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NUR 406 > Acute coronary syndrome > Flashcards

Acute coronary syndrome Flashcards

1
Q

what are the three conditions of ACS?

A

Unstable angina
NSTEMI
STEMI

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2
Q

what is caused by supply ischemia and leads to vasospasm?

A

printzmetals variant angina

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3
Q

unstable angina

A

New or changing chest pain caused by ischemia

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4
Q

Variant/vasospastic angina

A

prinzmetal angina

Caused by coronary artery spasm and endothelial dysfunction

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5
Q

when does variant angina occur?

A

Onset, timing is rest with minimal exertion may be at night

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6
Q

does ST segment elevation with variant angina?

A

Yes

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7
Q

treatment for variant angina

A

Nitrates to relax spasms

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8
Q

unstable plaques

A

Large, lipid core, thin cap
Active inflammation
Proliferation into intima of smooth muscle cells

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9
Q

t/f a small core with a thick cap is a more unstable plaque

A

False

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10
Q

can an infarction occur with a partial occlusion, or a dissolved thrombus?

A

No

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11
Q

ECG changes with unstable angina

A

Ischemic changes typically transient

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12
Q

do cardiac enzymes elevate with unstable angina?

A

No

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13
Q

theories of plaque rupture

A

increased SNS activity
Platelet aggregation
Thrombus formation

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14
Q

increased SNS activity

A

Increased BP, HR, force of contraction
Increased force of coronary artery blood flow
Increased force against injured endothelium

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15
Q

platelet aggregation

A

Platelets in here to ruptured plaque
Release substances that attract more platelets
Contribute to vasospasm

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16
Q

ACS

A

More severe chest pain last longer
No relief from nitrates
more symptoms - accompanying
Sense of impending doom

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17
Q

s/sx ACS

A

Chest pain, SOA
Discomfort in arms, back, neck, jaw, shoulders
diaphoresis, N/V

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18
Q

What are atypical symptoms with women?

A

heartburn
Sudden dizziness

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19
Q

s/sx MI

A

diaphoresis
Dyspnea
Extreme anxiety
Levine sign
Pale
Crushing chest pain
Weak peripheral pulses

20
Q

Acute MI

A

Ruptured plaque plus thrombus

Blood flow disrupted, prolonged or total disruption

21
Q

when do troponins levels increase with acute MI

A

With infarction, trends up

22
Q

is an acute MI reversible?

A

prolonged ischemia with no recovery
Myocardial cells suffer, irreversible, ischemic, necrosis

23
Q

Infarction

A

Tissue death

24
Q

ischemia

A

Hearts blood supply doesn’t Meet bodies demands

25
Q

transition from ischemia to infarction

A

ATP not able to be stored

Irreversible injury within 30 min-4hours

Tissue necrosis by four hours

Necrotic tissue cleared away by one to two weeks

Tough fibrous scar tissue replaces necrotic tissue by six weeks

26
Q

infarction

A

MI, DEAD CELLS
Can’t recover
Try to stop progression

27
Q

Injury

A

some recovery possible
Can still perfuse and restore to become viable

28
Q

t/f the injury, phase of damage has dead cells

A

False

29
Q

when is a full recovery possible?

A

Ischemia

30
Q

what does the extent of an MI depend on

A

Location of occlusion
Length of time of occlusion
Hearts, availability of collateral circulation

31
Q

STEMI

A

elevated ST
Wide, QRS
Peaked T waves then inverted
Elevated troponins
Larger infarct
Poor outcomes

32
Q

NSTEMI

A

depression/normal ST
Normal QRS
Inverted T-wave
Elevated troponins
Smaller infarct
Better outcomes

33
Q

which artery supplies the left ventricle with oxygenated blood

A

Left anterior descending artery

34
Q

which artery supplies the left anterior descending artery and left circumflex

A

Left main artery

35
Q

what occurs with a blockage at the beginning of the left anterior descending artery

A

Widowmaker

36
Q

acute MI pharm

A

oxygen
Aspirin
Morphine
Beta blockers
Nitrates

37
Q

oxygen

A

Increases oxygen to ischemic myocardium

38
Q

aspirin

A

Suppresses platelet aggregation
** Chew

39
Q

Morphine

A

decreases pain
Decreases pre-and afterload
Helps preserve tissue

40
Q

Beta blockers

A

selective Beta one
decreases HR, contractility
decreases, oxygen demand
Decreases infarct size

41
Q

Nitrates

A

decrees pre-and after load
Decreases infarct size

42
Q

t/f nitrates affect, mortality rate with a cute MI

A

False

43
Q

myocardial stunning

A

Rapid restoration of blood flow to myocardium contributes to reperfusion injury

44
Q

Reperfusion injury

A

Oxidized, free radicals generated by wbc’s

Cellular response – restore blood flow

45
Q

what type of dysrhythmias can occur from reperfusion?

A

Ventricular tachycardia
Ventricular fibrillation

NUR 406 (19 decks)

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