Acute Coronary Syndrome

Question 1

ACS encompasses the spectrum of - 3

Answer 1

Unstable angina
Development of NSTEMI
Development of STEMI

Question 2

Women’s symptoms of UA/MI

Answer 2

fatigue, shortness of breath, indigestion, anxiety

Question 3

Necrosis of entire thickness of myocardium takes

Answer 3

5–6 hours

Question 4

Myocardial Infarction symptoms

Answer 4

1) Pain
>heavy, constrictive, tightening

2) Sympathetic nervous system stimulation
>diaphoreses, vasoconstriction,
>ashen/clammy skin,
>glycogen release

3) Cardiovascular manifestations
>↑ HR and BP, then ↓ BP
>crackles, heart murmurs

4) Nausea and vomiting
5) Fever

Question 5

Total occlusion caused by

Answer 5

anaerobic metabolism and lactic acid accumulation

Question 6

MI Healing Process

Answer 6

• Within 24 hours, leukocytes infiltrate the area of cell death.
• Enzymes are released from the dead cardiac cells (important indicators of MI).
• Proteolytic enzymes of neutrophils and macrophages remove all necrotic tissue by second or third day
• Development of collateral circulation improves areas of poor perfusion.
• Necrotic zone is identifiable by ECG changes and nuclear scanning.
• 10–14 days after MI, scar tissue is still weak and vulnerable to stress.
• By 6 weeks after MI, scar tissue has replaced necrotic tissue.
• Ventricular remodelling

Question 7

MI Complications

Answer 7

1. Dysrhythmias
2. Heart Failure
3. Cardiogenic Shock
4. Papillary muscle dysfunction
5. Ventricular aneurysm
6. Acute pericarditis
7. Dressler Syndrome

Question 8

Diagnostic Studies: Acute Coronary Syndrome

Answer 8

• 12-lead ECG: changes in QRS complex, ST segment, and T wave can rule out or confirm UA or MI.
• Serum cardiac markers
• Coronary angiography

Question 9

Initial drug therapy after an MI includes

Answer 9

• IV nitroglycerin
• aspirin
• β-adrenergic blockers
• anticoagulation
 ACE inhibitors

Question 10

Planning: Overall goals for chest pain/ACS

Answer 10

Relief of pain
- nitroglycerin, morphine, oxygen
Preservation of myocardium
Immediate and appropriate treatment
Effective coping with illness-associated anxiety

Question 11

Acute interventions for anginal attack

Answer 11

Pain:

• nitroglycerin, morphine, oxygen
• raise head of bed to promote oxygen and refusion

Continuous monitoring

• 12-lead ECG
• VS, pulse oximetry
• Heart and lung sounds

Rest and comfort

• Balance rest and activity.
• Begin cardiac rehabilitation.
• You want to gradually increase the client’s workload

Emotional and behavioural reaction

• Maximize client’s social support systems.
• Consider open visitation.
• alleviation of stress and anxiety

Ambulatory and home care

• Client and caregiver teaching
• Physical exercise
• Resumption of sexual activity

Question 12

Coronary revascularization—CABG: ICU for first 24–36 hours

Answer 12

• Pulmonary artery catheter for measuring CO, other hemodynamic parameters
• Intra-arterial line for continuous BP monitoring
• Pleural/mediastinal chest tubes for chest drainage
• Continuous ECG monitoring to detect dysrhythmias (esp. atrial dysrhythmias)
• Endotracheal tube/mechanical ventilation
• Extubation within 12 hours
• Epicardial pacing wires for emergency pacing of the heart
• Urinary catheter to monitor urine output
• NG tube for gastric decompression

Care is focused on
• assessing the client for bleeding (e.g., chest tube drainage, incision sites).
• monitoring fluid status.
• replacing electrolytes PRN.
• restoring temperature (e.g., warming blankets).