Chapter 30: Acute Coronary Syndromes Flashcards
An acute coronary syndrome results from ____ buildup in the _____ (coronary atherosclerosis).
plaque
coronary arteries
Plaque buildup can rupture, leading to ____ formation and _____ to the heart.
thrombus
ischemia
Risk factors that lead to plaque buildup that causes an ACS
- Age: men > 45 years, women > 55 years (or early hysterectomy
- Family hx: 1st degree relative w/ coronary event before 55 years (men) or 65 years (women)
- Smoking
- HTN
- Known coronary artery disease
- Dyslipidemia
- Diabetes
- Chronic angina
- Lack of exercise
- Excessive alcohol
Classic signs and symptoms of ACS
chest pain (pressure and squeezing) lasting > 10 min, severe dyspnea, diaphoresis, syncope/presyncope, and/or palpitations
Pain from ACS can radiate to
arms, back, neck, jaw, or epigastric region
Patients with a prescription for SL nitroglycerin should use __ dose(s) every __ min up to ___ doses for relief of chest pain. If the pain is not improved or is worse __ min after the first dose, call 911 immediately
one dose every 5 min up to 3 doses
5 min
NSTE-ACS describes which 2 medical conditions
Unstable angina & NSTEMI
Cardiac enzymes in unstable angina are (neg/pos)
Cardiac enzymes in NSTEMI are (neg/pos)
Cardiac enzymes in STEMI are (neg/pos)
UA - negative
NSTEMI - Positive
STEMI - Positive
There is (partial/complete) blockage in unstable angina There is (partial/complete) blockage in NSTEMI There is (partial/complete) blockage in STEMI
UA - partial
NSTEMI - partial
STEMI - complete
___ should be performed and evaluated within 10 minutes at the site of first medical contact after ACS
A 12-lead ECG
Patients with STEMI or NSTEMI should be urgently transported to a hospital with _____ capability, if possible
percutaneous coronary intervention (PCI)
What are the most sensitive and specific biomarkers for ACS
Cardiac troponins I & T (TnI and TnT)
When should cardiac troponin levels be obtained in all patients with ACS symptoms
At presentation & 3-6 hours after symptom onset
What is PCI
a coronary revascularization procedure that involves inflating a small balloon inside a coronary artery to widen it and improve blood flow. Usually, a metal stent is placed into the artery after to keep it open
In STEMI, the blocked arteries need to be opened how quickly
as quickly as possible with PCI (preferred) or fibrinolytics
Acute treatment of ACS is aimed at
Immediate relief of ischemia & preventing MI expansion and death
Drug treatment for ACS
- remember MONA-GAP-BA*
- Morphine
- Oxygen
- Nitrates
- Aspirin
- GPIIb/IIIa antagonists
- Anticoagulants
- P2Y12 inhibitors
- Beta-blockers
- ACE inhibitors
Which antianginals are used in ACS
Morphine, BB, nitrates
MOA of antianginals in ACS
Decrease myocardial O2 demand or increase myocardial O2 supply (blood flow) to relieve ischemia
MOA of antiplatelets in ACS
Inhibit platelet aggregation to prevent clot formation/growth
MOA of anticoagulants in ACS
inhibit clotting factors to prevent clot formation/growth
NSTE-ACS (i.e, NSTEMI and unstable angina) are treated with:
MONA-GAP-BA +/- PCI
STEMI is treated with
MONA-GAP-BA + PCI (preferred) or fibrinolytic
When should morphine, O2, nitrates and ASA (MONA) be given
Immediately as needed
MOA of morphine in ACS
Antianginal; produces arterial and venous dilation (↓ preload and afterload)
Provides pain relief
MOA of nitrates in ACS
Antianginal: dilates coronary arteries and improves collateral blood flow; ↓ preload and afterload (modestly); reduces chest pain
Which dose and formulation of NTG should be administered in ACS
SL 0.4 mg
Which drug class is CI with nitrates
PDE5-i
Which dose and formulation of aspirin should be administered in ACS
Non-EC, chewable ASA
162-325 mg
Do not use which formulation of ASA in ACS
extended release
What is the maintenance dose of ASA that should be continued indefinitely in ACS
81-162 mg daily
Which drugs are GPIIb/IIIa receptor antagonists
abciximab, eptifibatide, and tirofiban
Which anticoagulant is preferred for STEMI
bivalirudin
Which anticoagulants are used in ACS
LMWHs (e.g. enoxaparin, dalteparin), UFH and bivalirudin