CAD and heart failure

• coronary artery disease (CAD) = occlusion of a vessel
• risk factors for CAD: modifiable (increased total cholesterol, HTN, DM, obesity, smoking, physical activity) or nonmodifiable (gender, race, heredity, age)
• manifestations of CAD: stable angina, unstable angina, or prinzmetal angina (spasms so not occlusions)
• surgical management of CAD: percutaneous transluminal coronary angioplasty (PTCI or PCI) or coronary artery bypass graft (CABG)
• PTCI or PCI: place a stent and push the occlusion up into the wall and open up the vessel
• CABG: bypass the occlusion
• CAD goal: patient is to have resolved chest pain (angina) without cardiac tissue loss and function
• nursing goal ALWAYS?

  prevent secondary injury
• CAD assessments: vitals (pay close attention to BP), monitor pain, telemetry (monitor for ST elevation), physical assessment (monitor for pale, diaphoretic, nausea, vomiting, SOB), patient history (pay attention to risk factors), recreational drug use (uppers do more damage), depression screening (depression = higher risk for CAD), lab values (electrolytes and cardiac enzyme markers)
• CKMB and troponin (cardiac markers) tell how long its been going on for
• CAD intervention priorities?

  administer oxygen if below 93%, obtain ECG (in less than 10 minutes), administer medications as needed
• CAD medications: MONA (morphine, oxygen, nitroglycerin, aspirin)

  1. oxygen (if less than 93%)
  2. nitroglycerin (if blood pressure above 90 systolic)
  3. morphine
  4. aspirin
• interventions after PCI: cardiac catheterization care, report and treat chest pain IMMEDIATELY (may indicate re occlusion), administer anticoagulants and anti platelets, maintain fluids (flush the dye used in heart cath from the renal system to protect the renal system), maintain bedrest unless otherwise ordered
• education for CAD: medication regimen, angina management (if you have chest pain rest and see if it goes away and if not then take medications), bleed precautions, risk factor reduction (change the modifiable risk factors), when to call emergency services (unrelieved chest pain, uncontrolled bleeding, swelling, redness), encourage cardiac rehab
• normal EF?

  55-70%
• systolic dysfunction: heart failure with reduced EF
• diastolic dysfunction: heart failure with preserved EF; thickened heart muscle
• heart failure (HF): myocardial cell dysfunction; inability of heart to meed demands of body (oxygen and perfusion)
• risk factors for HF: CAD, HTN, DM, metabolic syndrome, obesity, smoking, high sodium intake

  (similar to CAD risk factors)
• left sided HF S&S: fatigue and SOB (backed up into lungs), orthopnea and crackles in lungs, weight gain, tachycardia, hypotension, hypertension, murmurs (S3 and S4)
• right sided HF S&S: JVD, edema in abdomen (ascites) and legs, hepatomegaly, murmurs (S3 & S4), hypotension
• normal blood flow through the heart?

  body (veins), right atrium, right ventricle, lungs, left atrium, left ventricle, body (arteries)
• lab testing for HF: BNP (normal is less than 100)
• treatment for HF: reduction of risk factors, manipulation of cardiac output, medications
• HF medications: beta blockers (metoprolol), aldosterone antagonist diuretics, ACE inhibitors (lisinopril), calcium channel blockers, digoxin
• surgical management of HF: internal cardiac defibrillator (AICD) or ventricular assist device (LVAD)
• HF self management: symptom management (daily weight, increasing exertional dyspnea), medication adherence, lifestyle changes
• complications of HF: pulmonary edema (left sided HF; sudden filling of the lungs with fluid) and renal failure (due to decreased blood flow to kidneys)