ACUTE CORONARY SYNDROME Flashcards
Coronary artery disease is that in which ________ builds up inside the coronary arteries and restricts the flow of blood (and therefore _____________ ) to the heart
atherosclerotic plaque
the delivery of oxygen
Coronary artery disease can lead to acute coronary syndrome (ACS), which describes any condition characterized by signs and symptoms of ________—a sudden ________________
sudden myocardial ischemia
reduction in blood flow to the heart.
Acute coronary syndrome
• The signs and symptoms of ACS constitute a continuum of intensity from ________ to _________ to ______.
unstable angina
non–STsegment elevation MI (NSTEMI)
ST- segment elevation MI (STEMI)
stable angina and myocardial infarction (MI) both come under the ACS umbrella.
T/F
F
Unstable angina**
Unstable angina and NSTEMI normally result from a _________________________, whereas STEMI results from a _________________________,
partially or intermittently occluded coronary artery
fully occluded coronary artery.
ACS begins when a ______ —————— in a coronary artery stimulates _______ and _________ .
It’s the _______ occluding the vessel that prevents myocardial perfusion
disrupted
atherosclerotic plaque
platelet aggregation and thrombus formation
thrombus
Most cases of infarction are due to the formation of ____________ on the surface of the plaque.
an occluding thrombus
Infarction pathogenesis
Reduced blood supply causes less _____ production, leading to failure of the ______ and _____ and an accumulation of _____ and _____ , resulting in (acidosis or alkalosis?) .
At this point, __________—will occur unless interventions are begun that limit or reverse the ischemia and injury.
ATP
sodium– potassium and calcium pumps
hydrogen ions and lactate; acidosis
infarction— cell death
During the ischemic phase, cells exhibit __________________ metabolism. If myocardial perfusion continues to decrease, ____ metabolism ______ and eventually _______ metabolism will be significantly _______. This period is known as the _____ phase. If perfusion is not restored within about ______], myocardial ______ results and the damage is _______.
both aerobic and anaerobic
aerobic ; ceases
anaerobic; reduced
injury; 20 minutes
necrosis; irreversible
Impaired _______ , is the result of scar tissue replacing healthy tissue in the damaged area, decreases cardiac output, limiting perfusion to vital organs and peripheral tissue and ultimately contributing to signs and symptoms of _____.
myocardial contractility
shock
Clinical manifestations of ACS include changes in level of ______; _____ ;________ skin; ___tension; _____cardia; and ___eased urine output.
consciousness
cyanosis; cool, clammy
hypo; tachy; decr
SIGNS AND SYMPTOMS
•______ or ______ , continues to be recognized as the classic symptom of ACS.
Angina, or chest pain
In unstable angina, chest pain normally occurs either at ____ or with _____ and results in limited activity.
Chest pain associated with NSTEMI is normally (shorter or longer?) in duration and (less or more?) severe than chest pain associated with unstable angina.
In both conditions, the ______ and ____ can increase if not resolved with ____,_______, or both and may last longer than ________
rest; exertion
Longer; more
frequency and intensity of pain
rest, nitroglycerin
15 minutes.
SIGNS AND SYMPTOMS
• Pain may occur with or without radiation to the ____,_____,____, or _____ area.
•In addition to angina, patients with ACS also present with ___,_______,———- .
•Changes in vital signs, such as _________,_____,_______,_______ , and decreased _________ or cardiac rhythm abnormalities may also be present.
arm, neck, back, or epigastric
shortness of breath, nausea, and lightheadedness
tachycardia, tachypnea, hypertension, or hypotension
oxygen saturation (SaO2)
DIAGNOSING ACS
• The utility of various biomarkers is determined by the _______ and ______ as well as by the extent of their _________
timing and duration of their elevation
cardiac specificity
_____________ are the preferred biomarkers for diagnosing acute MI
With reason
Cardiac troponins
because elevated levels correlate with a more accurate diagnosis, predict a high risk of future cardiac events.
Cardiac troponins
• Levels of troponins ___ and —- increase within ___________ of myocardial injury
I and T
four to six hours
Cardiac troponins :
•troponin I levels remain elevated for ___-_____ , and troponin T levels remain elevated for ____-____.
four to seven days
10 to 14 days
Normal reference ranges for cardiac biomarkers vary among laboratories; in order to diagnose myocardial necrosis a ______ troponin elevation greater than the ______ percentile of an agreed-upon reference control group is required.
Single
99th