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NUR 406 > Acute Coronary Syndrome > Flashcards

Acute Coronary Syndrome Flashcards

1
Q

what is acute coronary syndrome

A

umbrella term for when blood vessels supplying the heart are blocked

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2
Q

what are the two types of unstable angina

A

supple ischemia
printzmetals (vasospasms)
unstable angina (thrombus)

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3
Q

what is printzmetals angina

A

coronary artery vasospasm caused by supply ischemia
- dec blood flow
- inc risk of myocaridal ischemia

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4
Q

what is unstable angina (thrombus)

A

rupture of a plaque that causes clot formation in vessel that occludes it

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5
Q

what are the three “complications” of ACS

A

unstable angina
NSTEMI
STEMI

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6
Q

what is unstable angina

A

any new or change in chest pain caused by ischemia
- diagnosis first time as unstable until able to find out what is causing then can be stable

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7
Q

what is a NSTEMI

A

non ST elevation myocardial infarction

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8
Q

what is a STEMI

A

ST elevation myocardial infarction

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9
Q

what is the cause of vasospasm angina

A

damaged endothelial of coronary vessel
spasms cause narrowing of artery

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10
Q

what are the characteristics of vasospasm angina

A

CAD may or may not be present
timing could be at rest, minimal exertion, night
elevated ST segment

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11
Q

what is the treatment of vasospasm angina

A

nitrate to relax the spasms

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12
Q

what is an unstable plaque

A

large lipid core with thin cap
active inflammation (ongoing)
proliferation into intima (middle lining of the blood vessel, inc risk of plaque rupture)

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13
Q

what determines if it is unstable angina

A
  • chest pain for the first time
  • chest pain more severe than usual and in new regions
    both are myocardial ischemia
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14
Q

what is the concern with unstable angina

A

ruptured plaque and thrombus
no infarction bc the occlusion is partial or thrombus dissolves
might see ischemic changes on ECG
no elevation of cardiac enzymes

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15
Q

what is the theory of plaque rupture

A

inc SNS activity inc BP, HR, force of contraction –> inc coronary artery blood flow and force against the damaged endothelium –> plaque ruptures –> platelets adhere to ruptured plaque and release of more substances to attract more plaques and vasospasm –> thrombus formation

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16
Q

how do we distinguish between ACS and stable angina

A

stable angina is short duration
relieved with nitrates
pain levels out
other symptoms like NV, diaphoresis

17
Q

what are the s/s of myocardial infarction

A

diaphoresis
dyspnea
extreme anxiety
levine’s sign (fist to chest)
pallor
retrosternal crushing chest pain that radiates to shoulder, arm, jaw, back
weak pulses

18
Q

what is an acute MI

A

rupture plaque and thrombus that disrupts blood flow for a prolonged period of time or totally occulded

19
Q

what lab verifies a MI

A

elevated troponin

20
Q

what is an acute MI

A

prolonged ischemia without recovery
- myocardial cells suffer irreversible ischemic necrosis
- ECGs will define STEMI, NSTEMI

21
Q

what is from ischemia to infarction

A

dec in O2 causes a dec in ATP which leads to irreversible injury –> tissue necrosis –> necrotic tissue is cleared away but myocardium weak and susceptible to rupture –> tough fibrous tissue dec conduction

22
Q

what are the zones of damage of MI

A

infarction: dead, not savable
injury: some recovery possible if we can get O2 there fast enough
ischemia: full recovery possible once blood flow reestablish

23
Q

what is the goal during re perfusion of the heart

A

get the O2 back ASAP to decrease the workload of the heart

24
Q

what are the three factors that influence an acute MI

A

location of level of occlusion
length of time its been occluded
hearts availability of collateral circulation

25
Q

STEMI characteristics

A

ST segment is elevated
QRS is pathologic (wide) and develops over hours
T wave is peaked, then inverted
troponin elevated
size of infarct large
outcomes poor

26
Q

NSTEMI

A

ST segment depression or normal
QRS normal
T wave inverted
troponin elevated
size of infarct smaller
outcomes better

27
Q

what is most important coronary artery

A

left descending artery

28
Q

what is the widowmaker

A

occlusion of the left main

29
Q

what does tomb stoning mean

A

showing areas of the heart are ischemic

30
Q

what is the initial treatment for MI

A

oxygen

31
Q

what are other drugs used to initally treat MI

A

morphine
nitros
asa
beta blockers
thrombolytic agents

32
Q

what is alteplase class

A

fibroinolytic therapy

33
Q

what is the moa of alteplase

A

dissolves clot by converting plasminogen into plasmin

34
Q

what is the main adverse effect of alteplase

A

bleeding

35
Q

what is the nursing consideration for alteplase

A

works best with 30-70 mins of MI
always given with heparin and anti platelet therapy

36
Q

what are the side effects of nitroglycerin

A

hypotension
headache
flushing

37
Q

what is the nursing consideration for nitros

A

dont give with sildenafil –> risk for hypotension

38
Q

what are the interventions for reperfusion

A

angioplasty and atherectomy
angioplasty and stent placement
CABG

39
Q

what is the problem with re perfusion

A

myocardial stunning
- oxidized free radicals come to site of injury and can react with O2 blood when it gets back and cause dysrhythmias

NUR 406 (15 decks)

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