Angina/MI Flashcards
Imaging tests to diagnose AMI
• Electrocardiogram – AMI changes • T-wave inversion • ST-segment elevation • Formation of Q wave • Echocardiogram • Radionuclide imaging • Hemodynamic monitoring
Clinical manifestations of acute myocardial infarction
• Continuous chest pain • Onset sudden • Manifestations include: – Nausea – Hypotension – Vomiting – Bradycardia
Pharmacological tx of angina
– Nitrates
• Sublingual nitroglycerin
• Longer-acting nitrate preparations oral tablets, ointment, or transdermal patches
– Beta-blockers propranolol (Inderal), metoprolol (Lopressor), nadolol, and atenolol
• Stable angina
• Contraindicated in asthma, and severe COPD- may cause severe bronchospasm
– Calcium channel blockers verapamil, diltiazem, and nifedipine
• Long-term prophylaxis
• Caution with dysrhythmias, heart failure, and hypotension
-Aspirin
Cardiac markers during diagnostic testing for MI
-Creatine kinase (levels are increased from damage)
– CK-MB (greater than 5% indicates MI)
– Troponins (only is present from necrosis of myocardial tissue)
– Myoglobin (one of the first cardiac markers to be detectable in the blood after an MI, because it is released within a few hours after symptom onset)
– CBC (MI will show elevated WBCs resulting from inflammation of the injured myocardium. The ESR will also be elevated because of inflammation)
– ABGs (oxygen and acid-base balance)
Pharmacological tx of myocardial infarction
-analgesics Sublingual nitro, morphine sulfate (gold standard for MI), IV nitro, Valium -fibrinolytics -anti dysrhythmias -other meds
What is stable angina
- occurs during heart working hard during physical exercise
- does not come as surprise
- usually last 5 minutes or less
- relieved with rest and meds
- may feel like gas/indigestion
- radiates to arm, neck, shoulder, jaw
Clinical therapy for MI
- Intensive coronary care unit first 24–48 hours
- Bed rest first 12 hours with bedside commode
- Oxygen 2–5 L/min nasal cannula
- Liquid diet, progress to low fat/cholesterol/sodium
- Limit caffeine, hot foods, cold foods
Pharmacological tx for cholesterol
-decrease LDL less than 130mg/dL
-Statins- lovastatin (mevacor), pravastatin (pravachol), simvastatin (Zocor)
• Nicotinic acid
• Bile acid sequestrants
• Fibrates – Aspirin – ACE inhibitors – Angiotensin Receptor Blockers
Clinical manifestations of acute coronary syndrome
- substernal or epigastric chest pain
- radiates from neck, left shoulder, left arm.
Pathophysiology of acute coronary syndrome
• Coronary blood flow reduced (partial blockage of the artery) • Precipitating events – Rupture or erosion of atherosclerotic plaque – Coronary artery spasm – Progressive vessel obstruction – Inflammation of coronary artery – Increased myocardial oxygen demand – Decreased oxygen supply
Pathophysiology of ischemia
• Oxygen supply inadequate • Critical factors for metabolic needs – Coronary perfusion – Myocardial workload • Categories of angina – Stable – Unstable – Variant
NSTEMI
Partial thickness blockage. ACS usually.
Complications of MI
• Complications
– Dysrhythmias (abnormal heart beats)
– Pump failure (left side not pumping correctly)
– Cardiogenic shock (result of pump failure, 40% loss of heart mass)
– Infarct extension
– Structural defects (scar tissue buildup from necrosis)
– Pericarditis (infxn)
– Dressler Syndrome (autoimmune dx)
Pathophysiology of myocardial infarction
- Full on blockage of the artery causing ischemia to heart muscle
- blood flow to muscle is blocked in artery
- damage to the heart
Risk factors for myocardial infarction
Nonmodifiable – Age – Gender – Family history of CAD – Race • Modifiable – Hypertension – Diabetes mellitus – Hyperlipidemia • Classification of serum cholesterol, triglycerides – Cigarette smoking – Obesity, diet – Physical inactivity
