MS4 Midterm 2025/2026 294Q&A. 100%
Verified.
Three stages of atherosclerosis
fatty streak, fibrous plaque, complicated lesion
Fatty Streak
accumulation of lipoproteins within the walls of an artery
Fibrous plaque
Smooth muscles cells proliferate, produce collagen and migrate over a fatty streak
Complicated lesions
plaque rupture, thrombus formation, further narrowing or total occlusion of vessel
Non mod for CAD
- Age (men >45, women>55), gender (earlier in men dt estrogen...women have atypical symptoms),
ethnicity (white and black males), family history, genetics
Modifyable for CAD
- hyperlip, HTN, sedentary, obesity, diabetes, metabolic syndrome, Smoking, fat should be 25-35% of
diet
How to manage hyperlip?
Increase mono poly unsaturated fats and decrease saturated and trans fats
mono and poly unsaturated fats
Mono: olive oil, avo, nuts
Polly: Fatty fish (salmon, tuna, mackerel, sardines), Flaxseeds, chia seeds, walnuts
Saturated fats
Solid at room temp: animal meats, butter, cheese, processed and fried foods.
Chronic stable angina
Triggered by physical exertion, stress, or emotional upset. Relieved by rest or nitroglycerin.
As a nurse, what do you do first and what is the priority intervention for chronic stable angina
First: nitro to relieve chest pain
Priority: lifestyle changes and meds (nitrates, beta blockers, antiplts) .
Unstable angina
New-onset chest pain, more frequent or severe, lasting over 10 minutes. Occurs at rest or with
minimal exertion.
,As a nurse, what do you do first and what is the priority intervention for unstable angina
First: nitro and antiplt therapy (aspirin)
Priority: Immediate revascularization (PCI/CABG)
Silent angina
Ischemia without chest pain, often seen in patients with diabetes or autonomic dysfunction
As a nurse, what do you do first and what is the priority intervention for Silent angina
First: assessment and ECG
Priority: Manage underlying condition (diabetes, HTN)
What do all presumed ACS pts get?
- AntiPLT meds (aspirin(, angina meds (nitro), and supplemental 02
ECG and biomarkers: Stemi
ECG: ST-segment elevation in at least two contiguous leads.
Markers: Elevated trops and CK-MB
Intervention for STEMI
First: Give aspirin and nitro
Intervention: Immediate reperfusion (PCI, thrombolytics)
ECG and biomarkers NSTEMI
ECG: ST segment depression, T wave inversion.
Biomarkers: Elevated trops but no CK-MB increase.
Intervention for NSTEMI
First: Aspirin, anticoag, and nitro
Priority: AntiPLT, PCI if necessary
When would you use PCI?
- acute STEMI (preferred within 90 min of symptom onset)
- unstable angina
- significant coronary artery blockages in patients who are stable.
When would you use CABG?
- severe multi-vessel disease
- left main coronary artery blockage
- failed PCI
- when PCI is not an option due to complex lesions.
- Uses internal mammary artery
How can a PCI cause dysrhythmias?
Can occur from irritation of the heart muscle during catheter placement or reperfusion injury.
How can PCI cause beeding?
, - Vessel puncture during catheterization
How can PCI cause coronary artery dissection
damage to the artery wall during balloon inflation or stent placement.
How can PCI cause re-stenosis?
- scar tissue or plaque causes a narrowing of the artery again after PCI.
Complications for CABG
- Infection at the surgical site.
- Graft failure or blockage.
- Bleeding or hypovolemia.
- Cardiac arrhythmias and postoperative shock
What would you see in an assessment post PCI/CABG that would indicate a complication?
Hypotension, decreased urine output, murmur, new chest pain, signs of fluid overload.
Post PCI procedure care
Bed rest, monitor for complications, administer heparin or antiplatelet therapy.
Post CABG procedure care
ICU monitoring, fluid status, medications, electrolyte replacemen
What are some adverse effects/complications of thrombolytic therapy?
Bleeding, arrhythmias from reperfusion, reocclusion
SS bleeding
- Gums, puncture sites, or intracranial hemorrhage (headache, altered consciousness), Hypotension,
tachycardia
Why would an arrhythmia be present after thrombolytic therapy?
- heart trying to manage reperfusion
What would recurrent chest pain or ST elevation mean after thrombolytic therapy?
indicates reocclusion
Example of thrombolytic therapy
- TPA
-dissolve blood clots by converting plasminogen into plasmin, which breaks down fibrin in clots
What is happening with L sided HF
heart struggles to get blood to the body causing a backup in the lungs which causes fluid to leak
from blood vessels into lung tissue
SS left sided HF
Verified.
Three stages of atherosclerosis
fatty streak, fibrous plaque, complicated lesion
Fatty Streak
accumulation of lipoproteins within the walls of an artery
Fibrous plaque
Smooth muscles cells proliferate, produce collagen and migrate over a fatty streak
Complicated lesions
plaque rupture, thrombus formation, further narrowing or total occlusion of vessel
Non mod for CAD
- Age (men >45, women>55), gender (earlier in men dt estrogen...women have atypical symptoms),
ethnicity (white and black males), family history, genetics
Modifyable for CAD
- hyperlip, HTN, sedentary, obesity, diabetes, metabolic syndrome, Smoking, fat should be 25-35% of
diet
How to manage hyperlip?
Increase mono poly unsaturated fats and decrease saturated and trans fats
mono and poly unsaturated fats
Mono: olive oil, avo, nuts
Polly: Fatty fish (salmon, tuna, mackerel, sardines), Flaxseeds, chia seeds, walnuts
Saturated fats
Solid at room temp: animal meats, butter, cheese, processed and fried foods.
Chronic stable angina
Triggered by physical exertion, stress, or emotional upset. Relieved by rest or nitroglycerin.
As a nurse, what do you do first and what is the priority intervention for chronic stable angina
First: nitro to relieve chest pain
Priority: lifestyle changes and meds (nitrates, beta blockers, antiplts) .
Unstable angina
New-onset chest pain, more frequent or severe, lasting over 10 minutes. Occurs at rest or with
minimal exertion.
,As a nurse, what do you do first and what is the priority intervention for unstable angina
First: nitro and antiplt therapy (aspirin)
Priority: Immediate revascularization (PCI/CABG)
Silent angina
Ischemia without chest pain, often seen in patients with diabetes or autonomic dysfunction
As a nurse, what do you do first and what is the priority intervention for Silent angina
First: assessment and ECG
Priority: Manage underlying condition (diabetes, HTN)
What do all presumed ACS pts get?
- AntiPLT meds (aspirin(, angina meds (nitro), and supplemental 02
ECG and biomarkers: Stemi
ECG: ST-segment elevation in at least two contiguous leads.
Markers: Elevated trops and CK-MB
Intervention for STEMI
First: Give aspirin and nitro
Intervention: Immediate reperfusion (PCI, thrombolytics)
ECG and biomarkers NSTEMI
ECG: ST segment depression, T wave inversion.
Biomarkers: Elevated trops but no CK-MB increase.
Intervention for NSTEMI
First: Aspirin, anticoag, and nitro
Priority: AntiPLT, PCI if necessary
When would you use PCI?
- acute STEMI (preferred within 90 min of symptom onset)
- unstable angina
- significant coronary artery blockages in patients who are stable.
When would you use CABG?
- severe multi-vessel disease
- left main coronary artery blockage
- failed PCI
- when PCI is not an option due to complex lesions.
- Uses internal mammary artery
How can a PCI cause dysrhythmias?
Can occur from irritation of the heart muscle during catheter placement or reperfusion injury.
How can PCI cause beeding?
, - Vessel puncture during catheterization
How can PCI cause coronary artery dissection
damage to the artery wall during balloon inflation or stent placement.
How can PCI cause re-stenosis?
- scar tissue or plaque causes a narrowing of the artery again after PCI.
Complications for CABG
- Infection at the surgical site.
- Graft failure or blockage.
- Bleeding or hypovolemia.
- Cardiac arrhythmias and postoperative shock
What would you see in an assessment post PCI/CABG that would indicate a complication?
Hypotension, decreased urine output, murmur, new chest pain, signs of fluid overload.
Post PCI procedure care
Bed rest, monitor for complications, administer heparin or antiplatelet therapy.
Post CABG procedure care
ICU monitoring, fluid status, medications, electrolyte replacemen
What are some adverse effects/complications of thrombolytic therapy?
Bleeding, arrhythmias from reperfusion, reocclusion
SS bleeding
- Gums, puncture sites, or intracranial hemorrhage (headache, altered consciousness), Hypotension,
tachycardia
Why would an arrhythmia be present after thrombolytic therapy?
- heart trying to manage reperfusion
What would recurrent chest pain or ST elevation mean after thrombolytic therapy?
indicates reocclusion
Example of thrombolytic therapy
- TPA
-dissolve blood clots by converting plasminogen into plasmin, which breaks down fibrin in clots
What is happening with L sided HF
heart struggles to get blood to the body causing a backup in the lungs which causes fluid to leak
from blood vessels into lung tissue
SS left sided HF
