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Ch 35 Mod IV

Ch 35 cardiac disorders ANGINA and AMI

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
Created by: Jgar2007



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