ACS pt 1 Flashcards
rogers
what is the definition of ACS?
acute myocardial ischemia resulting from an imbalance between myocardial oxygen demand and supply
why is dangerous if a clot forms higher up in the heart?
it can lead to more tissue damage downstream
what are the steps of formation of an ischemia?
rupture of atherosclerotic plaque
platelet adherence, activation, aggregation, and activation of clotting cascade
fibrin and platelets form clot
ischemia
what is the median age of ACS?
68 years
what is the ratio of males to females for ACS?
3:2
for the 12 million pts who are hospitalized, how many are NSTEMI and how may are STEMI?
70% NSTEMI
30% STEMI
what are the risk factors of ACS?
older age
male
positive family history of CAD
presence of peripheral arterial disease
DM
renal insufficiency
prior MI
smoking
what are precipitating factors?
recent exercise
weather
diet (large meal)
emotions
coitus
walking against the wind
smoking
how does retrosternal chest pain present?
may radiate to shoulder, down the left arm, to the back, or to the jaw
most often at rest
what are other signs and symptoms?
NV
diaphoresis
SOB
what are atypical symptoms?
epigastric pain
indigestion
stabbing or pleuritic pain
increasing COB in absence of chest pain
what populations are more likely to experience atypical symptoms?
elderly
females
diabetics
impaired renal function
dementia
what high risk features would warrant a transportation to emergency medical services?
continuing chest pain
severe dyspnea
syncope/presyncope
palpitations
after 10 minutes of arriving to emergency facility, what should all pts with acute chest pain have done?
12-lead ECG
what do the QRS waves signal?
ventricle contraction
what does the T wave signal?
ventricle relaxation
what does ST mean?
time from S to T
from contraction to relaxation
what is the main characteristics of a STEMI on an ECG?
persistent ST elevation
how does the Q wave change in a STEMI on an ECG?
often not present on initial ECG, but develops over hours to day
what does the ECG look like for an NSTEMI and UA?
may have normal ECG
sometimes have ST depression, transient ST-elevation, or new T-wave inversion
Q changes unlikely
no ST elevation
what should be measured asap after presentation to ED with acute CP and suspected ACS?
troponin
where does troponin originate from?
released from necrotic myocytes (injured heart cells) into the blood stream
what troponin test prefered?
high sensitivity
what are the normal levels of troponin in a high sensitivity test?
under 14 ng/L
