Chapter 18 Exam 3 Flashcards
Unstable Angina enzymes*
- no cardiac enzymes created, but chest pain will be very strong
Angina Pectoris*
- chest pain associated with intermittent myocardial ischemia
- no permanent damage occurs to the heart
- crackles/rales are indicative of left side congestion, they are bubbling and rattling of buildup of fluid in the lungs
3 patterns of Angina Pectoris *
- stable, unstable, and prinzmetal
Nitroglycerin*
dilates the coronary arteries
Stable Angina *
- most common
- characterized by stenoic atherosclerotic coronary vessels
- relived by rest and nitroglycerin
Unstable or crescendo angina*
- can progress to acute ischemia
- very similar to nonSTEMI heart attack, only difference is absence of serumbiomarker troponin
Prinzmetal/Variant angina*
- unpredictable
- vasospastic
- caused by coronary artery occlusions
- calcium channel blocking agents used for treatment
Acute Coronary Syndrome*
- Myocardial infarction (MI) or unstable angina
- ECG and biomarkers used for diagnosis
ACS ECG changes*
- t wave inversion or s wave depression
- ST elevation in case of a heart attack; also known as STEMI (st elevation; myocardial infarction)
- Q wave means old heart attack
- T wave inversion with biomarkers is a nonSTEMI
- segment depression means ischemia
Treatment of ACS with drugs*
- antiplatelets and statin drugs are the best thing for ACS with nonSTEMI/unstable angina
- reperfusion therapy is best thing for ACS with STEMI
- morphine, oxygen, nitrates, and aspirin together treat acs
Acute occulsion*
- blockage in an artery, vein, or within the heart
- can cause a range of cellular events depending on the availability and adequacy of collateral blood flow, relative workload, & length of time that flow is interrupted
Diagnosis of ACS*
depends on
- signs and symptoms
- electrocardiographic changes
- elevatioins of specific marker proteins in the blood
Signs and symptoms of ACS*
- sever crushing, excruciating chest pain that may radiate to the arm, shoulder, jaw, or back
- nausea
- vomiting
- diaphoresis (sweating)
- shortness of breath
- diabetics and elderly may not have pain due to neuropathy
More ACS info: Asymptomatic MI *
- lasts more than 15 min and is not relieved by rest or nitroglycerin
- can be asymptomatic MI (silent MI) which is typical in women, the elderly, and patients with diabetic neuropathies
- ECG for asymptomatic includes st segment elevation, large Q waves, and inverted T waves
ACS serum marker changes*
- myoglobin
- lactate dehydrogenase
- creatine kinase
- increased CK-MB and troponin I and T
ACS Treatment Steps
- Decreasing myocardial oxygen demand (rest, heart rate control, pain relief, afterload reduction)
- Increasing myocardial oxygen supply (thrombolysis, angioplasty, coronary bypass grafting)
- Monitoring and managing complications (early detection and management of dysrhthmias and conduction disorders, continuous ECG monitoring)
- beta blockers are given
Sudden Cardiac Arrest
- also called sudden cardiac death
- unexpected death from cardiac causes within 1 hour of symptom onset
- lethal dysrhythmia is usually primary case
Chronic Ischemic Cardiomyopathy
- heart failure develops insiduously due to progressive ischemic myocardial damage
- typically have history of angina or MI
- appears to be a consequence of slow, progressive apoptotic death of myocytes from chronic ischemia
- more common in older adults
Endocardial and Valvular Disease
endocardial & valvular structures may be damaged by:
- inflammation and scarring
- calcification
- congenital malformations
causes altered hemodynamics of the heart and increase myocardial workload
- will include stenosis. regurgitation, and prolapse
Stenosis
failure of the calve to open completely results in extra pressure work for the heart
Regurgitation (insufficiency)
inability of a valve to close completely results in extra volume work for the heart
Mitral Stenosis*
- blood flow from the left atrium to left ventricle is impaired during ventricular diastole
- increased pressure of the left atrium leads to atrial chamber enlargement and hypertrophy
Results of Mitral Stenosis *
- chronic pulmonary hypertension
- right ventricular hypertrophy
- right sided heart failure
Signs and symptoms of Mitral Stenosis *
- low pitched, rumbling diastolic murmur
- opening snap (sound)
- atrial dysrhythmias
- atrial clots
- exertional dyspnea