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EMRG 1230- CARDIAC UNIT > Chest Pain > Flashcards

Chest Pain Flashcards

1
Q

What is the pericardium?

A

the sac around the heart

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2
Q

What is the aorta?

A

largest artery of the human body

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3
Q

What is cardiac output purpose?

A

it ensures adequate tissue perfusion

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4
Q

What is the equation for cardiac output?

A

SV x HR

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5
Q

What are the two fluctuations in cardiac output that constantly depend on the metabolic needs of the body??

A

Direct and indirect stress

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6
Q

Direct stress defintion:

A

Structural or functional alterations in the heart that reduce the pump effectiveness

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7
Q

What are some effects direct stress causes on the body?

A

Ischemia
Infection
Arrhythmias
Congenital defects

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8
Q

What is indirect stress?

A

Disorders external to the heart that increase the workload, anything that makes the heart work harder than normal

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9
Q

What are the effects that indirect stress has on the body?

A

Anxiety
Stress from an accident
Excersise

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10
Q

What causes ischemia?

A

the reduction of blood supply to the myocardium caused by degenerative changes to the coronary arteries

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11
Q

What are the 2 mechanisms of clogged arteries?

A
  1. chronic gradual narrowing of arteries cause ischemia
  2. acute infarction can be caused by acute plaque rupture and subsequent thrombus formation and occlusion of coronary arteries (MI)
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12
Q

What are the predispoing factors that CANNOT be changed?

A

age, gender, genetics

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13
Q

What are the predisposing factors that CAN be changed?

A

smoking, sedentary lifestyle, obesity, uncontrolled HTN

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14
Q

What are causes of ischemia?

A

spastic contraction
- cold weather, caffeine, nicotine, anxiety, exertion

occlusion
- degenerative vascular disease
- platelets rupture and form clots or thrombosis

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15
Q

What does the process of ischemia lead to the production of?

A

Ischemia = decreased blood supply to the cells = anaerobic metabolism = lactic acid production

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16
Q

What is ARTERIOsclerosis??

A

degenerative disorder resulting in vascular obstruction
characterized by hardening of the arteries and thickening of the arterial walls

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17
Q

What is ARTHEROsclerosis??

A
  • thickening of the artery wall from the accumulation of fatty material
  • chronic disease that can remain asymptomatic for decades
  • affects ALL arteries but predominantly brain kidneys and heart
  • leads to narrowing of the vessels and reduction of blood flow through them
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18
Q

Chest pain is localized accumulation of ______

A

Lactic acid that irritates the nerve endings

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19
Q

What is angina pectoris?

A

aka chest pain
- deficiency of O2 for the heart muscle
- when the heart is working harder than usual and needs more o2 or when blood supply to the myocardium is impaired

20
Q

What does angina pectoris feel like??

A

More like a choking in the chest, not really PAIN, HEAVY pressure like symptoms

21
Q

What is stable angina?

A

follows the same pattern for every pt
- insufficient o2 supply, anaerobic metabolism and accumulation of lactic acid and CO2

22
Q

How long does stable angina typically last?

A

1-5 mins and relieved by rest!

23
Q

What is the best way to differentiate stable and unstable angina??

A
  1. TIME. (stable lasts 1-5, unstable lasts >15!!)
  2. RELIEF. (stable is relieved by rest, unstable is NOT as easily relieved!)
24
Q

At rest, stable angina is okay with a person with heart disease despite the narrowed arteries, true or false?

25
Stable angina is SUPPLY and demand. True or false? Explain why.
TRUE! Because despite the narrowed arteries in the person with stable angina, it is enough to meet daily needs but when the person experiences any stress on the heart, the blood flow is NOT enough to meet the heart needs!!! = ANGINA
26
What is unstable angina?
same etiology (CAUSE) as stable but the pain is more severe, different feeling.
27
How long does unstable angina last?
>15 mins
28
Unstable angina follows the same pattern as their usual angina, true or false?
FALSE. Unstable angina does NOT follow the same pattern as their usual angina!
29
What are questions to ask someone when they have angina?
- what is different today? - is this typical to your last heart attack? - does it feel the same as last time? - what kind of pain are you feeling?
30
What are symptoms of angina?
- recurrent, intermittent episodes of substernal chest pain. usually triggered by physical or emotional stress - tightness or pressure in the chest, often radiates into the neck or left arm! - pallor, diaphoresis and nausea - lasts seconds or much longer
31
How do you treat angina?
FULL assessment with DETAILED QUESTIONING - trying to rule in/out differential diagnosis Rule out c spine asking about neck pain!! Partner gets vitals while questioning Assess for O2, ASA, 12 lead, Nitro, IV therapy, vitals done every 5 mins minimum!
32
What is acute coronary syndrome?
results from prolonged cardiac disorder causing myocardial ischemia or infarction -STEMI, non STEMi and unstable angina - typically caused by a rupture of the plaque in the arteries and subsequent thrombosis of the coronary artery - basically blood clot forms around the ruptured artery blocking the artery
33
What is an acute myocardial infarction?
part of the coronary muscle is deprived of blood flow until that part dies
34
What is the most common cause of AMI?
plaque rupture and thrombus formation
35
How do you classify a STEMI vs NON STEMI?
ECG blood work: troponin is the distinguishing factor
36
Ischemic tissue is often electrically unstable this causes __________
cardiac arrhythmias (PVC's, atrial fib= irritation of the cardiac muscle)
37
Signs of a heart attack!
PAIN- sudden sub sternal chest pain! can radiate into the jaw, neck and left arm - usually described as severe, steady and crushing, no relief with vasodilators -gastric discomfort, described as indigestion - pallor - diaphoresis - dizziness, weakness, anxiety, fear of impending doom - hypotensive (especially during a RVI) - rapid and weak pulse, dyspnea, SOB
38
Management of ACS (acute coronary syndrome):
assessment and management for possible ACS should occur simultaneously be calm and place pt at rest determine the presence of possible ACS OPQRST - Palpation, Inhalation, Exhalation, Movement (PIEM) - TIME! Care must begin RIGHT away - limits infarct size
39
How to confirm possible MI?
Perform 12 lead ECG - assess for aspirin and o2 admin. Rapid acquisition for the 12 lead ECG before the secondary assessment and before ischemic therapy (nitro) is preferred
40
How many 12 lead ECG's should be performed and WHEN?
- one when we get there - one when we go MOBILE - one when we arrive at the hospital
41
Why does a 12 lead need to be done prior to nitro?
Because nitro=preload dependent check for a Right Ventricular Infarct!! move v4 to right side
42
What does ASA do?
reduces the size of the clot, ANTI CLOTTING - has been shown to significantly decrease mortality with MI - orally administered
43
What does NITRO do?
vasodilator! - relaxes peripheral vasculature and may reduce after load to reduce cardiac workload - wont relieve the pain in an MI as it has little to no effect on the blockage - does not reduce mortality - sublingually administered: under tongue
44
What is the side effects of nitro?
hypotension and headache
45
What is dissecting aortic aneurysm?
tear in the aorta that changes in the middle layer lead to an "ungluing" of the inner layer of the aorta, once it is torn dissection begins
46
Signs/ symptoms of triple A:
middle aged or older chronic hypertension "worst pain ive ever felt" - BAD PAIN. - ripping or tearing or knife feeling shock state pain is sudden located in the chest or the back between the shoulder blades and can radiate to the back or abdo difference in BP, because of blood flow through innominate artery

EMRG 1230- CARDIAC UNIT (11 decks)

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