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Ch 35 Mod IV
Ch 35 cardiac disorders ANGINA and AMI
Question | Answer |
---|---|
CAD occurs when major coronary arteries supplying blood to (epicardium, endo, or myo) are partially or completely ____. | myocardium, blocked |
Blockage of arteries are caused by what 3 things: | artery spasms, arteriosclerosis, athero |
Arteriosclerosic and atherosclerosis may result in ____ or ____ of myocardial tissue: what conditions | ischemia, infarction |
thickening, hardening, loss of elasticity of arterial walls | arterio |
what causes the innermost layer of the artery to stiffen, thicken, and decrease in diameter for ASHD pts> | collagen and smooth tissues |
Arteriosclerosis: what 3 things adhere(stick) to the damaged walls | lipids, cholesterol, calcium |
arteriosclerosis causes 3 conditions, name them: remember acronym HIPA | Hypertension, Impaired tissue Perfusion, aneurysms |
a form of arteriosclerosis, and is an ___disease that begins with___injury | atherosclerosis inflammatory; endothelial |
what are seen in advanced stages of atherosclerosis? | Complicated lesions |
three types of lesions of atherosclerosis | fatty streaks,fibrous plaque, and complicated lesions |
the earliest lesion in atherosclerosis. | fatty streak |
fatty streak: what is the color? | Yellow |
fatty streak: causes an obstruction true or false | false |
fatty streak: found in what area of the body by age 10? | aorta |
fatty streak: found in coronary arteries by what age? | 15 |
fatty streak: are irreversible, true or false | false |
fatty streak: S/Sx | none |
Nurse learns that there is fibrous plaque in the pts arteries. She knows this is what stage of atherosclerosis? | progressing stage because fibrous plaque is only seen in the progressing stage. |
What is the color of fibrous plaque? | whitish, grayish |
Fibrous plaque contributes to loss of arterial ____ and impairs ____. This impairs the vessels ability to meet increased ___ needs. | elasticity; vasodilate; O2 |
if plaque formation occur slowly, what type of circulation may develop? | Collateral circulation |
new branches of blood vessels that grow from existing arteries to provide increased blood flow: | collateral blood vessels |
non-modifiable risk factors with atherosclerosis-name 4 | gender, age, heridity, race |
how does gender protect women from developing atherosclerosis? | Hormone secreted-stops protecting women by menopause |
what are the early signs and symptoms of coronary artery disease? | none: CAD is asymptomatic during early stages |
Why do pts w/ early stage CAD not show any S/Sx (asymptomatic) | collateral circulation forms to compensate |
when do S/Sx appear in CAD | when blood supply is reduced by at least 50% |
CAD: clinical manifestations | angina pectoris, ACS(unstable angina and MI), sudden cardiac death |
the most common symptom of CAD | angina pectoris |
Angina pectoris results when? | demand for O2 by Myocaridal cells exceeds supply of O2 delivered |
name 3 types of angina pectoris | stable, unstable, variant angina |
stable angina: Characteristics - occurs when? subsides when? constant? not predictable? how long does it last? relieved w/ what med? | occurs w/ activity, subsides w/ rest; intermittent and predictable, lasts only a few minutes, nitro |
risk factors of stable angina | stress, heavy meals, smoking, exertion |
viselike, squeeszing, smothering pain on the sternum | stable angina |
stable angina: pain may radiate to 5 places | arms, shoulder, jaw, neck, epigastrium |
stable angina S/Sx | diaphoresis, dyspnea, nausea, vomiting |
two names for unstable angina | pre-infarction angina and crescendo angina |
unstable angina is treated as what type of condition | acute coronary syndrome: ACS |
unstable angina characteristics | more severe, occurs at rest or minimal activity, not relieved by NTG, or require frequent NTG, not predictable |
unstable angina may occur in a patient with a history of? | Stable angina |
unstable angina pain characteristics | described as more severe, changing pattern |
what may be the first clinical manifestation of CAD? | unstable angina |
patients with unstable angina are higher risk for what type of condition? | AMI |
a type of angina caused by coronary artery spasms | variant angina |
variant angina characteristics | not associated with CAD, unpredictable, often occurs at rest, pain goes away when spasms stop |
treatment for variant angina | calcium channel blockers for prevention |
ABCDE therapy for CAD stands for | aspirin and anginal therapy; beta blockers and blood pressure; cigarette and cholesterol; diet and diabetes; education and exercise |
low-dose aspirin is administered to interfere with___aggregation; reduce the risk of___. | platelet; MI |
if patient cannot tolerate aspirin what is given? | another antiplatelet medication (plavix) |
Antianginal therapy includes three things: | nitrates, beta blockers, calcium channel blockers |
nitroglycerin are used to treat what two things? | actual episodes of angina, prevent angina |
two routes of med administration for the onset of angina pain | sublingual, buccal |
three routes used to admin nitrates for angina attack prevention | oral, transdermal, topical |
Beta blockers and calcium channel blockers are prescribed for ___management of angina | long-term |
after initial relief and control of anginal pain, the focus of therapy will turn to__reduction | risk |
some risk reduction measures are: | blood pressure management, stop smoking, lipid control, diet, exercise, education, glucose control |
what medication may be prescribed for patients with stable angina to reduce the risk of AMI? | Ace inhibitors |
medical treatment for unstable angina | same as other angina is; additional anticoagulation therapy with LMWH |
Cultural: which two americans develop CAD earlier than other americans | Native American and African-Americans |
coronary artery disease is highest among which Americans? Lower among which Americans? | Caucasian; Latin Americans |
death of myocardial tissue | AMI |
myocardial tissue dies as a result of prolonged lack of ____ and ____ supply to the heart | blood, oxygen |
modifying factors of AMI | smoking, high-fat diet, hypertension, sedentary lifestyle, stress |
AMI occurs more frequently in men or women | men: considered a risk factor |
pathophysiology of AMI | begins w/ occlusion of coronary arteries -> ischemia -> injury and infarction |
how long must ischemia last for damaged tissue to be considered irreversible? | 20 mins |
how many hours after an MI will the healing process begin | 24hrs |
what happens on the third day | dead tissue broken down by enzymes and removed by macrophages |
what develops to supply blood to the injured area? | Collateral circulation |
between what days after AMI is the myocardium vulnerable to stress? Why | 10 to 14 days; weakness of the healing tissues |
after an AMI, how long does it take for tissues to heal? | 6 wks |
two categories of acute coronary syndrome | unstable angina, AMI |
STEMI and NSTEMI: which is partially occluded, which is completely occluded | partial = NSTEMI; total = STEMI |
Why is ST segment important to note in an ECG | the segment will look different w/ partial or total lack of oxygen |
name five complications of AMI | dysrhythmias, heart failure, rupture, cardiogenic shock, thromboembolism |
a disturbance in heart rhythm is called | dysrhythmias |
what intervention is ordered for patient w/ dysrhythmias | continuous cardiac monitoring |
most common complication of AMI | heart failure |
most frequent cause of death after an AMI | cardiogenic shock |
after AMI,thrombi may form in what two parts of the body | injured heart chambers, veins of the legs |
Pulmonary embolism may cause | pallor, cyanosis, heart failure |
How can ruptures/aneurysms happen after an AMI | weakened, inadequate scars from healing tissue may cause artial walls to buldge and rupture |
AMI break down | 1) occluded coronary arteries in 4-6 = ischemia = injury = infarction. 2) 20 mins, tissue damage irreversible. 3)after 24 hours, dead tissue breaks down 4) colleteral circulation occurs 5) 10-14 days susceptible to stress 5) complete healing in 6 wks |
classic symptom of AMI: where is the pain and what is the description | pain located below or behind sternum that is heavy, constrictive |
AMI pain may radiate where? | arms, back, neck, jaw |
AMI begins w/ exertion: T or F | false, it is w/ and w/o |
If AMI progresses what is the S/Sx | same as stable angina: diaphoretic, dsypnea, nausea, vomiting, light head |
AMI: skin is frequently | cold, clammy |
AMI: what feelings does pt feel | impending doom, great anxiety |
Which group shows atypical signs of AMI | older adults, women, diabetics |
If confusion arises w/ chest pains and other S/Sx of AMI what did Mrs. G say must be done: | immediately put on ECG (not sure of my notes) |
What confirms AMI? | ECG and lab evidence |
which lab did Mrs. G say lasts the longest | Troponin: 2 weeks |
in what extraordinary situation is troponin drawn vs. other enzymes or markers | ER for early diagnosis |
Mrs G said to remember which is the quickest test for AMI but why is not always useful | Myoglobin, no specific to cardiac injury |
when does CPK-MB return to normal level after an AMI | 2 to 3 days |
ECG appearances: ischemia | ST segment is depressed, T wave inverted |
ECG appearances: when is ST segment elevated | total occlusion |
ECG appearances: ST segment of partial occlusion | not elevated |
most frequent dsyrhythmias for AMI | PVC, V-fib, V-tach |
what is the difference in pain regarding AMI and unstable angina? | Indistinguishable |
name 3 antiplatelet medications | aspirin, ticlid, Plavix |
Mrs. G said that calcium channel blockers are more for which type of angina | variant |
non-modifiable risk factors of AMI | DM, Family Hx, male gender |
dysrhythmias occur in approximately how many percent of AMI? | 80% |
CHF can cause what two conditions | cardiogenic shock and death |
Cardioshock is marked by what syptoms | hypotension, cool, moist skin, decreased alertness, oliguria |
S/Sx of pulmonary embolism | SUDDEN SEVERE DYSPNEA, pallor, HF, cyanosis |
T or F: ventricular rupture/aneurysm is not always fatal | false: its always fatal |
AMI EKG changes | ST elevation in two or more leads, Q is 1/3rd the height of the R wave |