Acute Coronary Syndrome Flashcards
Myocardial Ischemia
Reduction or complete blockage of a coronary artery leading to decreased/no oxygen to the myocardium.
Risk Factors for Heart Disease
POD SHH
Physical Inactivity Obesity Diabetes Smoking High Cholesterol High Blood Pressure
Causes of Acute Coronary Syndrome
DAVINCI
D Deposits of plaque and Diabetes A Angina history – stable/unstable V Vasospasm I Increased cholesterol N Narcotic Use C CAD I Inflammation
S/S of Acute Coronary Syndrome
COLAPSED
C Chest Pain – radiation O Oxygen saturation decreased L Lethargic A Anxiety P Palpitations S Shortness of Breath E Elevated HR D Diaphoretic
Atypical Signs and Symptoms
Silent- SOB with not precipitating factors May or may not have chest pain If chest pain, may or may not radiate Arm weakness Back pain Vague weakness Indigestion or other GI complaints
Differential Diagnoses
What else could it be?
Pericarditis Thoracic aortic aneurysm Endocarditis Pericardial Effusion/Tamponade Pulmonary Emboli GERD/esophageal issues
Angina Stable vs Unstable
Stable - Chest pain with exertion that goes away with rest
Unstable – Chest pain that occurs at rest
Angina Classifications
1-4
4 is most severe
Class I – doesn’t occur with ordinary physical activity, rather with strenuous, rapid, or prolonged exertion
Class II- occurs with rapid or prolonged activity
Class III – significantly limits ordinary physical activities
Class IV – occurs with any level of exertion, primarily at rest
Diagnosis of MI
Serum cardiac markers *Troponin – gold standard *CK-MB (cardiac specific) EKG- 20% may be normal *STEMI vs NSTEMI Labs *CMP *Glucose *Cholesterol CXR
Ischemia
Cardiac Enzymes neg - angina
Prolonged ischemia leads to infarction
NSTEMI definition and characteristics
NSTEMI – artery is not fully occluded
Sub-endocardial infarction – not full thickness (3 layers of heart epicardium, myocardium, endocardium)
ST segment depression
Cardiac Enzymes present
STEMI definition and characteristics
STEMI – complete occlusion of the artery
NO blood supply to myocardium
Transmural infarction
Cardiac Enzymes Present
Can have damage to papillary muscles
New Left Bundle Branch Block
- *V1 =widened QRS with W shape
- *V6 =widened QRS with M shape
Treatment – Immediate MOAN
Morphine – treat the chest pain
Oxygen – the heart needs it
Aspirin (and clopidogrel) break up those platelets
Nitroglycerin – open those vessels, help the heart to rest
Other possible treatments
PTCI/A – Primary Percutaneous Coronary Intervention/Angioplasty
**Faster you can do it the better
Thrombolysis therapy
- *Alteplase
- *Reteplase
Other emergent meds to support BP, HTN, Dysrhythmias
Long term treatment ABAS
and
Risk factor modification
ACE Inhibitors – reduce BP and workload
Beta Blockers – BP and HR
ASA/Antiplatelet therapy
Statins – reduce cholesterol
