CAD: Acute coronary syndrome (MI, unstable angina) Flashcards
Unstable chronic angina= ?
Impending MI
Patho
Decreased blood flow to myocardium leads to what?
Ischemia and necrosis
Patho
Does the client have to be doing anything to bring the pain on?
No
Patho
Will rest or nitro relieve the pain?
No
S/s
Pain
- Pain may be crushing (elephant sitting on chest)
- Pressure radiating to left arm and left jaw
- NV
- Pain between shoulder blades
S/s
How do women present?
GI signs and symptoms–epigastric complaints or pain between the shoulders, an aching jaw or choking sensation
1 sign of MI in elderly?
S/s
SOB
S/s
Skin
Cold
Clammy
S/s
BP
Drops (CO is decreasing!)
S/s
Heart
ECG changes
S/s
GI
Vomiting (acute pain stimulates vagus nerve, which drips HR and BP so decrease in CO)
Troponin T levels?
Less than 0.10
Troponin I level?
Less than 0.03
STEMI
Client is having MI and goal is to get to cath lab for PCI in less than 90 min
NSTEMI
Less worrisome
CPK-MB
What is this?
Increase when?
Elevated and peaks?
Cardiac specific isoenzyme
Levels increase with damage to cardiac cells
Elevates in 3-6 hrs; peaks 12-24
Troponin
What is it?
Elevates?
Stays elevated for how long?
Cardiac biomarker with high specificity to myocardial damage
Elevates within 3-4 hours
Remains elevated for up to 3 weeks
Troponin levels are good for who?
Those who delayed seeking care
Myoglobin
Increases?
Peaks?
What results are good thing: positive or negative?
Increases within 1 hr
Peaks at 12 hours
NEGATIVE results= good thing
What cardiac biomarker is most sensitive indicator for MI?
Troponin
Which enzymes or biomarkers are most helpful when client delays seeking care?
Troponin
Complications?
Major arrhythmias
Complications
What untreated arrhythmias will put client at risk for sudden death?
Pulseless v-tach
V-fib
Asystole
Complications
Priority assessment for v-fib?
Defibrilate q
Complications
If the first shock doesnt work and the client remains in v-fib what is the first vasopressor we give?
Epi
Complications
What is the anti-arrhythmic used for V-fib and pulseless VT that is resistant to tx?
Amiodarone
*also used for fast arrhythmias
Complications
Check what function if pt. gets amiodarone and lives?
Thyroid function (amidarone has a lot of iodine)
Complications
What anti arrhythmic drugs are commonly give to prevent second episode of V-fib?
Amiodarone
Lidocaine
Complications
Lidocaine toxicity?
Numb
Neuro changes
Complications
What is the first anti-arrhythmic of choice?
Important SE?
Amiodarone
HYPOtension–this could lead to further arrhythmias!
Treatment
What meds are used for chest pain when they get to ED?
Morphine
Oxygen (over 90)
Nitroglycerin
Asprin (chewable)
Treatment
What position
Head up to decrease workload of heart and increase CO
Treatment: Thrombolytics
Goal?
Dissolve the clot that is blocking blood flow to heart muscle – decreases size of the infarction
Treatment: Thrombolytics
Meds?
Alteplase (t-PA)
Tenecteplase (TNKase–one time push)
Reteplase
Streptokinase
Treatment: Thrombolytics
How soon after the onset of myocardial pain should these drugs be administered?
Within 6-8 hours
Treatment: Thrombolytics
Stroke —
Time is brain
Treatment: Thrombolytics
Major complications?
Bleeding!!!
get good bleeding hx
Treatment: Thrombolytics
Absolute contraindications
Intracranial neoplasm
Intracranial bleed
Suspected aortic dissection
Internal bleeding
Treatment: Thrombolytics
During and after administration we take ____
Bleeding precautions
- draw blood when starting IVs to decrease the number of puncture sites
- use electric razor, soft toothbrush
- No IMs
Treatment: Thrombolytics
Antidote for dabigatran?
Idarucizumab
Percutaneous coronary intervention (angioplasty)
Major complication?
MI
*dont forget the client may bleed from heart cath site or they could re occlude –> any problems go to surgery
Percutaneous coronary intervention (angioplasty)
Chest pain after procedure
Call doc ASAP!!! –reoccluding
Percutaneous coronary intervention (angioplasty)
What are thrombolytic or anti-platelet meds?
Asprin
Clopidogrel
Abciximab
Eptifibatide
Percutaneous coronary intervention (angioplasty)
Who gets the abxicimab or eptifibatide?
High risk clients who have been stunted to keep artery open and those waiting to go to cath lab
CABG
When to get?
Used with what?
What supplies L.V?
Scheduled or emergent
Used with multiple vessel disease or left main coronary artery occlusion
Left main coronary artery supplies entire LV
CABG
Left main coronary artery occlusion think?
Sudden death or widow maker
Cardiac rehab
Stop what?
How to increase activity?
Diet changes?
Stop smoking
Increase gradually (stepped care plan)
Decrease fat, decrease salt, decrease cholesterol
Cardiac rehab
No what? (3)
No isometrics
No valsalva
No straining/suppository —(can give docusate)
Cardiac rehab
When can sex be resumed?
For clients w/o complications when they can walk up flight of stairs
Cardiac rehab
Best time for sex?
Morning (8-9)
Cardiac rehab
Best exercise for MI client?
Walking
Cardiac rehab–Teach s/s of HF
What are they?
Weight gain
Ankle edema
SOB
Confusion
