CARDIOVASCULAR SYSTEM Acute Coronary Syndromes MYOCARDIAL INFARCTION/ Unstable Angina

Question 1

What’s the diff between stable and unstable angina?

Answer 1

stable= u know what brings it on

unstable= u don’t know what brings it on (MI, STEMI, NSTEMI)

Question 2

Acute Coronary Syndromes MYOCARDIAL INFARCTION/ Unstable Angina is caused by a decreased blood flow to the myocardium that leads to _____, and ____.

Answer 2

ischemia and necrosis

Question 3

Does the patient have to be doing anything to bring on this pain?

Answer 3

No; they may be asleep

Question 4

Will rest or nitroglycerine relieve this pain?

Answer 4

NO

Question 5

S/S OF MI:

____ pain

____skin

____ BP

____ Cardiac output

_____ WBCs

_____ temperature

______ changes can they vomit sometimes? why?

Answer 5

• increased pain
• cold clammy skin
• decreased bp
• decreased CO
• increased wbc (inflammation)
• increased temp (inflammation)
• EKG changes
• yes vomit; anytime you have someone in tremendous pain, they may start to vomit because when you’re in pain, the vagus nerve can be stimulated which drops your heart rate. when the rate drops= decreased CO= less blood in GI tract and they get nausea and they begin to vomit.

Question 6

The MOST common sign is ___ in the chest with radiation to the___ side.

Answer 6

pressure; left

Question 7

What are the cardiac enzymes that are drawn?

Which ISOENZYME is the MOST sensitive indicator of an MI?

Answer 7

CPK (creatinine phospho kinase) test; enzymes found mostly in the heart, brain, and skeletal muscle.

• CKMB (creatinine kinase myoglobin blood) test

Question 8

Why is troponin a better indicator of cardiac damage than CPK?

Answer 8

• Nothing else can make the troponin go up except the heart itself; whereas, a simple I.M shot can make the CPK go up.

*Troponin= cardiac muscle damage * < 0.01

Question 9

TROPONIN:

Can be detected___ to ___ hours after onset of chest pain can last __ to ___ days after heart damage.

Answer 9

3 to 6

6 to 8

Question 10

Which enzymes or markers that are most helpful when the patient delays seeking care?

Answer 10

LDH (Lactase dehydronase…. levels rise in response to cell damage) and troponin

Question 11

CHEST PAIN TX:

When a client presents to the E.R with any form of chest pain, you give them an ____ right there.

Answer 11

-aspirin

Question 12

If you’re in the middle of an MI, What is the drug of choice for pain? why?

Answer 12

IV morphine. pain relief and vasodilation which decreases the workload of the heart immediately.

Question 13

Who greets every patient that have chest pain?

Answer 13

M.O.N.A (Morphine, Oxigen, Nitroglycerine, Aspirin)

Question 14

Which untreated arrhythmias will put the patient at risk for sudden death?

What drugs do we give to treat these?

Answer 14

*V.FIB

Pulseless V.Tach

Asystole —-Lidocaine (treats irregular arrythmias as well as numb skin), amiodarone (anti-arrythmic)

Question 15

When someone goes into V-FIB, what do you better hurry up and do?

Answer 15

Defib them without delay or they can die. The longer you wait to shock someone, the greater the chance it’s not gonna work.

Question 16

What is a symptom of Lidocaine toxicity?

Answer 16

Any neuro change, so you better be doing neuro checks

Question 17

what is an important side effect of amiodarone?

Answer 17

HYPOTENSION

Question 18

what are you worried about with other arrhythmias?

Answer 18

decreased cardiac output

Question 19

Someones has come into the ER and they’re having an MI and we put them in the “head up” position. why?

Answer 19

it will decrease cardiac workload and increase cardiac output.

* remember, when u lay flat, it increases cardiac workload*

Question 20

When you are lying flat, is your heart working harder or less?

Answer 20

harder; it ‘s a stress on the heart. when you’re flat, your heart is pumping uphill.