ACS

Question 1

two types of unstable angina

Answer 1

printzmental’s variant (vasospasm)

thrombus

Question 2

what is unstable angina?

Answer 2

new or changing chest pain caused by ischemia

Question 3

NSTEMI

Answer 3

non-ST segment elevation myocardial infarction
ST segment depression or normal
normal QRS
inverted T wave
elevated troponin
smaller infarct
better outcomes

Question 4

STEMI

Answer 4

ST segment elevation myocardial infarction
wide QRS, develops over hours
peaked T wave then inverted
Troponin elevated
large infarct
outcome is poor

Question 5

ACS is comprised of

Answer 5

unstable angina
NSTEMI
STEMI
all are life threatening

Question 6

prinzmetal angina

Answer 6

variant/vasospastic angina
caused by coronary artery spasm
endothelial dysfunction

Question 7

characteristics of prinzmetal angina

Answer 7

CAD may or may not be present
onset at rest, with minimal exertion, at night
ST elevation
not caused by atherosclerosis

Question 8

unstable plaque

Answer 8

large lipid core, active inflammation
breaks loose
measured with CRP
thin cap

Question 9

unstable angina

Answer 9

chest pain occurring for 1st time
chest pain is more severe than usual
myocardial ischemia
caused by a ruptured plaque and thrombus

Question 10

why is there no infarction?

Answer 10

occlusion is partial or thrombus dissolves

Question 11

what type of ECG changes are seen with unstable angina?

Answer 11

might see ischemic changes, typically transient

Question 12

are cardiac enzymes elevated with unstable angina?

Answer 12

no

Question 13

theory of plaque ruputre

Answer 13

increased SNS activity ( r/t psychological stress, exercise, circadian rhythms)
increased BP, HR and force of contraction
increased fore of coronary artery flow
increased force exerted against injured endothelium
PLAQUE RUPTURE
platelets adhere to ruptured plaque
release substances that attract more platelets and contribute to vasospasm
THROMBUS FORMATION

Question 14

ACS vs. Stable angina

Answer 14

severity and duration
relief with nitrates
additional pain descriptors
accompanying symptoms

Question 15

most common signs in men for ACS

Answer 15

discomfort or tingling in arms, back, neck, shoulder and jaw
chest pain
shortness of breath

Question 16

most common signs in women for ACS

Answer 16

sudden dizziness
heart burn like feeling
cold sweat
unusual tiredness
nausea or vomiting

Question 17

s/s of MI

Answer 17

diaphoresis
dyspnea
extreme anxiety
levines sigh (fist to chest)
pallor
retrosternal crushing chest pain that radiates to shoulder, arm, jaw or back pain

Question 18

what is an acute myocardial infarction

Answer 18

ruptured plaque and thrombus
blood flow is disrupted and prolonged
total blood flow disruption
Troponin Elevated

Question 19

MI’s are classified by which ECG findings?

Answer 19

STEMI

NSTEMI

Question 20

irreversible heart injury occurs within

Answer 20

30min to 4 hours

Question 21

tissue necrosis of heart begins

Answer 21

at 4 hours

Question 22

necrotic tissue s cleared away by

Answer 22

1-2 weeks

Question 23

tough fibrous scar tissue replaces necrotic tissue by

Answer 23

6 weeks

Question 24

three zones of damage

Answer 24

Infarction= necrosis
injury
ischemia

Question 25

infarction zone

Answer 25

necrosis
MI, dead cells
beyond hope of recovery but can stop in from increasing

Question 26

Injury zone

Answer 26

some recovery possible
can still perfuse it and restore it to become viable
not dead yet

Question 27

ischemia zone

Answer 27

full recovery is possible

Question 28

The extent of damage of an acute MI is influenced by what three factors?

Answer 28

location or level of occlusion in coronary artery
length of time that the coronary artery has been occluded
Heart’s availability of collateral circulation

Question 29

Left anterior descending artery supplies what

Answer 29

the left ventricle

Question 30

the LAD is most commonly involved in

Answer 30

myocardial infarction

Question 31

what is a widowmaker?

Answer 31

a tight blockage or total blockage at the beginning of the LAD
ECG Tombstones

Question 32

Acute MI treatment

Answer 32

oxygen
morphine
ASA
nitro
beta-blockers (if no contraindications)
thrombolytic agents (if pt is eligible)

Question 33

typically when are thrombolytic agents used?

Answer 33

within 4-6 hours of beginning of MI

Question 34

STEMI pharmacotherapy: immediate

Answer 34

oxygen
ASA
morphine
beta blocker
nitro

Question 35

What does oxygen do during a stemi?

Answer 35

increases o2 delivery to ischemic myocardium

Question 36

what does aspirin do during a stemi?

Answer 36

suppresses platelet aggregation
CHEW
decreases mortality

Question 37

what does morphine do during a stemi?

Answer 37

decreases pain
reduces preload and afterload
helps preserve ischemic tissue

Question 38

what do beta blockers do during a stemi?

Answer 38

reduce HR and contractility (reduce oxygen demand)

reduces pain, infarct size, and mortality

Question 39

what does nitro do during a stemi?

Answer 39

reduces preload and afterload, limits infarct size

does not reduce mortality

Question 40

STEMI fibrinolytic therapy

Answer 40

alteplase (tPA)
works best between 30-70 min
always given with heparin and antiplatelet therapy

Question 41

MOA of alteplase

Answer 41

dissolves clot by converting plasminogen into plasmin

Question 42

side effects of nitroglycerin

Answer 42

severe hypotension
particularly with other nitrates
DO NOT administer with sildenafil