Acute Coronary Syndrome Flashcards
what is acute coronary syndrome
umbrella term for when blood vessels supplying the heart are blocked
what are the two types of unstable angina
supple ischemia
printzmetals (vasospasms)
unstable angina (thrombus)
what is printzmetals angina
coronary artery vasospasm caused by supply ischemia
- dec blood flow
- inc risk of myocaridal ischemia
what is unstable angina (thrombus)
rupture of a plaque that causes clot formation in vessel that occludes it
what are the three “complications” of ACS
unstable angina
NSTEMI
STEMI
what is unstable angina
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
what is a NSTEMI
non ST elevation myocardial infarction
what is a STEMI
ST elevation myocardial infarction
what is the cause of vasospasm angina
damaged endothelial of coronary vessel
spasms cause narrowing of artery
what are the characteristics of vasospasm angina
CAD may or may not be present
timing could be at rest, minimal exertion, night
elevated ST segment
what is the treatment of vasospasm angina
nitrate to relax the spasms
what is an unstable plaque
large lipid core with thin cap
active inflammation (ongoing)
proliferation into intima (middle lining of the blood vessel, inc risk of plaque rupture)
what determines if it is unstable angina
- chest pain for the first time
- chest pain more severe than usual and in new regions
both are myocardial ischemia
what is the concern with unstable angina
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
what is the theory of plaque rupture
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
how do we distinguish between ACS and stable angina
stable angina is short duration
relieved with nitrates
pain levels out
other symptoms like NV, diaphoresis
what are the s/s of myocardial infarction
diaphoresis
dyspnea
extreme anxiety
levine’s sign (fist to chest)
pallor
retrosternal crushing chest pain that radiates to shoulder, arm, jaw, back
weak pulses
what is an acute MI
rupture plaque and thrombus that disrupts blood flow for a prolonged period of time or totally occulded
what lab verifies a MI
elevated troponin
what is an acute MI
prolonged ischemia without recovery
- myocardial cells suffer irreversible ischemic necrosis
- ECGs will define STEMI, NSTEMI
what is from ischemia to infarction
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
what are the zones of damage of MI
infarction: dead, not savable
injury: some recovery possible if we can get O2 there fast enough
ischemia: full recovery possible once blood flow reestablish
what is the goal during re perfusion of the heart
get the O2 back ASAP to decrease the workload of the heart
what are the three factors that influence an acute MI
location of level of occlusion
length of time its been occluded
hearts availability of collateral circulation
