Cardiovascular dysfunctions Flashcards
Acute Coronary Syndrome
ACS UA NSTEMI STEMI MI
UA
Unstable Angina
- PCI usually not indicated
- Not candidates for thrombosis
NSTEMI
non ST segment elevation MI
ST depression
No thrombolytics
May require PCI
STEMI
ST elevation
**Need prompt reperfusion
Assess for thrombolysis PCI or CABG
- Give tPA?
MI
Sustained Ischemia
Rapid Dx and Management of ACS to reduce complications
O2 ASA NTG 12 lead EKG IV access Serum cardiac biomarkers repeat in 6-12 hrs CXR Hx/Risk assessment
UA and NSTEMI
Fibrinolytic therapy is not recommended (used to break up clots)
1. Assess Risk
Low: prob no PCI
Intermediate: 1 of the following: CP>20 min, T wave inversion, elevated biomarkers, >70yo = Possible PCI
High: Prompt PCI
2. Tx
Assess Risk: Low
No intermediate or high risk features but there is at least one of the following:
new onset of cp not prolonged
nml EKG during cp
nml cardiac biomarkers
Probably NO PCI
Assess Risk: Intermediate
1 of the following; Cp> 20 min T wave inversion Q qaves Elevated cardaic biomarkers Age>70
POSSIBLY PCI
Assess Risk: High
1 of the following: Angina Ischemia at rest CP> 20 min New ST depression recurrent angina CHF s/sx <40% EF SBP <100 HR>100 or less than 60 prior CABG >75 yo
PROMPT PCI
Tx of UA and NSTEMI
- O2, continuous ECG, monitor, IV
- ASA, NTG
- Beta blockers
- IV NTG, MS
- Heparin
- Clopidogrel (plavix), anti-platelets
STEMI
Requires reperfusion
STEMI assess
Assess R/F complications: Adv age, DM Prior MI, A Fib, AVB Mitral Valve dysfunction ST elevation despite reperfusion Anterior MI Incr HR Dec BP Renal insufficiency
STEMI TX
O2, monitor, IV ASA< NTG, MS Fibrinolytic or PCI B Blockers Heparin Plavix ACE-I/ARB MgSo4 Ca 2+ blocker
Possible complications of MI
Arrythmias Rupture: Papillary muscle, ventricular septal or cardiac Papillary muscle dysfunction Ventricular aneurysm Pericarditis HF Pulm Edema Cardiogenic Shock Recurrent ischemia
Drug of choice for arrhythmias
Amiodorone
Pacemaker Indications:
Bradydysrythmias
Tachydysarrythmias
Demand Pacemaker
When HR less than “X” the pacemaker will fire
Fixed pacemaker
HR set at certain amount
Nursing care with pacemaker:
- Assess pacemaker function
- Pt teaching
- keep dry x 1 week
- take pulse
- carry pacemaker ID card
- Avoid direct blows to pacer
Implanted Cardiovertor Defibrillator: ICD Indications
- Survivors of sudden cardiac arrest
2. Documented life threatening medication resistant ventricular dyshythmias
With ICD, avoid lifting for ____.
one week
When the ICD fires:
Lie down.
If pt has LOC, call 911
Defibrillate with external paddles prn
if fires and not feeling well, contact MD
Call the MD within 24 hours of shock and immediately if you experience a second shock in _____ hours
24 hours
