Acute Coronary Syndrome Flashcards
What is the difference between unstable angina, NSTEMI, and STEMI?
Think about what is present and what is absent in each one.
Unstable angina: Main symptom is pain, no evidence of heart attack on EKG or cardiac biomarkers
NSTEMI: Heart attack with increased biomarkers but no evidence on EKG
STEMI: Heart attack with EKG evidence
What is the physiologic rationale for the necrosis that occurs with an MI?
A clot or plaque blocks a coronary artery, stopping blood flow to part of the heart muscle.
The heart muscle depends on oxygen to function; without it, cells can’t produce enough energy.
Without oxygen, heart muscle cells start to die because they can’t survive.
The longer the blockage lasts, the more cells die, leading to permanent heart damage.
Transmural infarct
Affects?
Occur when?
Most common
Affects the entire thickness of the heart muscle: innermost to outermost
Most commonly occur when there is obstruction of a single artery
Subendothelial infarct
Affects what part of heart muscle?
Occur more frequently when there is?
Affects only the inner layer of heart muscle
Occur more frequently when there is severely narrowed but still patent arteries
What are the differences between the zones of tissue damage? What could happen if treatment is delayed?
Necrotic zone?
Injured zone?
Ischemic zone?
Necrotic zone: zone of myocardial tissue that becomes necrotic because of an absolute lack of blood flow
Injured zone: A surrounding zone of injured cells, some of which will recover
Ischemic zone: An outer zone in which cells are ischemic and can be salvaged if blood flow can be reestablished quickly (within 20-40 min)
What are the implications when there is a delay in treatment?
The injured areas start to turn necrotic.
Explain cholesterol levels, including total, LDL, and HDL.
Total cholesterol <200
HDL >50 mg/dl
LDL <100 mg/dl
Define risk factors for developing an MI. What is your role as an RN concerning risk factors?
Modifiable? 6
Stress and Depression
BP levels
Physical activity
Elevated homocysteine level
Obesity: BMI >30, waist >40 men, >35 women
Tobacco use (2-6x greater chance. Tobacco decreases estrogen, estrogen is cardioprotective)
The cause of Myocardial Infaction / reduced blood flow is either
Reduced blood flow may also be a result of?
Narrowing of a coronary artery due to atherosclerosis
Complete occlusion of an artery due to embolus or thrombus
Shock and Hemmorage
Describe the clinical manifestations associated with an MI.
What occurs?
Pain is caused by?
Pain is
Discomfort is described as?
Chest pain that occurs suddenly and continues without relief,
pain is caused by ishemia.
Pain is heavy and may radiate to the shoulders and down the arms, usually the left arm
Tightness, burning sensation, pressure, or indigestion
Pain begins how and may radiate to?
How does pain differ with women who are experiencing an MI?
What do they complain of?
Begins spontaneously and may radiate to Jaw and neck
50% of women with an MI do not complain of chest pain.
Come with vague complaints such as SOB, N/V, back and jaw pain.
How does pain differ with older adults who are experiencing an MI?
What may occur?
May complain of?
25% experience?
Major manifestation is?
Jaw pain or fainting may occur
May complain of indigestion
25% of older adults only experience shortness of breath
confusion or disorientation due to decreased cardiac output
MI chest pain often accompanied by?
SPDDLN
Shortness of breath
Pallor
Diaphoresis
Dizziness
Lightheadedness,
Nausea and vomiting- vagal stimulation
Describe the ECG changes that are present with an MI.
What is sudden death?
can cause?
ST?
Q?
T?
Sudden death from STEMI is death that occurs within 1 hour of symptom onset
Can cause fatal arrythmias
ST elevation
Q wave prolongation
T wave inversion
What are the cardiac biomarkers? 2
Troponin – primary biomarker for myocardial infarction
Begin to rise within 3 hours and may remain 7-10 days.
Creatine-Kinase (MB)- rise within 4-8 hours and decline to normal limits in 2-3 days.
Troponin is found in myocardial cells, and now that cells are affected it is in the bloodstream.
What is the purpose of a cardiac stress test?
How do you explain this diagnostic test to a patient?
How well your heart functions
Put the person on treadmill, attach EKG leads, increase speed and incline slowly to make the heart work hard.
What is the purpose of a cardiac catheterization?
Uses dye to provide images of the coronary circulation
Identifies the location and severity of any blockages
Nursing Implications of Cardiac Cath
Patient will be?
After dye is injected?
Patient may?
Bedrest?
Keep extremity?
Assess?
Increase?
Patient will be fasting 4-8 hours before the procedure.
When the contrast dye is injected, the patient will feel a warm flushed sensation. This is normal and may last 10-15 seconds.
The patient may cough as the catheter enters the pulmonary artery.
Bedrest 4-8 hours after the procedure.
Keep the extremity extended and immobilized with sandbags to prevent bleeding.
Assess pulses, color, and sensation in both extremities and compare.
Increase fluid intake because the contrast dye has a diuretic effect
What is the rationale for oxygen therapy when a patient is experiencing an MI?
To increase the amount of oxygen delivered to the ischemic heart muscle
How will it be administered?
What are the implications for oxygen therapy if the patient has a chronic respiratory condition e.g., emphysema, chronic bronchitis, etc.?
Nasal Canula because it goes straight inside the body and because its less intimidating than the mask.
Be careful with the amount of oxygen if the patient has a history of COPD or other chronic respiratory conditions because their breathing is initiated by CO2.
Explain the rationale for nitroglycerin therapy when a patient is experiencing an MI.
What is the drug of choice?
When infusing IV?
When pain has subsided?
Causes vasodilation, helps increase blood flow, which helps increase o2, which helps with pain.
Intravenous Nitroglycerin is the drug of
choice.
When infusing IV, the BP and pain level should be assessed every 3-5 min
When pain has subsided, a topical or
SL nitrate may be prescribed.
What do Beta blockers cause for an MI?
When can u not give beta blockers?
Decrease in myocardial oxygen demand.
Decrease in cardiac contractility
Decrease in blood pressure and Pulse
They should not be given in STEMI caused by cocaine
Explain the rationale for anticoagulant and antiplatelet therapy when a patient is experiencing an MI.
Drug of choice?
What is a major side effect?
Aspirin is given for?
Heparin is the drug of choice
Heparin prolongs the clotting time of
the blood, decreasing the probability of
clot formation
Major side effect is bleeding
Aspirin is given for preventing platelet aggregation in people with ACS, effects last 8-10 days after stopping.
Explain the rationale for thrombolytic therapy when a patient is experiencing an MI.
What is a major side effect?
Dissolves any clots that may have formed in the coronary artery (clot busters)
To be effective, they must be given early after chest pain starts before tissue necrosis occurs
Bleeding!!!
Explain the rationale for the administration of morphine when a patient is experiencing an MI.
I gave THREE reasons morphine is given.
Relieves pain
Relaxes smooth muscle and decreases
circulating catecholamines.
This results in a decrease in the myocardial oxygen demand
Reduces anxiety
Causes RESPIRATORY DEPRESSION!!!!
Morphine affects cardiovascular and respitory system
Explain the purpose of percutaneous coronary intervention (stent).
How would explain this procedure to a patient.
What are two primary side effects that can occur from a PCI….the answer to this is basic nursing and it is not directly related to the procedure.
To open blocked arteries.
Non-surgical procedure that uses a
catheter to place a small stent that opens up narrow blood vessels in the heart that are blocked by plaque buildup, aka atherosclerosis
Explain the purpose of a coronary artery bypass graft (CABG)
Where is the ‘extra’ blood vessel obtained from?
Saphenous veins are used and placed in heart to increase blood flow.
It connected do valves together
Why should constipation be avoided?
Restric what?
Straining can stimulate the vagus nerve and cause hypotension and bradycardia
Restrict fulid in acute period
