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Patho 2 - Exam 1 > ACS > Flashcards

ACS Flashcards

1
Q

What is printzmetal’s variant angina?

A

Vasospasm which decreases oxygenated blood flow to the heart and increase the risk of MI. This is not related to atherosclerosis plaque build up. This is a supply ischemia.

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2
Q

What type of ischemia is chronic stable angina?

A

Demand ischemia

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3
Q

What type of ischemia is unstable angina?

A

Supply ischemia

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4
Q

New or changing chest pain caused by ischemia is known as what?

A

Unstable angina

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5
Q

What are the causes of a variant / vasospastic / prinzmetal angina?

A

Coronary artery spasm or some underlying cause like endothelial damage

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6
Q

What is the onset / timing of variant / vasospastic / prinzmetal angina?

A

May happen at rest, minimal exertion, or at night

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7
Q

What is the treatment for variant / vasospastic / prinzmetal angina?

A

Nitrate to relax the spasm.

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8
Q

What are the characteristics of an unstable plaque?

A

Large lipid core with small fibrous cap, active inflammation.

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9
Q

What are the characteristics of a stable plaque?

A

Small lipid core, thicker fibrous cap.

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10
Q

Why does unstable angina, itself, not cause an infarction?

A

Because there is not a full occlusion

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11
Q

Are there troponin level changes with unstable angina?

A

No

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12
Q

What types of EKG changes would you expect to see with unstable angina?

A

Transient ischemia changes (not ST elevations).

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13
Q

Describe the theory of plaque rupture?

A

Increased SNS activity (psychological stress, exercise, circadian rhythms) > increased BP, HR, and force of contractions > increased force of coronary artery blood flow > increased force exerted against injured endothelium > plaque rupture > platelets adhere to the ruptured plaque > release of substances that attract more platelets and contributes to vasospasms > thrombus formation

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14
Q

What is the duration and limit for stable angina?

A

About 5 minutes, typically should be gone within 15 minutes

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15
Q

True or false: Acute coronary syndrome has no relief with nitrates.

A

True

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16
Q

What are the signs for an MI in women?

A

Sudden dizziness, heartburn, cold sweats, N/V, unusual fatigue

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17
Q

What are the most common symptoms in men with a heart attack?

A

Discomfort / tingling in arms, back, neck, shoulder, or jaw
Chest pain
SOA

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18
Q

What are the signs and symptoms of an MI?

A

Diaphoresis
Dyspnea
Extreme anxiety
Levine’s sign (fist to chest)
Pallor
Retroster hi bab love

retrosternal crushing chest pain that radiates to shoulder, arm, jaw, badk
Weak pulses

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19
Q

Why is there an infarction with an MI?

A

Blood flow disruption is prolonged and/or is total

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20
Q

When would you expect to see “EKG tombstoning” and what does it mean?

A

STEMI - this indicates a large myocardial area is experiencing an infarct and needs intervention immediately.

21
Q

Compare the ST segment between an NSTEMI or STEMI:

A

STEMI = elevated
NSTEMI = depression / normal

22
Q

Compare the QRS complex between an NSTEMI or STEMI:

A

STEMI: usually pathologic (wide), develops over hours
NSTEMI: normal

23
Q

Compare T waves between an NSTEMI or STEMI:

A

STEMI: peaked, then inverted
NSTEMI: inverted

24
Q

Compare troponin levels between an NSTEMI or STEMI:

A

Elevated in both

25
Q

Compare the size of the infarct between an NSTEMI or STEMI:

A

STEMI: larger
NTEMI: smaller

26
Q

Compare the general outcomes between an NSTEMI or STEMI:

A

STEMI: poor
NSTEMI: better

27
Q

What are the 3 factors that influence the extent of damage following a heart attack?

A

1) Location / level of occlusion in the coronary artery
2) Length of time the coronary artery has been occluded
3) Heart’s availability of collateral circulation

28
Q

Reperfusion therapy needs to be completed how long after an MI? Why?

A

30 minutes - 4 hours
Due to irreversible tissue injury before necrosis

29
Q

How does scar tissue impact conduction through the heart?

A

Decreases

30
Q

In relation to ACS what are the three zones of damage?

A

Infarction, injury, and ischemia

31
Q

What is the ischemic zone?

A

Full recovery is possible with the tissue

32
Q

What is the injury zone?

A

Some recovery is possible, can still perfuse it and restore it to become viable. This tissue is not dead yet.

33
Q

What is the infarction zome?

A

Myocardial infarction - dead cells, beyond hope of recovery but can stop it from increasing in size.

34
Q

What are 2 specific ways to limit the extension of the size of infarction?

A

Increase oxygenation, decrease demand on the heart

35
Q

What coronary artery is known as the widow maker?

A

Left anterior descending - this is what perfuses the left ventricle.

36
Q

What coronary artery supplies blood to the left circumflex and LAD artery?

A

Left main artery

37
Q

Why do we encourage chewing of an ASA with chest pain?

A

Increased speed at which the medication is absorbed for anti-platelet effects. Suppresses platelet aggregation. Decreases mortality.

38
Q

In a patient that has had a STEMI, why do we give oxygen?

A

Increase oxygen delivery to the ischemic myocardium

39
Q

In a patient that has had a STEMI, why do we give morphine?

A

Decrease pain, reduce preload and afterload, helps preserve ischemic tissue

40
Q

In a patient that has had a STEMI, why do we give beta blockers?

A

Reduce HR and contractility, reduces oxygen demand, reduces pain, infarct size, and mortality

41
Q

In a patient that has had a STEMI, why do we give nitroglycerin?

A

Reduces preload and afterload, limits infarct size, does NOT reduce mortality

42
Q

What are the major causes of death because of MI?

A

Hesitation and delayed request for medical emergency care.

43
Q

What drug class is Alteplase?

A

Fibrolytic

44
Q

What is the MOA of Alteplase?

A

Dissolves clot by converting plasminogen to plasmin

45
Q

What is the indication for Alteplase?

A

STEMI

46
Q

What is the major adverse reaction of Alteplase?

A

Bleeding

47
Q

When does Alteplase work best?

A

30-70 minutes of event

48
Q

What two medications are always given with Alteplase?

A

Heparin and antiplatelet therapy (clopidogrel)

Patho 2 - Exam 1 (5 decks)

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