Coronary Artery Disease (CAD), Exam Questions and answers./ APPROVED EXAM PREDICTION PAPER/

Coronary Artery Disease (CAD), Exam Questions and answers. 1. 2. Discuss the components of the physical assessment of the cardiac system. 3. 4. Apply the terms preload, after-load, contractility, cardiac output to cardiac function. 13. Identify pre and post nursing priorities for patients having left or right heart catheterization 15. Compare & contrast the clinical manifestations and diagnostic studies of coronary syndrome: unstable angina pectoris, NSTEMI, and STEMI. 16. List the healthcare professionals that would be involved in diagnosing and treating patients with CVD 17. Describe the collaborative management/care of a client with CV disease 18. Distinguish which diagnostic tests are used in the assessment of the cardiac system (include patient preparation and patient education): ECG, ambulatory (Holter) monitoring, exercise testing, echocardiogram, trans-esophageal echocardiography, cardiac catheterization, electrophysiological studies, CBC, cardiac enzymes, bl - - Cardiovascular Disease (CVD)??? - -Heart conditions that include diseased vessels, structural problems, and blood clots. What is CAD? - -- Includes stable and non-stable acute coronary syndromes - Lack of blood (oxygen) to myocardium --- ischemia with progression to infarction - Chronic Ischemia --- Stable angina --- Symptoms occur USUALLY with exertion, relieved with rest --- Collateralization may occur - Rapid Progression --- Acute coronary syndrome (ACS) ------ Unstable angina (rest pain) ------ Acute Myocardial Infarction --- Sudden cardiac death Coronary Artery Disease (CAD) - -- is a broad term that includes chronic stable angina and acute coronary syndrome. - Any abnormal condition that may affect the heart's arteries and produce various pathologic effects, especially the reduced flow of oxygen and nutrients to the myocardium. - The most common kind of coronary artery disease is coronary atherosclerosis. - Angina pectoris, the classic symptom of coronary artery disease, results from myocardial ischemia. - is the single largest killer of american men and women in all ethnic groups. - It affects the arteries that provide blood, oxygen, and nutrients to the myocardium Coronary Heart Disease (CHD) - -- also called Coronary Artery Disease (CAD) - or simply heart disease Describe pathophysiology of CAD and ACS - -- Atherosclerosis --- Phase 1 through phase 5: ----- 1. < 30, latent manifestation, ----------- Lesions I - III ----- 2. type IV and V lesions (vulnerable plaque, atheroma) ----- 3. Acute disruption of type IV and V lesions ----------Thrombus formation ----- 4. Arterial stenosis, ACS ----- 5. calcification to plaque, ulceration Acute Coronary Syndrome (ACS) - -- is used to describe patients who have either unstable angina or an acute myocardial infarction. - the atherosclerotic plaque in the coronary artery ruptures, resulting in platelet aggregation, thrombus formation, and vasoconstriction. Describe the pathophysiology of acute myocardial infarction (AMI) from the onset of injury through the healing process. - -- Pathophysiology - sudden occlusion of coronary artery - Myocardium is DYING = INFARCTING - Time is heart muscle! Myocardial Infarction (MI) - -- Necrosis of a portion of cardiac muscle caused by an obstruction in a coronary artery resulting from atherosclerosis, a thrombus, or a spasm. - The onset is characterized by a crushing, viselike chest pain that may radiate to the left arm, neck, jaw, or epigastrium and sometimes stimulates the sensation of acute indigestion or a gallbladder attack. - The patient usually becomes ashen, clammy, short of breath, nauseated, faint, and anxious and often feels that death is imminent. - Typical signs are tachycardia, a barely palpable pulse, low BP, mildly elevated temperature, cardiac arrhythmia, and elevation of the S-T segment and Q wave on the ECG. Acute Myocardial Infarction (AMI) - -- Acute myocardial infarction is the medical name for a heart attack. - A heart attack is a life-threatening condition that occurs when blood flow to the heart muscle is abruptly cut off, causing tissue damage. - This is usually the result of a blockage in one or more of the coronary arteries Ischemic Heart Disease - -- Coronary artery disease (CAD), also known as ischemic heart disease (IHD), - refers to a group of diseases which includes stable angina, unstable angina, myocardial infarction, and sudden cardiac death. ST Elevation Myocardial Infarction (STEMI) - -- ST elevation in two contiguous leads on a 12-lead ECG. - This indicates myocardial infarction/necrosis. Discuss the incidence and prevalence of CAD - -- In the United States, someone has a heart attack every 34 seconds. Every 60 seconds, someone in the United States dies from a heart disease-related event. - Most (64% F, 50% M) patients suffering an AMI did not know they had CAD - Average AMI age - 64 (M) and 70 (F) • THIS DOES NOT MEAN YOUNG PEOPLE DO NOT HAVE HEART ATTACKS, BECAUSE THEY DO!!!!!! - 95% of patients having an MI die before reaching hospital due to arrhythmia (V fib), this is why AED is so critical for survival Describe the etiology and risk factors for coronary artery disease. - - Assess modifiable CAD risk factors - -- Smoking - Hypertension - Elevated serum cholesterol levels (HDL, LDL) - Physical inactivity, obesity, and diabetes - Alcohol intake Assess non-modifiable CAD risk factors - -- Heredity (ethnicity) - Increasing age - for women age is the most key risk factor > 40 yrs old = more likely to die within year of having MI