Acute Coronary syndromes Flashcards
What is coronary artery disease?
an umbrella term that includes angina and acute coronary syndrome
Ischemia
insufficient oxygen is supplied to meet requirements
Infarction
necrosis when ischemia is prolonged causing decreased perfusion and irreversible damage
what is the difference between stable and unstable angina?
stable is predictable and occurs with exertion
unstable is new onset, poorly relieved by NTG
What is angina pectoris?
chest pain caused by temporary imbalance of oxygen supply and the demand for oxygen
What is Chronic stable angina?
chest discomfort that occurs with moderate to prolonged exertion due to FIXED atherosclerotic plaque
Typical 3 features of chronic stable angina
substernal chest pain or heaviness
precipitated by stress
relieved by rest or NTG
What is a diagnostic indicator for stable angina?
cardiac biomarkers like troponin are not elevated
what is the usual dosage for plavix?
75 mg/day
What is acute coronary syndrome?
used to describe patients with unstable angina or acute MI
Vasospastic angina
chest pain from coronary artery spasm and occurs at rest
Myocardial infarction
myocardial tissue is deprived of oxygen
what are the 2 types of MIs?
Non ST segment elevation (NSTEMI)
ST elevation (STEMI)
How does an NSTEMI present on an EKG?
ST segment depression and T inversion
How does a STEMI present on a EKG?
ST segment elevation
What are the cardiac biomarkers?
Troponin T
Troponin I
CK-MB
Myoglobin
Characteristics of Unstable angina
pressure lasting longer than 15 min
poorly relieved by NTG
severe activity limitation
increase in number of attacks
What does the T-wave inversion represent for NSTEMI?
some ischemia
What does the ST elevation represent for STEMI?
zone of injury
What happens over a 2-3 month period after an infarction?
ventricular remodeling
What is the problem with ventricular remodeling?
scar tissue decreases left ventricular function
causes HF
does not contract or conduct electrically
What is the immediate tx for a patient presenting with MI symptoms?
Morphine
Oxygen (NC)
Nitroglycerin
Aspirin 324-650mg
Dosage for sublingual NTG
0.4 mg 5 min up to 3 doses for stable angina
multiple doses titrated for NSTEMI
Nursing management for ACS
Managing acute pain
increase perfusion
identify and manage dysrhythmias
monitor and manage heart failure
what are some diagnostic procedures to rule out cardiac etiology?
stress test
imaging
angiogram
What is a coronoary angiogram?
catheter is snaked through femoral artery and contrast is injected to visualize blockages
What is an angioplasty?
a balloon is used to stretch the vessels of the wall and put in a stent
what are some things to take into consideration for an angiogram?
allergies
bleedings
pulses
creatinine
What is a CABG?
coronary artery bypass graph
disease in multiple areas
harvest veins from body and create bypass graphs
what are examples of percutaneous therapies?
angiogram and angioplasty
what are some complications of CABG?
bleeding
cardiac tamponade
change in LOC
hypo or hypertension
What do you assess after a CABG?
distal pulses
what medication can interact with nitroglycerin?
Viagra
Why would we do a transesophageal echo? (TEE)
to get a clearer view
to look for clots or vegetation
what is the pre procedure for cath lab?
vital signs
auscultate lungs
assess pulses
allergy hx
make sure signed consent is done
analyze labs
withhold anticoagulants or diuretics
potential complications for cath lab
tamponade
hematoma
retroperitoneal bleeding
post cath nursing interventions
assess VS every 15 min
keep leg straight for 2-6 hrs
assess site
what is cardiogenic shock?
heart can’t pump enough to meet demands
s/s of cardiogenic shock
tachycardia
hypotension
cold clammy skin
tachypnea
