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240 > ACS > Flashcards

ACS Flashcards

1
Q

acute coronary syndrome (ACS)

A

a progression of coronary events
stable angina or unstable angina
STEMI or NSTEMI

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2
Q

unstable angina EKG

A

can be:

  1. normal
  2. inverted T waves
  3. ST depression
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3
Q

unstable angina etiology

A

chest pain caused by ruptured or thickened plaque with platelet and fibrin thrombus causing increased coronary obstruction

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4
Q

unstable angina symptoms

A

irregular/unpredictable chest pain of increasing intensity, frequency, or duration
occurs at rest or with minimal activity
unresponsive to NTG

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5
Q

unstable angina pharmological treatment

A 
NTG
beta blockers
tissue plasminogen activators (tPA)
O2
clopidogrel
morphine
statins
aspirin
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6
Q

coronary artery disease (CAD)

A

leading global cause of death
number 1 cause of death in US
leading cause of death for women

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7
Q

acute coronary syndrome (ACS) patho

A

clinical manifestation of coronary disease
development of fatty plaques in artieries
narrows coronary vasculature and limits blood flow and oxygen delivery to coronary muscle

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8
Q

acute coronary syndrome modifiable risk factors

A 
alcohol/tobacco use
HTN
sedentary lifestyle/obesity
dyslipidemia
DM
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9
Q

acute coronary syndrome innate risk factors

A 
age
gender
heredity
stress
menopause
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10
Q

angina pectoris

A

“strangling chest”

chest pain caused by myocardial ischemia

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11
Q

ischemia

A

occurs when oxygen supply > oxygen demand

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12
Q

angina pectoris precipitating caues

A 
exertion
temperature extremes
emotional stress
large meal
tobacco
sexual activity 
stimulant use
circadian rhythm patterns
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13
Q

stable angina etiology

A

myocardial ischemia

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14
Q

stable angina symptoms

A

episodic pain lasting 5-10 minutes
aggravated by exertion, cold, eating, emotional stress
relieved by rest, NTG

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15
Q

stable angina pharmacological treatment

A 
NTG
aspirin
beta blockers
calcium channel blockers
ACE inhibitors
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16
Q

variant angina causes

A

coronary vasospasm

17
Q

variant angina symptoms

A

occurs at rest without provocation
triggered by smoking
occurs with or without the presence of CAD
transient ST-segment elevation during pain
often associated with AV block or ventricular arrhythmias

18
Q

variant angina treatment

A

calcium channel blockers

19
Q

myocardial infarction (MI)

A

occurs when heart muscle is abruptly deprived of oxygen
ischemia is the first phase
injury occurs when tissue is injured from lack of O2
necrosis = death of myocardium tissue

20
Q

location of MI

A

mostly occurs in left ventricle and categorized by the wall of left ventricle it occurs upon
anterior wall is caused by occlusion left anterior descending artery (LAD) and is 25% of MIs with highest mortality rate
lateral wall occurs with occlusion of circumflex artery
inferior wall occurs with occlusion of right coronary artery (RCA)

21
Q

NSTEMI

A

associated with ST segment depression or T wave inversion on ECG
occurs as a result of subtotal occluding thrombus
may be undistinguishable from unstable angina without serologic evidence of myocardial necrosis

22
Q

NSTEMI assessment and treatment

A 
admission
serial EKGs, cardiac enzymes
rest 24-48 hrs
continuous bedside EKG
analgesics
supplemental O2
pharmacological therapy
23
Q

STEMI

A

ST segment is elevated
most common cause is reduced myocardial perfusion 2/2 occlusive thrombus
reperfusion therapy should be initiated within 12 hours of symptom onset

24
Q

APQRST

A 
Associated sx
Precipitating factors
Quality
Region/radiation/risk factors
Severity
Timing
25
Q

ACS nursing actions

A 
place pt in semi-Fowlers
EKG within 10 minutes
draw blood, start IV
initiate treatment
frequent vitals
26
Q

ACS nursing actions (meds)

A 
NTG if systolic >90
supplemental O2
morphine IV
beta blockers
ACE inhibitors
27
Q

ECG manifestations

A

crucial within 10 min
deviation of ST segment will determine amt of damage to heart muscle
prolonged ST elevation, new LBBB or new Q waves indicate STEMI
NSTEMI may present with ST depression or T wave inversion

28
Q

ischemia ECG changes

A

T wave inversion
ST depression > 0.5mm
ST that remains at baseline for > 0.12 seconds

29
Q

injury ECG

A

ST segment elevation of 1mm or more above baseline

T wave may be taller and pointed

30
Q

infarction ECG

A

> 3mm ST segment elevation in 2 contiguous leads

31
Q

troponin I

A

most accurate marker of myocardial injury
increase in blood 4-12 hrs
peaks in 12 hrs and remains elevated for 4-10 days

32
Q

troponin T

A

may be predictive of MI size

>0.01 ng/mL considered elevated

33
Q

exercise testing

A

focuses on ECG during exercise

gives info about dysrhytmias, HR, BP, exertion rate, exercise capacity, myocardial O2 update, VO2, ventilator threshold

34
Q

cardiac catheterization

A

used to determine exact location of the myocardial injury and specific obstructions to coronary vasculature

35
Q

anti-ischemic meds

A

NTG
morphine
beta blockers

36
Q

anti-thrombotic therapy

A

aspirin
P2Y12 inhibitor (clopidogrel or ticagrelor)
unfractionated heparin
low molecular weight heparin

37
Q

percutaneous transluminal coronary intervention (PTCI)

A

placement of stent into narrowed coronary artery
percutaneous balloon angioplasty (PTCA)
reperfuse myocardium
antiplatelet therapy required

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