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Study > CAD: Acute coronary syndrome (MI, unstable angina) > Flashcards

CAD: Acute coronary syndrome (MI, unstable angina) Flashcards

1
Q

Unstable chronic angina= ?

A

Impending MI

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2
Q

Patho

Decreased blood flow to myocardium leads to what?

A

Ischemia and necrosis

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3
Q

Patho

Does the client have to be doing anything to bring the pain on?

A

No

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4
Q

Patho

Will rest or nitro relieve the pain?

A

No

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5
Q

S/s

Pain

A
  • Pain may be crushing (elephant sitting on chest)
  • Pressure radiating to left arm and left jaw
  • NV
  • Pain between shoulder blades
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6
Q

S/s

How do women present?

A

GI signs and symptoms–epigastric complaints or pain between the shoulders, an aching jaw or choking sensation

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7
Q

1 sign of MI in elderly?

S/s

A

SOB

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8
Q

S/s

Skin

A

Cold

Clammy

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9
Q

S/s

BP

A

Drops (CO is decreasing!)

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10
Q

S/s

Heart

A

ECG changes

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11
Q

S/s

GI

A

Vomiting (acute pain stimulates vagus nerve, which drips HR and BP so decrease in CO)

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12
Q

Troponin T levels?

A

Less than 0.10

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13
Q

Troponin I level?

A

Less than 0.03

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14
Q

STEMI

A

Client is having MI and goal is to get to cath lab for PCI in less than 90 min

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15
Q

NSTEMI

A

Less worrisome

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16
Q

CPK-MB

What is this?
Increase when?
Elevated and peaks?

A

Cardiac specific isoenzyme

Levels increase with damage to cardiac cells

Elevates in 3-6 hrs; peaks 12-24

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17
Q

Troponin

What is it?
Elevates?
Stays elevated for how long?

A

Cardiac biomarker with high specificity to myocardial damage

Elevates within 3-4 hours

Remains elevated for up to 3 weeks

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18
Q

Troponin levels are good for who?

A

Those who delayed seeking care

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19
Q

Myoglobin

Increases?
Peaks?
What results are good thing: positive or negative?

A

Increases within 1 hr
Peaks at 12 hours
NEGATIVE results= good thing

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20
Q

What cardiac biomarker is most sensitive indicator for MI?

A

Troponin

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21
Q

Which enzymes or biomarkers are most helpful when client delays seeking care?

A

Troponin

22
Q

Complications?

A

Major arrhythmias

23
Q

Complications

What untreated arrhythmias will put client at risk for sudden death?

A

Pulseless v-tach
V-fib
Asystole

24
Q

Complications

Priority assessment for v-fib?

A

Defibrilate q

25
Q

Complications

If the first shock doesnt work and the client remains in v-fib what is the first vasopressor we give?

A

Epi

26
Q

Complications

What is the anti-arrhythmic used for V-fib and pulseless VT that is resistant to tx?

A

Amiodarone

*also used for fast arrhythmias

27
Q

Complications

Check what function if pt. gets amiodarone and lives?

A

Thyroid function (amidarone has a lot of iodine)

28
Q

Complications

What anti arrhythmic drugs are commonly give to prevent second episode of V-fib?

A

Amiodarone

Lidocaine

29
Q

Complications

Lidocaine toxicity?

A

Numb

Neuro changes

30
Q

Complications

What is the first anti-arrhythmic of choice?
Important SE?

A

Amiodarone

HYPOtension–this could lead to further arrhythmias!

31
Q

Treatment

What meds are used for chest pain when they get to ED?

A

Morphine
Oxygen (over 90)
Nitroglycerin
Asprin (chewable)

32
Q

Treatment

What position

A

Head up to decrease workload of heart and increase CO

33
Q

Treatment: Thrombolytics

Goal?

A

Dissolve the clot that is blocking blood flow to heart muscle – decreases size of the infarction

34
Q

Treatment: Thrombolytics

Meds?

A

Alteplase (t-PA)
Tenecteplase (TNKase–one time push)
Reteplase
Streptokinase

35
Q

Treatment: Thrombolytics

How soon after the onset of myocardial pain should these drugs be administered?

A

Within 6-8 hours

36
Q

Treatment: Thrombolytics

Stroke —

A

Time is brain

37
Q

Treatment: Thrombolytics

Major complications?

A

Bleeding!!!

get good bleeding hx

38
Q

Treatment: Thrombolytics

Absolute contraindications

A

Intracranial neoplasm
Intracranial bleed
Suspected aortic dissection
Internal bleeding

39
Q

Treatment: Thrombolytics

During and after administration we take ____

A

Bleeding precautions

  • draw blood when starting IVs to decrease the number of puncture sites
  • use electric razor, soft toothbrush
  • No IMs
40
Q

Treatment: Thrombolytics

Antidote for dabigatran?

A

Idarucizumab

41
Q

Percutaneous coronary intervention (angioplasty)

Major complication?

A

MI

*dont forget the client may bleed from heart cath site or they could re occlude –> any problems go to surgery

42
Q

Percutaneous coronary intervention (angioplasty)

Chest pain after procedure

A

Call doc ASAP!!! –reoccluding

43
Q

Percutaneous coronary intervention (angioplasty)

What are thrombolytic or anti-platelet meds?

A

Asprin
Clopidogrel
Abciximab
Eptifibatide

44
Q

Percutaneous coronary intervention (angioplasty)

Who gets the abxicimab or eptifibatide?

A

High risk clients who have been stunted to keep artery open and those waiting to go to cath lab

45
Q

CABG

When to get?
Used with what?
What supplies L.V?

A

Scheduled or emergent

Used with multiple vessel disease or left main coronary artery occlusion

Left main coronary artery supplies entire LV

46
Q

CABG

Left main coronary artery occlusion think?

A

Sudden death or widow maker

47
Q

Cardiac rehab

Stop what?
How to increase activity?
Diet changes?

A

Stop smoking

Increase gradually (stepped care plan)

Decrease fat, decrease salt, decrease cholesterol

48
Q

Cardiac rehab

No what? (3)

A

No isometrics
No valsalva
No straining/suppository —(can give docusate)

49
Q

Cardiac rehab

When can sex be resumed?

A

For clients w/o complications when they can walk up flight of stairs

50
Q

Cardiac rehab

Best time for sex?

A

Morning (8-9)

51
Q

Cardiac rehab

Best exercise for MI client?

A

Walking

52
Q

Cardiac rehab–Teach s/s of HF

What are they?

A

Weight gain
Ankle edema
SOB
Confusion

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