acute coronary syndrome (exam 3, slide show 2) Flashcards
1
Q
what is acute coronary syndrome? (ACS)
A
- conditions which blood flow to the heart is blocked
-ex: myocardial infractions and unstable angina’s
2
Q
what are causes and risk factors of ACS?
A
- dyslipidemia
- smoking
- hypertension
- obesity
- physical inactivity
- male gender
- advanced age
- family history of heart disease
- race
3
Q
what is ACS caused by?
A
- narrowing of the coronary arteries, which blocks blood flow to the heart muscle resulting in (cell) death or damage
4
Q
what is acute coronary syndrome?
A
- when ischemia is prolonged and is not immediately reversible and can cuase otehr contions
5
Q
what other conditions can acute coronary syndrome cause?
A
- unstable angina (UA)
- non st segments elevation MI (NSTEMI)
- ST - segment elveation (STEMI_
6
Q
what is the etiology of acute coronary syndrome? ACS?
A
- deterioration of once stable plaque
- rupture
- platelet aggregation
- thrombus
7
Q
what is the result if partial occlusion of coronary artery?
A
- unstable angina (UA) or non stemi MI
8
Q
what is the result of a total occlusion of coronary artery?
A
- full stemi
9
Q
what are the clinical manifestations of unstable angina?
A
- change in usual pattern of chest pain (is more severe) & last longer than usual
- new in onset
- occurs at rest
- has a worsening pattern
- UA is unpredictable and represents a medical emergency
- as it causes cell death
10
Q
what is a MI?
A
- result of sustained ischemia (more than 20 min) causing irreversible cell death (necrosis)
- takes 4 5 hrs
11
Q
when a PT has an MI what determines the degree of damage?
A
- depends on the area of the heart involved and the size if the infract
- most MI’s involved left ventricle
- contractile function of the heart is disrupted in areas of myocardial necrosis
12
Q
what are the cardiovascular clinical manifestations of an MI
A
- initially, high HR and BP, then low BP (if enough cell death)
- crackles in the lung due to pulmonary edema
- jugular venous distension
- abnormal heart sounds
13
Q
what are the clinical manifestations of an MI that are due to the SNS?
A
- release of glycogen
- Diaphoresis = high HR and BP
- vasoconstriction of peripheral blood vessels
- skin will be ashen, clammy, cool to the touch
14
Q
how do we know its an MI?
A
- long pain in chest
- take EKG, is there SI elevation?
- take a lab
- there will be myoglobin and troponin in labs which means heart attack
- could mean they had an MI or are currently having an MI
15
Q
how to read an EKG in relation to ST elevations?
A
- ST elevation means a Stemi MI
- no ST elevation means no stemi
- is there biomarkers?
- yes? then non stemi MI
- no? then its an unstable angina bc its no ST elevation and no biomarkers
16
Q
what are the biomarkers in an MI?
A
- there will be myoglobin and troponin in labs which means heart attack
- CK - MB as well
17
Q
what is the MI healing process?
A
- in 24 hr leukocytes infiltrate the area of cell death
- enzymes are released from the dead cardiac cells
- Proteolytic enzymes of neutrophils and macrophages remove all necrotic tissue by second or third day
- development of collateral circulation improves areas of poor perfusion
- 10 to 14 days after MI, scar tissue is still weak and vulnerable to stress
- takes 6 weeks to heal
18
Q
what happens at 6 weeks post MI?
A
- scar tissue has replaced necrotic tissue
- area is “healed”
19
Q
what is ventricular remodeling?
A
- normal myocardium will hypertrophy and dilate in attempt to compensate for the infracted and damaged muscle after the MI
- cells get bigger to compensate, muscle grows, smaller ventricles, less blood getting out = another cardiac disease
20
Q
what is the biggest complications of MI?
A
- dysrhythmias
- most common complication (80 % of MI pt’s)
- most common cause of death in pre hospital period
- life threatening dysrhythmias seen with anterior MI, heart failure, or shock
21
Q
what are the other big complications of MI’s?
A
- heart failure
- cardiogenic shock
- papillary muscle dysfunction
- ventricular aneurysm
22
Q
what is heart failure?
A
- complication that occurs when the pumping power of the heart has diminished
23
Q
what is cardiogenic shock?
A
- occurs when inadequate O2 and nutrients are supplied to the tissue due to severe LV failure
- requires aggressive management
24
Q
what is papillary muscle dysfunction?
A
- causes mitral valve regurgitation
- condition aggravates an already compromised LV
25
what is a ventricular aneurysm?
- results when infracted myocardial wall becomes thinned and bulges out during contraction
26
what is the goal of treatment for ACS?
- decreased myocardial 02 demand
- increased 02 supply
- monitor and managing complications as they arise
27
what is mitral stenosis? and what can it lead to?
- blood can't flow from L atrium to L ventricle during diastole
- increased pressure of the left atrium leads to atrial chamber enlargement and hypertrophy
28
what can mitrial stenosis lead to?
- atrial chamber enlargement and hypertrophy bc increased pressure from the left atrium to atrial chamber
- can also lead to chronic pulmonary hypertension, right ventricular hypertrophy, and right sided heart failure
29
what are some clinical findings of mitral stenosis?
- murmurs
- dysrhythmias
- exertional dyspnea
30
what is mitral regurgitation? & what could happen
- blood back up to the left atrium during systole
- L atrium and ventricle dilate and hypertrophy d/t extra
volume
31
what can mitral regurgitation lead to?
- left sided heart failure
32
what are the clincial manifestations of mitral regurgitation?
- murmurs
- dysrhythmias
- chronic weakness/fatigue
33
34
what are the clinical manifestations of mitral valve prolapse?
- murmurs
- dysrhythmias
- fatigue
35
what is aortic stenosis?
- can't pump blood out of the left ventricle during systole
- left ventricle hypertrophy as a result may lead to ischemia and left sided heart failure
36
what is the predominate cause of aortic stenosis?
- age-related calcium deposits on
the aortic cusps
37
what is aortic regurgitation?
- blood backs up into left ventricle during diastole bc the value wont close
38
what is the cause of aortic regurgitation?
- abnormal aortic valve or aortic root dilation
39
what can aortic regurgitation lead to?
- left ventricle hypertrophy and dilation with eventual left sided heart failure
40
what are the clinical manifestations of aortic regurgitation?
- murmurs
- changes in BP
41
what are the signs and symptoms of rhematic fever?
- fever
- painful and tender joints
- red, hot or swollen joints
- small, painless bumps beneath the skin
- chest pain (!)
- heart murmur (!)
- fatigue
- unusual behavior
42
what are the complications of rheumatic fever?
- valve stenosis
- valve regurgitation
- damage to heart muscle
43
what is pericarditis?
- inflammation of the pericardium
- the sac like membrane covering the heart
44
what is an acute pericardial tamponade?
- sudden fluid accumulation
- pericardium can't adjust (big increase in pressure)
45
what are the causes of pericardial tamponade?
- chest trauma
- ruptured aorta
- ruptured of ventricle after a heart attack
