ACS,SCD Flashcards
a) Asymptomatic?
b) Stable Angina?
a) happens progressively
people don’t notice the plaque buildup
don’t realize until the damage is done
b) During activity
Emotional stress
(inc O2 demand)
Pain stops w/ rest
a) Ischemia?
b) Infarct?
a) 1 minute of blockage-
muscles ability decreased to contract
Reversible
b) 20-40 minutes of blockage
Irreversible Damage
Too acidic
a) Subendocardial?
b) Transmural?
a) partial thickness of inner part of the
myocardium
NSTEMI
Some damage but still some functioning
muscle tissue
b) entire thickness of myocardium
STEMI
Loss of all function – no contractility
a) NSTEMI?
b) STEMI?
a) block in a minor artery or a partial obstruction in a major artery
b) ruptured plaque blocks a major artery completely
Normal sinus rhythm (NSR)?
the rhythm that originates from the sinus node and describes the characteristic rhythm of the healthy human heart.
TIMI (thrombolysis in MI) risk score
Scores:
a) low risk
b) Intermediate risk
c) high risk
Tells you the risk of MIs
a) 0-2
b) 3-4
c) 5-7
Factors
a) age?
b) at least three risk factors for
c) Presence of what segment?
d) At least how many times prior angina episode?
e) Use of what med in prior 7 days?
a) ≥65 years
b) HTN
DM
Dyslipidemia(imbalance of lipids)
Smoking
Positive family history of early MI
c) ST segment deviation
d) At least two anginal episodes in prior 24 hours
e) aspirin
Possible ECG changes
a) Ischemia?
b) Cell injury?
c) Cell death?
a) ST depression & T wave inversion
b) ST elevation
c) Abnormal Q wave
Unstable angina
NSTEMI
a) S/S?
b) Type of blockage?
c) Duration?
d) ECG changes?
f) Biomarkers
(Troponin)
a) Pain occurs w/ rest
inc in intensity/occurrence/duration
b) Ischemia (O2 supply is just reduced)
c) > 20 min
d) Transitory ST depression(unstable)
Persistent ST depression(NSTEMI)
T wave inversion
Wide QRS complex
f) Unstable Normal/not tissue death
NSTEMI Elavated/tissue death
Nursing Management
Prior to all procedures?
Chest pain
12-lead ECG( identify NSTEMI or STEMI?)
When the pt has chest pain=ECG!!
IV access(make sure to patancy,flush)
Manegement
UA/NSTEMI
a) Goals?
b) Management
a) Prevent ischemia/infarction/death
Modify disease process (long term)
b) Rest & nitrates(no exercise or eat)
oxygen < 90%
Morphine(chest pain)
B-blocker(less work load)
Anti-platelet/anticoagulants
DX LABS
UA/NSTEMI
we want baseline labs and then will draw every 6-8 hrs to check values
Troponin I & T
released with cell death,higher the number, worse
CK-MB (cardiac specific)
CBC
Serum electrolytes (abnormal potassium levels can further annoy the heart)
BUN, Creatinine (because of contrast dye that is given in cath lab)
DX
UA/NSTEMI
Procedure
Treadmil/bike
Echocardiogram
Cardiac catheterization
Post-catheterization
a) Nursing care
b) Complications
a) Bed rest(2-6hr)
HOB <30(pressure=bleeding)
Immobilize etremity(can cause clots break)
Monitor for bleeding
Montior for reaction to dye
Encourage fluid intake
b) Bleeding
Obstracted blood flow to extremity (sing of clot)
Signs of Coronary Reperfusion
Relief of chest pain
Reperfusion dysrhythmias (PVCs)
Reduction of ST segment elevation (normal)
CK/CK-MB peak in less than 12 hours(normal)
STEMI
a) S/S?
b) Type of blockage?
c) Duration?
d) ECG changes?
e) Biomarkers
Emergency!!
a) Dyspnea
Apprehension(anxiety)
Fatigue,SOB(common in women)
Severe immobilizing chest pain
Cool clammy skin,
Lightheaded, N/V
b) Occlusion (O2 supply is completely stopped)
c) > 20 min
d) ST elevation
T wave inversion
Abnormal Q wave
e) Elevated(troponin,CK,CK-MB)
Acute STEMI
a) Procedure?
b) Make sure to document about?
a) Emergent PCI with in 2 hr on set of chest pain
-minimal invasive with conrast die
Fibrinolytic Therapy
Antiplatlet
Anticoagulation
b) The first chest pain felt by pt
How long have you had this pain?
When did it start?
Ballon within 90mins
Fibrinolytic Therapy
a) What is it?
b) Medications?
c) Establish?
a) If PCI not available within 2 hr
Door to needle = 30 minutes
Fibrinolytic therapy with 30 min of arrival
b) Clot Buster
TPA (ateplase)
Streptokinase
Heparin
c) 2-3 IVs antecubital BEFORE administration
Fibrinolytic Therapy
Contraindications
Why? because the pt is at risk for BLEEDING(intracranial bleeding)
Hx of stroke
Severe,uncontrolled HTN
Surgery/trauma within last 2 months
Known coagulopathy issues (hx of clotting issues)
Presence of brain tumor, AV malformation, or aneurysm
STEMI Medication
a) For chest pain
b) Other meds?
a) Morphine
b) Beta blockers/ACEi
-dec the workload
Antiplatelet/anticoagulants
Nitroglyceri
Stool softeners
Statins
Core interventions for acute MI
nemonic A,B,C,D,E,F,G+P
Primary PCI received within 90 min of arrival
A: Aspirin on arrival Aspirin & Anticoagulants
B: B-blockers and BP
C: Cholesterol and Cigarettes (STOP)
D: Diet
E: Exercise
F: Fibrinolytic therapy with 30 min of arrival
G: Graphics to help visualize symptoms
a) Heart attack
b) Sudden cardiac death
a) Problem with the blood supply to the heart
Causesd by a blockage that stops blood flow
b) Heart’s electrical system
Heart suddenly starts beating so fast
Sudden Cardiac Death (SCD)
Most often d/t?
CAD
Post MI
Hypertrophic cardiomyopathy
-especially young athletes
Prevention of SCD
Prevention of CAD
Lifestyle modification
BP, weight, glucose, cholesterol control
Smoking, diet & physical activity
Screen Athletes
Prevention with patients post-MI
Control the heart rhythem
Impaird LV dysfunction
Β-blockers, ACE inhibitors, statins
Suppression of ventricular dysrhythmias
Implanted cardioverter-defibrillator (ICD)
But wait at least 40 days after MI
When Prevention Doesn’t Work
Early activation of emergency services
Early & effective compressions
Early defibrillation
(electrical current to help your heart return to a normal rhythm )
Post-resuscitation Care
Early coronary angiography (PCI)
Early hemodynamic stabilization
Electrophysiologic assessment/treatment before discharge
Therapeutic hypothermia
(for those who doesn’t wake up post arrest, comatose patients)
Therapeutic hypothermia
a) this is all about protecting where?
b) Keep temp to?
C) Rapid cooling within?
a) Their brain
Make everything slow down so allow the brain to be reperfused
b) 32-34
c) 4-6hrs
Therapeutic hypothermia
During care
Mechanical ventilation: SaO2 94-96%
Temp keep 32°-34° C
Hemodynamic monitoring
ECG
lab
Infection prevention
Control shivering
Therapeutic hypothermia
Rewarm slowly why?
0.25°-0.5° C per hour
Prevents sudden vasodilation
Hypotension & shock
Stop K+ replacement several hours before the start of rewarming
