Acute Coronary Syndrome

Question 1

Unstable Angina

Answer 1

• Chest pain or discomfort tht occurs at rest or w/ exertion & causes severe activity limitation
• Pressure may last longer than 15mins
• Poorly relieved by rest or nitroglycerin
• May present w/ ST changes but don’t have changes in troponin or creatinine kinase (CK) lvls

Question 2

Myocardial Infarction

Answer 2

• When myocardial tissue is abruptly & severly deprived of oxygen
• When blood flow is quickly reduced by 80-90%, ischemia develops
• Ischemia can lead to injury and necrosis of myocardial tissue if blood flow is not restored
• Evolved over a period of several hrs
• Extent of infarction depends on collateral circulation, anaerobic metabolism, & workload demands
• Physical changes don’t occur in heart until 6hrs after infarction
• Once infarction occurs, scar tissue permanently changes size & shape of entire left ventricle; ventricle remodeling

Question 3

Key Features of Angina

Answer 3

• Substernal chest discomfort
  > radiating to left arm
  > precipitated by exertion or stress
  > relieved by nitroglycerin or rest
  > lasting less than 15 mins

Question 4

Key Features of MI

Answer 4

• Pain or discomfort
  > substernal chest pain/pressure radiating to elft arm
  > pain or discomfort in jaw, back, shoulder, or abdomen
  > occuring w/out cause, usually in morning
  > relieved only by opioids
  > lasting 30mins+

Question 5

Frequent Associated Symptoms of MI

Answer 5

• N/V
• Diaphoresis
• Dyspnea
• Feelings of fear or anxiety
• Dysrhythmias
• Fatigue
• Palpitations
• Epigastric distress
• Anxiety
• Dizziness
• Disorientation/acute confusion
• Feeling “SOB”

Question 6

Lab Assessment - Acute Coronary Syndromes

Answer 6

• Troponins (T & I): can be elevated w/in 3-4hrs & may remian elecated for 10-14days
• CK-MB: creatinine kinase MB