ACS Flashcards

You may prefer our related Brainscape-certified flashcards:
1
Q

What is the pathophysiology of ACS?

A

Artheromstous plaque formation in coronary vasculature, exposing fibrin, collagen, cholesterol and cellular debris
This creates stimulation for: platelet adhesion, aggregation, thrombus formation and localised vasoconstriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

ACS is a …

A

Critical stage of IHD with differing degrees of occlusion and embolisation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the pathophysiology for a stable angina?

A

Stable intact lesion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the pathophysiology of unstable angina?

A

Breached endothelium with or without superimposed fibrin clot and coronary spasm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the pathophysiology of an MI?

A

Plaque rupture with superimposed fibrin clot leading to total coronary occlusion and coronary spasm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How do you diagnose ACS?

A

Pt history
Typical symptoms
ECG changes
Biochemical markers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the rational for the assessment of ACS?

A
Diagnostic
Therapeutic
Humanistic concern
Improve and maintain pt nurse relationship
Accountability
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the possible differential diagnosis for a of presenting with ACS?

A
Angina pectoris
MI
Pericarditis
Dissecting aortic aneurysm 
Tracheobronchitis
Pleural pain
Reflux oesphagitis
Chest wall pain
Anxiety
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the PQRST assessment of chest pain?

A
Precipitating factors
Qualitative factors
Region and radiation
Severity and associated symptoms
Timing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is included in precipitating factors for Chest pain assessment?

A

What factors precipitated discomfort?

What was happening at symptom onset?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is included in qualitative factors in chest pain assessment?

A

Describe pain
What does pain feel like in own words
How did or feel at time of pain?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is included in region and radiation for chest pain assessment?

A

Where and how far pain spreads

Pain normally in left arm, inner aspect of arm sometimes as far as fingers, jaw (not to ear), neck, back, epigastrium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is included in severity and associated symptoms for chest pain assessment?

A

How bad is the pain?
0-10
Aware of any other pain?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is included in timing for the chest pain assessment?

A

How long did it last?

What makes the pain better?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the or groups with atypical presentations of ACS?

A

Women
Elderly
Diabetes
Ethnic minority

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the risk factors for ACS?

A
Smoking
Hypercholestraemia
Diet
Sedentary lifestyle
Alcohol consumption
Hypertension
Obesity
Socioeconomic deprivation 
Diabetes
17
Q

What are the symptoms of ACS?

A
Chest pain
Hypotension
Autonomic nervous system activation
Pallor
Sweating
Rhythm disturbances
18
Q

What does ST depression mean?

A

Ischaemia, left ventricular hypertrophy,

Digoxin toxicity

19
Q

What does ST elevation mean?

A

Acute MI

20
Q

What does T wave flattening mean?

A

Ischaemia and hypokalaemia

21
Q

What are the STEMI ECG changes?

A
Total coronary occlusion
Ongoing chest pain
Persistent ST elevation
New LBBB
Raised biochemical markers
22
Q

What are the non STEMI ECG changes?

A

Acute ishaemic event
Chest pain
Various ECG changes: persistent ST depression and/or T wave inversion, flattened T waves, normal ECG
Raised biochemical markers

23
Q

What are the biochemical markers associated with ACS and how long are they present?

A

CK creatin kinase: released after irreversible clear injury from hypoxia, takes 4-6 hrs to rise and 24hrs to peak
Troponin: released after myocardial damage, 3-4 hrs to detect and elevated 1-2 weeks

24
Q

What is the treatment for an MI?

A
Immediate treatment
ECG
Aspirin 300 mg chewed
Clopidogrel
Pain relief
25
Q

What are the key priorities NICE guidelines (2010) for ACS?

A

12 lead ECG asap
Recording and sending ECG should not delay transfer to hospital
Don’t routinely administer O2 (monitor SATs)
Don’t assess symptoms of an ACS differently in ethnic groups

26
Q

What is the treatment for angina?

A

Drugs that reduce cardiac workload: beta blockers, nitrates, calcium channel blockers
Drugs that reduce the risk of infarction: anti platelet drugs
Drugs that reduce cholesterol: statins

27
Q

What is the treatment for MI?

A

Primary angioplasty reduces death, stroke and non fatal infarction
CABG of diffuse disease
PTCA
PCI = reperfusion and stroke reduction benefits after 3 hrs
Thrombolysis where no PCI available

28
Q

What are the benefits of primary angioplasty for ACS pts?

A
More effective restoration of patency
Improved LV function
Reduction in re-occlusion
Reduced stroke risk
Improved survival
Reduction in hospital stay
29
Q

What is the continuing care of a pt with an MI?

A

Monitor for arrhythimas
Pain management
Secondary prevention/rehab (lifestyle, cardiac rehab, drug therapy, cardiologist review)

30
Q

What is cardiac rehab?

A

Tailored to individual needs
Culturally sensitive
Includes: health education, stress management and exercises

31
Q

What is the drug therapy for pts post MI?

A
ACE inhibitors
Aspirin indefinitely
Clopidogrel
Beta blockers 
Statins
32
Q

What is the definition of ACS?

A

A combination of clinical signs and symptoms resulting from myocardial ischaemia
Includes: unstable angina, STEMI and non STEMI