CARDIAC + CCRN Questions
cardiac
Acute Coronary Syndrome (definition) - answer-Syndrome of acute
myocardial ischemia caused by atherosclerotic plaque rupture and thrombus
formation
Acute Coronary Syndrome (etiology) - answer-Same as Coronary Artery Dz,
Angina Pectoris, and Myocardial Infarction
Coronary Artery Disease (definition) - answer-A progressive disease of the
coronary arteries that results in their narrowing of obstruction
CAD (pathophysiology) - answer-1.Arteriosclerosis: a group of diseases
characterized by thickening and loss of elasticity (calcification) of arterial
walls
2. Atherosclerosis: the most common form of arteriosclerosis.
a. A chronic disease process characterized by the build-up of fatty plague
along the subintimal layer of arteries leading to a decrease in arterial luman.
3. Decreased blood flow and oxygen supply to the myocardium lead to
imbalance between oxygen supply and oxygen demand.
a. Gradual or partial occlusion: ischemia causing angina
b. Sudden or complete occlusion: necrosis causing MI
Pathologic Consequence of Atherosclerosis and Arteriosclerosis - answer-1.
Angina pectoris
2. MI
3. Heart failure
4. Dysrhythmias caused ischemia
5. Sudden death
Angina Pectoris (etiology) - answer-Factors that decrease supply
a. Arteriosclerosis/atherosclerosis
b. Coronary artery spasm
c. Aortitis
d. Dysrhythmias
e. Anemia
f. Shock
Factors that increase demand:
a. HTN
b. Aortic valve dz
,c. Tachydysrhythmias
d. HF
e. Hyperthyroidism
Angina Pectoris (clinical presentation - subjective) - answer-1. Subjective
a. Substernal chest discomfort that usually lasts 1 to 4 minutes and subsides
with rest and/or nitro use.
1. Discomfort may be described as burning, squeezing, tightness, pressure,
heaviness, indigestion, or aching.
2. Pain may radiate to shoulders, back, arms, jaw, neck, and epigastrium
b. Dyspnea
c. N/V
d. Anxiety
e. Weakness
Angina Pectoris (objective) - answer-a. Tachycardia
b. Hypotension or HTN
c. Tachypnea
d. Pallor
e. Diaphoresis
g. S4
Angina Pectoris (Diagnostic) - answer-a. Serum
1. Isoenzymes: negative for cardiac damage
2. Fasting glucose: to identify DM or glucose intolerance as a risk factor
b. ECG
1. ST segment depression in unstable angina
2. ST segment elevation in variant angina
3. Ventricular dysrhythmias may be present
c. Cardiac cauterization: coronary artery occlusion 75% or greater; may be
negative in variant angina but develop occlusion from spasm
Types of Angina - answer-Stable and Unstable Angina
Stable Angina (signs and symptoms) - answer-- Unchanging frequency,
duration, and severity
- Predictable to the patient
- ST segment depression may occur during pain
Angina Pectoris (Collaborative Management) - answer-1. Relieve chest pain
a. Nitro
b. Calcium channel blockers (especially for variant angina)
c. Morphine sulfate may be required for unstable angina
,2. Increase oxygen demand
a. nasal canula 5L/min during ischemic pain unless contraindicated by lung
dz.
b. Blood transfusion if angina caused by anemia
c. Platelet aggregation inhibitors (e.g., aspirin or ticlopidine to prevent
platelet aggregation; heparin may be prescribed to prevent clotting or
extension of clot
d. IABP - may be used in unstable angina; IABP increases coronary artery
perfusion pressure (CAPP)
3. Decrease oxygen demand
a. Removal of provoking factors
1. Activity cessation immediately when chest pain occurs
2. Bed rest during pain; semi-Fowler position usually most comfortable
b. NTG as prescribed
1. NTG in doses less than 1 mcg/kg/min is a predominately venous dilator
(decreases after load and preload as well); it decreases myocardial workload
and myocardial oxygen consumption by decreasing preload.
Percutaneous Coronary Intervention (procedures) - answer-PTCA
(percutaneous transluminal coronary angioplasty): inflation of a balloon-
tipped catheter in an area of coronary artery stenosis from plague; plague is
pushed back against the wall of vessel and fractured (controlled trauma)
Coronary Artery Stent: Use of a metal that acts as a scaffolding device to
support a coronary artery and maintain potency after PTCA
Brachytherapy: use of intracoronary irradiation to reduce risk of restenosis
Coronary atherectomy: removal of plaque from coronary artery by a high-
speed diamond tipped (rotational) or shaving (directional) device
PCI (indications) - answer-Unstable or chronic angina
Acute or post acute MI
Post-CABG with postoperative angina
Patient must be surgical candidate (in case of coronary artery dissection)
PCI (contraindications) - answer-Left main CAD (unless there is a patent
bypass around it, referred to as protected)
Stenosis of coronary artery at orifice
Variant angina
Myocardial Infarction - answer-Death of a portion of the myocardium
MI (etiology) - answer-Most are caused by arteriosclerosis and thrombosis
, Arteriosclerosis/atherosclerosis
Coronary artery thrombosis
Coronary artery spasm
Cocaine-induced: excessive sympathetic stimulation causes tachycardia,
HTN, arterial vasoconstriction, and spasm; coronary artery spasm may cause
MI, especially non-Q wave infarction
MI (patho) - answer-Atherosclerosis with unstable plaque
Plaque rupture may be caused by inflammation and/or infection
C-reactive protein (CRP) rises rapidly following an inflammatory response
Inadequate oxygenation causes anaerobic metabolism - which causes lactic
acidoses
Prolonged ischemic causes electrical and mechanical death of myocardium
Ischemia, injury, and acidosis causes electrical irritability; this potentially
leads to PVCs, VT, VF
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