Acute Coronary Syndrome

Question 1

Coronary Artery Disease

Answer 1

Fatty Plaque Buildup
AKA:
-Coronary Heart Disease
-Atherosclerotic Heart Disease
-“Hardening of Arteries”

Coronary arteries supply blood to myocardium

Question 2

4 Primary Coronary Arteries

Answer 2

LMCA - Left Main Coronary Arteries
LAD - Left Anterior Descending
LCX - Left Circumflex
RCA - Right Coronary Arteries

Question 3

Risk Factor for CAD

Answer 3

Gender
Heredity/Genetics
Age
Obesity/Physical inactivity
Smoking
Hypertension
Blood cholesterol
Diabetes Mellitus
Chronic Kidney Disease (always look at the kideny in Heart conditions)

Question 4

Hyperlipidemia

Answer 4

Total Cholesterol level (sum of HDL, LDL, VLDL)
Level >200 investigate lipid panel
HDL- good
LDL- bad
VLDL-not routinely measured
Triglycerides

Question 5

Infarction

Answer 5

total blockage - no blood flow -> necrotic tissue

Question 6

Ischemia

Answer 6

lack of O2 -> can cause heart attack

Question 7

Angina

Answer 7

chest pain w/ ishemia: supply < demand ( does not cause cell deaths)

Question 8

Angina (chronic ischemic heart disease)

Stable

Answer 8

Predictable
ceases w/ activity restriction
lasts < 5 mins
responds to meds (nitro)
partial occlusion

Question 9

Angina (ACS) (MI)

Unstable

Answer 9

**unpredictable **
lasts >5min
unresponsive to meds
total occulsion

not a HA, No ST elevation
No cardiac enzyme elevation
No fibrinolystics used
Normal EKG, no Increase Troponin

Question 10

Angina (chronic ischemic heart disease)

Prinzmetal/ Variant

Answer 10

**not predictable **
Causes: coronary vasospasm
not r/t physical activity
Treat: Ca channel blockers

Question 11

Acute Coronary Syndrome

Answer 11

Cardiac event r/t ischemia or infarction

Question 12

ACS (MI)

STEMI

Answer 12

• Full occulsion
• Occulsive thrombus
• ST elevation
• Cardiac enzyme elevation
• Fibrinolytics = beneficial ( limit size of infarction)
• Entire thickness of cardiac muscle is necrotic/ infarcted

Fibrinolytics - give w/in 12 hr, do not give: bleed risk pt, recent surgery or trauma

Question 13

ACS (MI)

NSTEMI

Answer 13

• Partial occlusion
• Non occlusive thrombus
• No ST wave elevation, normal EKG
• Cardiac enzyme elevation
• No fibrinolytics
• Partial damage/ necrosis

Question 14

Myocardial Infarction

Answer 14

2 Major complications of MI
* dysrhythmias
* cardiogenic shock

**Clinical Presentation **
Tachy, PVCs, Brady, HypoTN, Tachypenic, dimined heart sounds, gallop (S3), increase cap fill, restlessmess, crackles, pulmonary edma, air hunger, othopnea, decrease CO/ UO, systemic murmur, confusion, anxiety

Question 15

Anything > 0 =

Answer 15

HEART ATTACK !!

Question 16

Troponin 1

Answer 16

inital increase: 3-6 hr
Duration: 3-5 days

Question 17

Troponin T

Answer 17

inital increase: 3-6 hr
Duration: 5-10 dys

Question 18

CK-MB

Answer 18

inital increase: 3-6 hr
Duration: 2-3 dys

Question 19

Myoglobin

Answer 19

Initial increase: w/in 1st hr
Duration: declines 1st day

Question 20

Early Management of ACS

Answer 20

O2, vitals, 12 lead EKG, ASA, IV access, Nitro, Morphine
1. ASA - chewable ASA/plavix -> prevents clots from growing
2. O2
3. Nitro - (ask about ED drugs) 0.4mg SL ( x3 max), BP > 100/60
4. Morphine - 5 mg IV

Beta Blockers - metoprolol PO/IV, ACE inhibitors- Lisinopril

M-morphine, O- O2, N- Nitro, A-Aspirin