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Acute Health Challenges > Angina & MI > Flashcards

Angina & MI Flashcards

1
Q

damage to endothelium

A

1) damage occurs
2) monocyte and platelet macrophage gather at injury site
3) fatty streak is created from lipid proteins
4) fibrous plaque cap created and eventually breaks off from BP forming a clot
5) complicated lesion

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2
Q

coronary arteries

A
  • RCA feeds heart and responsible for electrical conduction
  • LCA feeds heart and responsible for contraction
  • circumflex is a branch of LCA
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3
Q

collateral circulation

A
  • when blockage occurs, body develops alternate pathways
  • younger people have less because less time to develop
  • smokers have more
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4
Q

angiogenesis

A

creation of new arteries that act as pathway around a block

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5
Q

factors affecting myocardial function

A
  • balance between O2 supply and demand
  • decreased O2 from low Hgb or respiratory illness
  • increased O2 demand from exercise, stress, fever, heavy meals, anxiety, stimulants, HTN, hyperthyroidism, and tachycardia
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6
Q

ischemia

A
  • decreased BF causing pain (angina)

- can be reversed

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7
Q

heart cell injury

A
  • cellular death (MI)

- cannot be reversed

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8
Q

angina

A
  • chest discomfort from temporary imbalance between supply and demand of myocardial blood
  • distal cells are starving for O2
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9
Q

what causes anginal pain

A
  • lactic acid irritates nerve endings in heart
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10
Q

angina pathway

A

decreased O2 —> ishcemia —> anaerobic metabolism —> lactic acid —> nerve stimulation —> angina

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11
Q

types of angina

A
  • stable
  • unstable
  • varina/Prinzmetal
  • nocturnal
  • decubitus
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12
Q

stable angina

A
  • predictable, similar pattern
  • similar onset, duration, and intensity
  • relieved by rest/nitro
  • short lived (5-15 mins)
  • provoked by exertion
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13
Q

unstable angina

A
  • less predictable
  • increase in onset, duration, or intensity
  • not received by rest
  • stubborn to nitro
  • easily provoked/@ rest
  • increased plaque buildup
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14
Q

variant/Prinzmetals angina

A
  • coronary vasospasm
  • occurs @ rest
  • from cocaine, stimulants, smoking, increased Ca, histamines
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15
Q

nocturnal angina

A
  • occurs only at night

- not necessarily when lying or sleeping

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16
Q

decubitus angina

A
  • occurs when lying down

- relieved by sitting or standing

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17
Q

factors to determine difference between angina and MI

A
  • precipitating factors
  • cellular level
  • S&S
  • timing
  • treatment
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18
Q

precipitating factors of angina

A
  • 4 E’s: eating, exercise/exertion, strong emotions, exposure to cold
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19
Q

signs and symptoms of angina

A
  • ache/pressure
  • rarely sharp/stabbing
  • constrictive feeling
  • indigestion
  • burning
  • heaviness
  • relieved by rest/nirto
  • not always named “pain”
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20
Q

prodromal symptoms

A
  • vague symptoms of angina/MI

- occurs more often in women causing them to wait longer to go to ER

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21
Q

what is an MI

A
  • angina that has lasted >20 mins
  • 20 mins = infarction territory = cells death
  • cells die on inside first then through myocardium (transmural)
  • 5-6 hrs to go through entire thickness
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22
Q

transmural MI

A
  • cell death through entire thickness of heart wall
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23
Q

signs and symptoms of an MI

A
  • more severe pain
  • crushing feeling
  • ashen (grey)
  • clammy
  • cool to touch as all blood diverted to heart
  • BP increases then decreases
  • N&V
  • anxiety
  • fever within 24hrs up to 1wk
  • > 20 min pain not relieved by rest/nitro
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24
Q

why do you develop a fever with MI

A

necrotic cells produce systemic inflammation

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25
Q

silent MI

A
  • often with DM
  • peripheral neuropathies so they don’t feel the pain
  • end up with CHF
26
Q

types of MI

A
  • to determine where damage is
  • inferior
  • anterior
  • lateral
27
Q

inferior MI

A
  • RCA occluded (SA and AV nodes)

- worried about arrhythmias

28
Q

anterior MI

A
  • LCA occluded (contraction)

- cariogenic shock, decreased CO and BP

29
Q

lateral MI

A
  • circumflex occluded (branch of LCA)
30
Q

to determine angina or MI

A
  • ECG ST elevation yes or no
  • cardiac markers yes or no
  • if no = angina
  • if yes = MI
  • ST elevation = STEMI (can be Q wave or non Q wave)
  • no ST elevation = NSTEMI (can be Q wave or non Q wave)
31
Q

STEMI

A

full blockage and transmural

32
Q

NSTEMI

A

partial blockage and non-transmural

33
Q

cardiac markers for MI

A
  • troponin (TnT)
  • creatine kinase MB (CK-MB)
  • lactate dehydrogenase (LDH)
  • aspartate transaminase (AST)
  • CRP
34
Q

troponin (TnT)

A
  • cTnT or cTn1
  • > 14ng/L = +
  • most sensitive marker
  • highly sensitive released with MI
  • cells die and burst open releasing enzyme detectable in 1hr
  • increase in blood 3hrs following event
  • back to normal in 5-14 days
35
Q

what condition can have chronically high troponin

A

CHF

36
Q

creatine kinase MB

A
  • need lab to fraction CK
  • MB specific to heart muscle
  • higher # = more extensive damage
  • cells release enzyme when they die
  • repeated enzymes and symptoms determine MI timeframe
  • increased in 12hrs and decreased in 2 days
37
Q

CK-MM

A

specific to skeletal muscle

38
Q

CK-BB

A

specific to brain

39
Q

CRP

A
  • general inflammatory marker

- need more info for heart as not specific

40
Q

lactate dehydrogenase (LDH)

A
  • increased and peak at 3 days then gradually decrease
41
Q

aspartate transaminase (AST)

A
  • increase and peak at 48 hrs

- back to normal 4 days

42
Q

pain locations for angina and MI

A
  • upper chest
  • neck & jaw
  • substernal
  • left arm or both arms
  • epigastric
  • left shoulder
  • intrascapular (women)
43
Q

exercise/stress test

A
  • BP cuff and ECG
  • assess symptoms with activity
  • looking for ST depression, BP spikes, and SOB
  • cant have anything beforehand to help/hinder (cardiac meds, smoking)
44
Q

echocardiogram

A
  • measures thickness of myocardium and valves

- can see direction of BF and valve issues

45
Q

nuclear cardiology

A
  • MUGA scan
  • MIBI test
  • modified MIBI test
46
Q

MUGA scan

A
  • info on wall motion
  • mix blood with radioactive tracer
  • healthy cells absorb tracer and light up
  • dead cells do not absorb and are dark
47
Q

MIBI test

A
  • nuclear stress test
  • look at coronary BF changes with stress
  • one with exercise and one without
48
Q

modified MIBI test

A
  • for pts who cant exercise

- meds given to mimic exercise

49
Q

treating angina with nitro

A
  • max 3 doses - pain should decrease with each dose
  • decreases BP
  • need to check BP before admin —> hold if systolic <90
  • vitals Q5mins
  • if still pain after 3 doses or need to hold then give morphine or fentanyl
50
Q

forms of nitro

A
  • IV
  • spray
  • patch
  • paste
51
Q

pain med admin for angina

A
  • morphine or fentanyl only as they provide vasodilation without lowering BP
  • IV push for fast onset, may need to call MD
  • morphine = 1-3mg IV push q5mins max 30mg/hr
  • fentanyl = 10-20mcg IV push q5mins max 300mcg/hr
52
Q

pt rings complaining of heartburn/chest pain

A
  • treat as cardiac until known otherwise
    1) lay them down with head slightly elevated (semi fowlers)
    2) assess —> PQRST, palpate area, vital, order stat ECG (before nitro so it won’t affect results)
    3) vitals q5mins —> determine if give/hold nitro
    4) repeat ECG q20mins
53
Q

nitrates

A
  • nitroglycerine, isodril
  • potent vasodilator for veins and arteries
  • side effects —> headache, decrease BP, lightheadedness, peripheral edema
  • nursing care —> monitor BP and assess for associated BP symptoms
54
Q

nitro & viagra/cialis

A
  • dont give nitro within 24 hrs of viagra

- dont give nitro within 48 hrs of Cialis

55
Q

angina pharm interventions

A
  • antiplatelet
  • anticoagulant
  • short and long acting nitrate
  • beta blocker
  • Ca channel blocker
  • ACE inhibitor/ARB
  • statin therapy - to lower lipoproteins
56
Q

treating an MI

A
  • fibrinolytic therapy —> TNK = tenecteplase streptokinase
  • blasting clots to open coronary artery to prevent extensive MI/damage
  • rapid admin - give IV
  • admin within 30 mins of symptom onset (door-to-drug at DECH 30 mins)
  • greatest benefit within 6hr but still benefit up to 12 hrs
  • bleeding is expected
57
Q

bleeding with TNK

A
  • pt hx important
  • increases bleeding risk
  • contraindicated if at risk for internal bleeding
  • weight risks & benefits
  • minor bleeds expected - gums, IV, wound
  • hemorrhage signs - increased HR, decreased BP
58
Q

common meds post MI

A
  • aspirin/antiplatelet/anticoagulant
  • short & long acting nitro
  • beta blocker (metoprolol)
  • Ca channel blockes
  • ACE inhibitors
  • anti anxiety
  • stool softener - dont want straining
59
Q

post MI complications

A
  • re-infarction —> 2nd or extension; 2-3 days unstable plaque; most vulnerable up to 2 wks
  • dysrhythmias
  • cariogenic shock
  • HF —> LV damage cant contract to push blood out = blood backs up = HF
  • valve dysfunction
  • ventricular aneurysm —> weakened heart can balloon out, will collect blood and clot; rupture = lethal
  • pericarditis —> hearts fibrous sac inflamed, compressed heart and doesn’t allow to fill/compress fully
60
Q

most common post MI complication

A
  • dysrhythmias

- 80%

61
Q

process of the healing heart

A
  • 2-3 days = inflammatory response; muscle wall very thin
  • 4-10 days = collagen matrix laid down for scar tissue
  • 10-14 days = weak scar tissue; myocardium very vulnerable
  • 6wks = scar tissue has replaced necrotic tissue
62
Q

cardiac rehab

A
  • exercise and education

- decreases risk for another MI by 25%

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