessment.
Lead ECG: May show ischemic changes like T-wave inversions.
Laboratory studies: Cardiac biomarker analysis.
Exercise or pharmacologic stress test.
Invasive procedures, like cardiac catheterization and coronary angiography, to assess coronary artery patency.

Medical Management of Angina

Nitrates: Nitroglycerin (Nitrostat, Nitro-Bid) to reduce myocardial oxygen consumption through selective vasodilation.
Beta-blockers: Metoprolol, Atenolol, to reduce myocardial oxygen consumption by blocking beta-adrenergic stimulation of the heart, slowing heart rate and conduction.
Calcium channel blockers: Amlodipine, Diltiazem, Felodipine, used for patients unresponsive to beta-blockers. Helps with vasospasm by relaxing blood vessels, reducing blood pressure, and increasing coronary perfusion.
Antiplatelet Medications: Aspirin, Clopidogrel (Plavix) to prevent platelet aggregation

Acute Coronary Syndrome (ACS)

An emergent situation marked by an acute onset of myocardial ischemia leading to myocardial death, if not treated promptly.
Includes unstable angina, non-ST segment elevation MI (NSTEMI), and ST-segment elevation MI (STEMI).

Myocardial Infarction (MI)

Irreversible myocardial necrosis or cell death due to decreased or absent coronary blood flow to a specific area of the myocardium.
Often called acute MI, meaning a sudden onset and life-threatening condition.
Usually linked to ST-segment elevation on a 12-lead ECG.

### Pathophysiology of MI

Prolonged ischemia results from an imbalance between oxygen supply and demand.
Irreversible cell damage and muscle death occur.
Coronary artery thrombosis is the most common cause of infarction, often triggered by plaque rupture.

### Clinical Manifestations of MI

Acute onset of chest pain, often poorly localized, radiating to the neck, jaw, shoulders, and inner aspects of the upper arms.
Tightness, choking, strangling sensations, and a feeling of impending death.
Shortness of breath.
Indigestion, nausea.
Unusual fatigue, weakness.

### Assessment & Diagnostic Findings for MI

Patient history and pain assessment.
12-lead ECG is critical to make a diagnosis.
Blood laboratory values: Increased cardiac biomarkers.
Exercise or pharmacologic stress test: Monitor heart function with ECG and echocardiogram.

### Differentiation of ACS subtypes

Unstable angina: Clinical manifestations of ischemia, but ECG and cardiac biomarkers do not show evidence of acute MI.
STEMI: ECG evidence of acute MI with characteristic ST-segment elevation in 2 leads on a 12-lead ECG.
NSTEMI: Elevated cardiac biomarkers (e.g., troponin), but no definitive ECG evidence of acute MI.

### Laboratory Studies for MI

Cardiac Enzymes:
- Creatine kinase (CK): Elevated levels indicate heart cell damage, especially the CK-MB isoenzyme.
- Myoglobin: Rises 2-3 hours after MI, not cardiac-specific.
- Troponin T and I: Most sensitive and specific marker of cardiac damage, with levels rising 3-12 hours after MI.

### Medical Management of MI

Goals are to rapidly restore blood flow and limit myocardial damage.
Initial Management: Prompt transport to the emergency department (ED)
Inpatient Management:
- Oxygen therapy: To reduce myocardial oxygen demand and prevent tissue hypoxia.
- Pain management: Nitrates (e.g., nitroglycerin) to reduce chest pain and improve blood flow.
- Antiplatelet therapy: Aspirin to prevent further platelet aggregation and thrombus formation.
- Anticoagulation: Heparin to prevent new clot formation.
- Beta-blockers: To reduce myocardial oxygen demand and heart rate.
- ACE inhibitors: To inhibit vasoconstriction and reduce blood pressure.
- Cardiac monitoring: Continuous electrocardiographic monitoring to track heart rhythm and detect any abnormalities.

### Reperfusion Therapy for MI

Percutaneous coronary intervention (PCI): Opening the occluded coronary artery. The goal is to perform PCI within 90 minutes of arrival to the ED, or within 90 minutes of symptom onset.
Thrombolytic therapy: Dissolves blood clots in the coronary arteries, given within 30 minutes of presentation to the hospital. Must be administered within 6 hours of symptom onset. Example medications: Alteplase (Activase), Reteplase (Retavase), Tenecteplase (TNKase).

### Cardiac Rehabilitation

Goal is to extend life and improve quality of life for patients who have had a MI.
Three phases:
- Phase I: Begins upon diagnosis of atherosclerosis, focusing on education, risk factor modification, and supervised exercise.
- Phase II: Occurs after discharge, involving supervised exercise programs and continued education.
- Phase III: Long-term outpatient program to maintain cardiovascular stability and conditioning.

### Nursing Process for Patients with Angina and ACS

Nursing Diagnosis:
- Ineffective cardiac tissue perfusion secondary to CAD.
- Death anxiety related to cardiac symptoms.
- Deficient knowledge about the underlying disease and complications.
- Noncompliance with therapeutic regimens.
- Acute pain related to increased myocardial oxygen demand and decreased oxygen supply.
- Risk for decreased cardiac tissue perfusion related to reduced coronary blood flow.
- Risk for imbalanced fluid volume.
- Risk for ineffective peripheral tissue perfusion related to decreased cardiac output from left ventricular dysfunction.
- Anxiety related to cardiac event and possible death.
- Deficient knowledge about post-ACS self-care.

### Nursing Management

Monitor vital signs, ECG, and symptoms to detect complications.
Administer medications as prescribed.
Educate patients about the disease, risk factors, medications, lifestyle modifications, and self-care after discharge.
Implement pain management strategies and provide psychological support.
Promote physical activity and encourage smoking cessation.

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Description

This quiz explores the characteristics, clinical manifestations, and risk factors associated with coronary atherosclerosis. It covers the accumulation of lipids and fibrous tissue in coronary vessels and the subsequent impact on blood flow to the myocardium. Assess your understanding of this critical cardiovascular condition.