CAD: Acute Flashcards
Group of condition similar to symptoms of chest pain
which is not, or only partially relieved by GTN
Acute Coronary Syndrome
Conditions of ACS include
- Acute myocardial infarction (AMI)
- UA
- NSTEMI
- STEMI
ACS arises from rupture of an
__________
unstable atheromatous plaque
determine the degree of
myocardial necrosis that occurs
Volume of the eventual thrombus and the time
the vessel is occluded
Chest pain that often occurs at rest, can occur suddenly, may
worsen suddenly or may be stuttering, recurring over days to weeks
Unstable Angina
Symptoms similar to unstable angina but differentiated on the basis
of markers and ECG
Non-ST- Elevation Myocardial Infarction
A condition that requires immediate reperfusion therapy, through
either thrombolysis or percutaneous coronary intervention (PCI)
ST-Elevation Myocardial Infarction
Acute Coronary Syndrome includes
Unstable Angina
Non-ST- Elevation Myocardial Infarction
ST-Elevation Myocardial Infarction
ST-Elevation Myocardial Infarction requires immediate _______
reperfusion therapy
Manifestations of Acute Coronary Syndrome:
1. __________ chest pain and discomfort
2. _____________ cellular injury
3. Release of ____________ - (Troponin I and T, CK-MB, CPK,
LDH)
4. _________________s- (ST elevation, T wave inversion,
pronounced Q waves)
5. Inflammatory response from the __________
6.___________
- Severe chest pain and discomfort
- Irreversible cellular injury
- Release of myocardial enzymes - (Troponin I and T, CK-MB, CPK,
LDH) - Electrocardiogram changes- (ST elevation, T wave inversion,
pronounced Q waves) - Inflammatory response from the injured myocardium
- Coagulative necrosis
Release of myocardial enzymes such as ________________ manifests acute coronary syndrorme
Troponin I and T, CK-MB, CPK,
LDH
Electrocardiogram changes such as ____________ manifests acute coronary syndrorme
ST elevation, T wave inversion,
pronounced Q wave
- Results
from decreased oxygen and
nutrient delivery To
myocardium
Myocardial Ischemia
Results if
ischemia progresses unresolved
or untreated
Myocardial Injury
Death
of myocardial cells
Myocardial Infarction
indicates full thickness
cardiac muscle injury
ST-segment elevation
indicates muscle necrosis
pathological Q-wave
indicates
muscle ischemia.
T-wave inversion
Cardiac Markers
*Troponin
*Creatinine kinase
found in cardiac and skeletal muscle
Troponin T
found only in cardiac muscle
Troponin I
found in cardiac and skeletal muscles
Troponin C
Found primarily in the heart muscle, skeletal muscle
and brain tissue
Creatinine kinase
Aids in the diagnosis of acute myocardial or skeletal
muscle damage
Creatinine kinase
CK- BB
Brain tissues
CK- MM
– Skeletal muscles
CK-MB
Heart muscle
Overall Treatment Goals for ACS
1. __________ chest pain and anxiety
2. __________ cardiac workload and _________ cardiac
rhythm
3. Prevent / reduce myocardial damage by limiting the
__________ and preserving the __________
4. Prevent or arrest complications
5. Reopen ( reperfuse ) closed coronary vessel with
__________________
- Reduce chest pain and anxiety
- Reduce cardiac workload and stabilize cardiac
rhythm - Prevent / reduce myocardial damage by limiting the
area affected and preserving the pump function - Prevent or arrest complications
- Reopen ( reperfuse ) closed coronary vessel with
thrombolytic drug and/or PCI
Causes venous pooling and reduces
preload, cardiac workload and oxygen
consumption
Morphine
Morphine causes venous pooling and __________ (increases/reduces)
preload, cardiac workload and oxygen
consumption
reduces
Morphine is used for ________
myocardial pain and anxiety
May cause orthostatic hypotension and fainting and Can produce bradyarrhythmia
Morphine
Morphine may cause _______ and ________. It can also produce
orthostatic hypotension and fainting; bradyarrhythmia
Administered in patients with arterial
saturation less than 90%, respiratory distress
or high risk features of hypoxemia
Oxygen
Oxygen is administered in patients with arterial
saturation __________________, respiratory distress
or high risk features of hypoxemia
less than 90%
causes venous dilation which reduces left
ventricular volume (preload) and myocardial wall
tension, decreasing oxygen demand
Nitrates
Nitrates causes venous dilation which ________(increases/reduces) left
ventricular volume (preload) and myocardial wall
tension, decreasing oxygen demand
reduces
also reduce arteriolar resistance, helping reduce
afterload, which decrease myocardial oxygen demand
Nitroglycerin
Nitroglycerin also (increase/reduce) arteriolar resistance, helping (increase/reduce)
afterload, which (increase/decrease) myocardial oxygen demand
reduce; reduce; decrease
T/F: Antiplatelet therapy should be initiated promptly
T
T/F: Aspirin should be administered as soon as possible
after presentation and continued indefinitely
T
should be administered to patients who
cannot tolerate GI effect and those who are
hypersensitive to ASA
Clopidogrel
Management for STEMI
*Fibrinolytics
Aspirin
Thienopyridine
Glycoprotein IIB/ IIIA Receptor inhibitor
Anticoagulant
Nitroglycerin
Beta-blockers
Calcium channel blocker
causes the
thrombus clot to be lysed when administered early after
symptom onset (6 to 12 hrs) and to restore blood flow
thrombolytic agents/Fibrinolytics
The conversion of _______ to ________ promotes
fibrinolysis and breakdown of the clot.
Plasminogen to plasmin
Therapy of choice when PCI is not available
Fibrinolytics
Preferred antiplatelet agent in the treatment of all ACS
Aspirin
Clopidogrel and ticlopidine
Thienopyridine
Recommended to be administered to patients with ST elevation ACS if patient
is allergic to aspirin
Thienopyridine
First line GP IIB/IIIA receptor inhibitor for patients undergoing PCI who have not
received fibrinolytics
Abciximab
Should not be administered if patients who will not undergo PCI
Abciximab
Combination of Abciximab with _____________________ has been shown to reduce risk of
reinfarction and need for repeated PCI
Aspirin/thienopyridine and UFH
Initiated at time of PCI and infusion is continued for 12 h
Abciximab
Abciximab is initiated at time of PCI and infusion is continued for _______
12 hours
Abciximab may (increase/decrease) risk of bleeding
increase
UFH administered as continuous infusion
Anticoagulant
First line anticoagulant for treatment of patients with ST elevation
Anticoagulant
Should be initiated in the ED and continued for 24 hours or longer in patients
who will bridged over to receive chronic warfarin therapy following MI
Anticoagulant
Dose is frequently adjusted to a target activated partial thromboplastin time
(aPTT)
Anticoagulant
