ACS Flashcards
What is printzmetal’s variant angina?
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.
What type of ischemia is chronic stable angina?
Demand ischemia
What type of ischemia is unstable angina?
Supply ischemia
New or changing chest pain caused by ischemia is known as what?
Unstable angina
What are the causes of a variant / vasospastic / prinzmetal angina?
Coronary artery spasm or some underlying cause like endothelial damage
What is the onset / timing of variant / vasospastic / prinzmetal angina?
May happen at rest, minimal exertion, or at night
What is the treatment for variant / vasospastic / prinzmetal angina?
Nitrate to relax the spasm.
What are the characteristics of an unstable plaque?
Large lipid core with small fibrous cap, active inflammation.
What are the characteristics of a stable plaque?
Small lipid core, thicker fibrous cap.
Why does unstable angina, itself, not cause an infarction?
Because there is not a full occlusion
Are there troponin level changes with unstable angina?
No
What types of EKG changes would you expect to see with unstable angina?
Transient ischemia changes (not ST elevations).
Describe the theory of plaque rupture?
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
What is the duration and limit for stable angina?
About 5 minutes, typically should be gone within 15 minutes
True or false: Acute coronary syndrome has no relief with nitrates.
True
What are the signs for an MI in women?
Sudden dizziness, heartburn, cold sweats, N/V, unusual fatigue
What are the most common symptoms in men with a heart attack?
Discomfort / tingling in arms, back, neck, shoulder, or jaw
Chest pain
SOA
What are the signs and symptoms of an MI?
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
Why is there an infarction with an MI?
Blood flow disruption is prolonged and/or is total
When would you expect to see “EKG tombstoning” and what does it mean?
STEMI - this indicates a large myocardial area is experiencing an infarct and needs intervention immediately.
Compare the ST segment between an NSTEMI or STEMI:
STEMI = elevated
NSTEMI = depression / normal
Compare the QRS complex between an NSTEMI or STEMI:
STEMI: usually pathologic (wide), develops over hours
NSTEMI: normal
Compare T waves between an NSTEMI or STEMI:
STEMI: peaked, then inverted
NSTEMI: inverted
Compare troponin levels between an NSTEMI or STEMI:
Elevated in both
Compare the size of the infarct between an NSTEMI or STEMI:
STEMI: larger
NTEMI: smaller
Compare the general outcomes between an NSTEMI or STEMI:
STEMI: poor
NSTEMI: better
What are the 3 factors that influence the extent of damage following a heart attack?
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
Reperfusion therapy needs to be completed how long after an MI? Why?
30 minutes - 4 hours
Due to irreversible tissue injury before necrosis
How does scar tissue impact conduction through the heart?
Decreases
In relation to ACS what are the three zones of damage?
Infarction, injury, and ischemia
What is the ischemic zone?
Full recovery is possible with the tissue
What is the injury zone?
Some recovery is possible, can still perfuse it and restore it to become viable. This tissue is not dead yet.
What is the infarction zome?
Myocardial infarction - dead cells, beyond hope of recovery but can stop it from increasing in size.
What are 2 specific ways to limit the extension of the size of infarction?
Increase oxygenation, decrease demand on the heart
What coronary artery is known as the widow maker?
Left anterior descending - this is what perfuses the left ventricle.
What coronary artery supplies blood to the left circumflex and LAD artery?
Left main artery
Why do we encourage chewing of an ASA with chest pain?
Increased speed at which the medication is absorbed for anti-platelet effects. Suppresses platelet aggregation. Decreases mortality.
In a patient that has had a STEMI, why do we give oxygen?
Increase oxygen delivery to the ischemic myocardium
In a patient that has had a STEMI, why do we give morphine?
Decrease pain, reduce preload and afterload, helps preserve ischemic tissue
In a patient that has had a STEMI, why do we give beta blockers?
Reduce HR and contractility, reduces oxygen demand, reduces pain, infarct size, and mortality
In a patient that has had a STEMI, why do we give nitroglycerin?
Reduces preload and afterload, limits infarct size, does NOT reduce mortality
What are the major causes of death because of MI?
Hesitation and delayed request for medical emergency care.
What drug class is Alteplase?
Fibrolytic
What is the MOA of Alteplase?
Dissolves clot by converting plasminogen to plasmin
What is the indication for Alteplase?
STEMI
What is the major adverse reaction of Alteplase?
Bleeding
When does Alteplase work best?
30-70 minutes of event
What two medications are always given with Alteplase?
Heparin and antiplatelet therapy (clopidogrel)
