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NUR 405 (Med Surg II) > CAD / ACS pt. 2 (Exam 1) > Flashcards

CAD / ACS pt. 2 (Exam 1) Flashcards

1
Q

Acute Coronary Syndrome is

A

Unstable angina

Acute myocardial infarction

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2
Q

Patient has chest pain and there are ECG changes =

A

STEMI

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3
Q

Patient has chest pain and there are no ECG changes but Troponin is elevated =

A

NSTEMI

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4
Q

Patient has chest pain and there are no ECG changes and Troponin is not elevated =

A

Unstable Angina

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5
Q

Difference between NSTEMI and Unstable Angina

A

Heart Damage with NSTEMI

No heart damage with Unstable Angina

we can tell this by looking at troponin levels

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6
Q

Unstable Angina Characteristics

A

Often occurs at rest - more than 20 min in duration

New onset that limits physical activity

More frequent, longer in duration and occurs with less exertion

Poorly relieved by rest or NTG

Has symptoms

IS AN EMERGENCY

No elevations in serum troponin

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7
Q

Why is unstable angina an emergency?

A

Because it precedes an MI

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8
Q

T/F: Serum troponin is elevated with unstable angina?

A

False (non cardiac damage)

Serum troponin is only elevated with NSTEMI

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9
Q

DM & Women anginal S/S

A

Fatigue (most prominent)

SOA

Indigestion

Anxiety

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10
Q

Angina (Stable) vs MI Pain (Unstable)

A

Anginal Pain
-Precipitated by exertion / stress
-Relieved by rest/NTG
-Lasting > 15 min

MI Pain
-Occurring without cause
-Often Early Morning (4-6 am) (corisol)
-Relieved only by opiods
-Lasting >20 min
-Symptoms

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11
Q

Unstable and MI pain is only relieved by

A

Opioids

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12
Q

Unstable angina pain associated symptoms

A

N/V

Diaphoresis

Dyspnea

Feelings of anxiety / fear

Dysrhythmias

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13
Q

Myocardial Infarction process takes time

A

(cells can stand ischemia x 20 min before cell death)

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14
Q

What part of the heart is affected earliest in a MI

How long does it take for the heart to necrose?

A

Subendocardium layer (inside layer)

Takes 4-6 hours for entire thickness of muscle to necrose

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15
Q

The location of the a MI correlates with

A

Involved coronary circulation

Damage takes place where the blockage is.

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16
Q

MI’s are described based on

A

Location of damage

(anterior - inferior - lateral - septal - posterior)

17
Q

What does MI pain feel like?

A

Chest pain not relieved by rest, position, change, or nitrates

Heaviness
Pressure
Tightness
Burning
Constriction
Crushing

PRESSURE (not pain)

18
Q

Do all MI have pain or pressure?

A

No patients can have silent MI’s

19
Q

Complications of MI

A

Dysrhythmias

Heart failure (reduce pumping)

Cardiogenic shock (loss of BP)

Papillary muscle dysfunction (murmur)

Pericarditis (Pericardial friction rub)

20
Q

Most common complication of MI

A

Dysrhythmias

-Most common cause of pre-hospital death

21
Q

If patient comes in with suspected MI they are put on ______ ASAP

22
Q

Complication of MI: Heart failure

A

Occurs because of muscle death resulting in reduced pumping action of the heart

23
Q

Complication of MI: Cardiogenic Shock

A

-Due to severe left ventricular failure

-Patient loose BP and goes into shock

-High mortality rate

24
Q

Complication of MI: Papillary Muscle Dysfunction

A

Consequence: New murmur noted

25
Q

Pericarditis

A

Occurs 2-3 days after acute MI

Consequence: New pericardial friction rub

26
Q

What does a pericardial friction rub sound like?

A

Continues grinding

Two pieces of sand-paper

27
Q

How to determine if friction rub is cardiac or respiratory in origin

A

Ask patient to hold breath

If grading stops = respiratory

28
Q

Diagnostic Testing for ACS: EKG

A

-r/o or confirm UA/MI

-Look for change in ORS, ST, and T wave

-Serial EKG’s may be ordered as ischemia
and infarction can change over matter of few hours

29
Q

Diagnostic Testing for ACS: Serum Cardiac Markers

A

Serum troponin has greater sensitivity and specificity than CK MB and myoglobin

Troponin increases in 2-3 hrs and returns to baseline in 10-14 days

30
Q

Troponin increases in ________ and restures to baseline in _________

A

2-3 hrs

10-14 days

31
Q

STEMI vs NSTEMI: ST segment

A

Stemi = elevation

Nstemi = Depression or normal

32
Q

Diagnostic Testing for ACS: Coronary angiography

A

Left Heart Cath

See if there are blockages in Coronary arteries

33
Q

STEMI vs NSTEMI: QRS segment

A

STEMI = pathologic (wide) and develops over hours

NSTEMI = Normal

34
Q

STEMI vs NSTEMI: T wave

A

STEMI = Peaked then inverted

NSTEMI = Inverted

35
Q

STEMI vs NSTEMI: Troponin I

A

STEMI = Elevated

NSTEMI = Elevated

36
Q

STEMI vs NSTEMI: Size of infarct

A

STEMI = Larger

NSTEMI = Smaller

37
Q

STEMI vs NSTEMI: Outcomes

A

STEMI = Poor

NSTEMI = Better

NUR 405 (Med Surg II) (23 decks)

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