ACS - medsurg 2 Flashcards
what are the 2 conditions that follow under acute coronary syndrome (ACS)
unstable angina & acute MI
when comparing angina pain to MI pain, characteristics of MI would include
-w/o a cause & usually in the early morning d/t cortisol surge
-relieved only by opioids
->20mins
-Sx: diaphoresis, dyspnea, anxiety, dysrhythmias
if someone “drops dead” bc of a heart attack, what was the cause
dysrhythmia
during an MI, how long can cells stand ischemia before cell death occurs
20 minutes
during an MI, how long does it take for the entire thickness of heart muscle to necrose
4-6 hrs
what layer of the heart is affected first during an MI
subendocardium
MI’s are described based on
location of damage (anterior, inferior, lateral, septal or posterior)
what does MI pain feel like
severe, immobilizing chest pain not relieved by rest, position change or nitrates
what is the hallmark sign of a MI
non responsive to nitrates
how might a pt describe their sx during an MI
-persistent
-heaviness, pressure, tightness
-burning
-constriction, crushing
complications of MI
-dysrhythmias
-HF
-cardiogenic shock
-papillary muscle dysfunction
-pericarditis
complications of MI: dysrhythmias
get on tele immediately
-most common comp
-causes pre hospital death
complications of MI: HF
occurs because of reduced pumping action of the heart
complications of MI: cardiogenic shock
loss of BP d/t severe left ventricular failure
complications of MI: papillary muscle dysfunction
leads to new murmur noted
complications of MI: pericarditis
-occurs 2-3 days after acute MI
-new pericardial friction rub
dx testing for ACS
EKG (serial order)
-look for change in QRS, ST seg & T wave
-elevated or non elevated ST determined STEMI or NSTEMI
ischemia characteristics
-ST depression
-temporary damage
-reduced blood flow
infraction characteristics
-ST elevation
-permanent damage
-complete blockage
-death of tissue
STEMI: ST, QRS, T wave, Troponin, size, outcome
ST: elevation
QRS: wide (over hours)
T wave: peaked then inverted
Troponin: elevated
size: larger
outcome: poor
ST elevated in two anatomically contiguous leads
NSTEMI: ST, QRS, T wave, Troponin, size, outcome
ST: depression or normal
QRS: normal
T wave: inverted
Troponin: elevated
size: smaller
outcome: better
initial assessment for ACS
-consider MI if pt comes in with expected sx or if women, older or diabetic w/ atypical sx
-12 lead EKG within 10 mins of arrival
initial interventions
-assess/stabilize ABC’s
-position pt upright, admin O2, obtain VS, PQRST
-attach tele
-establish IV access
-ASA 325mg
-lab work
-monitor heart & lung sounds
what lab work should be obtained for ACS admission
-cardiac markers
-electrolytes
-H&H
-coags
