Coronary Vascular Disorders (Online Lecture)/Coronary Vascular Disorders Acute Coronary Syndrome Flashcards
1
Q
acute ischemic heart disease
what is it
A
lack of adequate blood flow to the heart and results in inadequate oxygen supply to meet demands this results in supply-demand mismatch
2
Q
diagnoses under acute coronary syndrome (5)
A
chronic (unstable) angina
unstable angina
Prinzmetals (Variant) angina
Non ST segment elevation MI (NSTEMI)
ST segment elevation MI (STEMI)
3
Q
chronic stable angina
definition
A
angina that has not increased in frequency or severity over time
4
Q
how is chronic stable angina relieved
A
with rest and sublingual nitroglycerine
5
Q
what exacerbates chronic stable angina pain
A
exertion, cold, stress, emotion
6
Q
people with chronic stable angina usually have a diagnosis of
A
hypetension
high cholesterol
CAD
atherosclerosis
7
Q
is chronic stable angina predictable or not
A
yes it is predictable
8
Q
unstable angina
definition
A
angina that is changed in frequency, severity, or duration or occurs with less exertion or rest
9
Q
unstable angina
new or old onset
A
new onset
10
Q
unstable angina
duration of pain
A
more than 20 minutes
11
Q
unstable angina
how will this present in someone who has chronic stable angina
A
changed frequency
more severe
lasting longer
occurring with less exertion
could occur at rest
12
Q
is unstable angina relieved with nitroglycerine or rest
A
no
13
Q
is unstable angina something to go to the ER
A
yes, immediate medical attention
14
Q
prinzemetal (variant) angina
definition
A
resting angina caused by coronary artery spasm
15
Q
when does prinzemetal (variant) angina occur
A
always at rest
normally at night (12am-8am)
16
Q
prinzmetal (variant) angina is associated with
A
acute MI
arrhythmias
sudden cardiac death
17
Q
NSTEMI
defintion
A
intermittently occlusive thrombus that may cause myocardial necrosis of the inner most layer of the myocardium
18
Q
NSTEMI and STEMI present the same as
A
unstable angina
19
Q
how do we differentiate between NSTEMI AND STEMI
A
12 lead EKG
Cardiac biomarkers
20
Q
if someone is diagnosed with a NSTEMI how long do we have to take them to cath
A
24 hours, longer than a STEMI
21
Q
STEMI
definition
A
occlusive thrombus
thrombus occluding a coronary vessel for a prolonged period of time
reduced blood flow results in myocardial ischemia, injury, and necrosis with damage extending through all myocardial layers
22
Q
if someone is diagnosed with a STEMI how long do we have to take them to cath
A
90 mins critical
23
Q
clinical manifestations
males
A
shortness of breath
nasuea
anxiety
pressure
radiation of pain
prodromal symptoms (general malaise)
24
Q
PQRST method
P
A
Provoke
- what provokes the pain or what precipitates the pain
25
PQRST method
Q
Quality
- what is the quality of the pain
26
PQRST method
R
Radiation
- does the pain radiate to locations other than the chest
27
PQRST method
S
Severity
- what is the severity of pain (scale 1-10)
28
PQRST method
T
Timing
- what is the time of onset of this episode of pain
29
why is timing of discomfit critial
chronic vs unstable angina
30
what else is important to ask
associated symptoms
effect of exertion and rest
effect of nitrates
31
who are 3 groups of people who present atypical
women
diabetics
elderly
32
women presents
tired
lack of energy
shortness of breath
more likely to deny pain
33
diabetic presents
silent ischemia (don't experience pain in same regard)
34
elderly presents
weakness
dysnpnea
confusion
shortness of breath
35
areas where pain can radiate
back
area between shoulder blades
upper abdomen
elbows
ears
36
nursing diagnoses
risk for decreased cardiac perfusion
37
nursing interventions
priority nursing concern
treatment of angina pain
38
nursing interventions
stop all _________ and sit or rest in _____________
activity
bed
39
nursing interventions
assessment
VS
respiratory distress
assessment of pain
*ECG
40
nursing interventions
administer
oxygen
- maintain over 90%
41
nursing interventions
administer __________ as ordered
medications
42
nursing interventions
ultimate goal
reperfusion (cath lab)
43
nursing interventions
postion for
comfort
44
nursing interventions
administer nitroglycerine
- what does it do
vasodilator
- reduces blood flow and reduces myocardial oxygen consumption
- reduces preload
- causes venous pooling in LE
45
nursing interventions
administer morphine
- why
pain
46
nursing interventions
administer heparin
prevent new clot
47
nursing interventions
- quite and calm environment
decrease stress and anxiety
48
nursing interventions
administer aspirin
- what is it and what does it do
antiplatlet
- decrease platelet aggregation
when there is an occlusion an inflammatory response is to increase platelet migration
49
nursing interventions
administer beta blockers
- why
reduce myocardial oxygen consumption/demand by reducing heart rate and contractility
50
nursing interventions
administer calcium channel blockers
- why
reduce myocardial oxygen consumption/demand through decrease heart rate and strength of contraction
51
health teaching
- smoking
smoke cessation
52
health teaching
- diet
low fat/sodium
53
health teaching
- activity
physical and sexual
54
health teaching
- blood pressure and glucose
make sure it is under control
55
health teaching
- self monitoring
educate on the sign and symptoms and when seeking medical assistance is needed
56
why might these patients have crackles
left ventricle is failing
- unable to push blood out
57
if someone has fear of impending doom, what do you do
believe them
58
what is the priority from urgent to least urgent
STEMI
NSTEMI
unstable angina
noncardiac
59
acute coronary syndrome encompasses what 3 issues
STEMI
NSTEMI
unstable angina
60
why do we always rule out possible cardio before anything else
this will kill you the quickest
61
12 lead EKG how fast
10 mins upon admission
62
what are the 3 cardiac biomarkers
troponin
CK
CK-MB
63
what are some other labs we might want
BMP
CBC
PTT/INR (clotting and if they have to go to cath lab)
64
ST elevation must be seen in how many leads
2 or more leads
65
STEMI
- classification
ST changes
elevated cardiac biomarkers
66
STEMI needs to go to the cath lab in what time
90 mins
67
T wave inversion means
Ischemia
68
do we normally ever see T wave inversion presentation
no
this is an early sign and patient is normally not presenting to the ER at this point
69
ST elevation means
injury
- acute injury is happening
70
Q wave formation means
Infarct
71
persistent Q wave means
they had an MI before
72
NSTEMI
- classificiation
no ST elevation
elevated cardiac biomarkers
73
NSTEMI time to cath lab
24 hours
74
unstable angina
- classification
No ST elevation
no elevated cardiac biomarkers
75
instead of ST elevation in NSTEMI, what might you see
ST segment depression
76
inversion of what wave might also indicate a NSTEMI
T wave inversion
77
what is the most sensitive cardiac marker
troponin
78
troponin tells you
injury to myocytes, not just death
79
troponin levels rise
4-6 hours after onset of ischemic symptoms
80
troponin levels peak at
18-24 hours after an MI
81
troponin levels will return to normal
in 2 weeks
82
CK MB (creatine kinase)
sensitive for what
cardiac tissue but not as sensitive in early MI
83
CK MB (creatine kinase)
levels rise
4-8
84
CK MB (creatine kinase)
peaks
12-24
85
CK MB (creatine kinase)
returns to normal
24-48
86
myoglobin
sensitive to what
muscle damage, not cardiac specific though
87
myoglobin
elevates
1-3 hours
(very quick)
88
myoglobin
peaks
12 hours after infarct
89
myoglobin
returns
18-24 hours
90
additional diagnosis
chest X ray
- rule out others
echocardiography
- view ventricles
stress test
- out patient
91
primary therapeutic goals
optimize....
blood flow to the myocardium to reduce the amount of myocardial necrosis
92
restoration and maintence of blood flow to myocardium is important to improve
patient outcomes
93
2 interventions we can do to optimize blood flow
pharm
mechanical
94
since MONA is not in the correct order, what is the correct order
AONM
95
AONM
- A stands for
aspirin
96
AONM
- O stands for
oxygen
97
AONM
- N stands for
nitroglycerine
98
AONM
- M stands for
morphine
99
aspirin
- action
antiplatelet
100
aspirin
- dose
160-325mg
101
when do we want to administer aspirin
as soon as possible
102
aspirin is standard therapy for
all patients with new pain suggestive of AMI
103
oxygen is given if saturation is less than
94%
104
if saturation is less than 94% what L do we start at
4L/min
105
what is nitroglycerins action
venodilator
106
what does a venodilator do
cause venous pooling
which leads to
less blood returning to heart
which leads to
reducing myocardial oxygen consumption and demand
which leads to
reduction in preload
dilates coronary artery
which leads to
collateral flow (all other arteries are open)
107
oral nitroglycerine side effects
orthostatic hypotension
hypotension
right sided MI = extreme hypotension
108
what do we assess before and after giving nitroglycerine
BP & HR
VS
pain
109
what is the maximum nitroglycerin does
3 mins
110
what is the time frame in between doses
5 mins
111
what other forms can nitroglcycerine be given
IV
112
IV nitro side effects
severe headache
dizziness
light headedness
orthostatic hypotension
113
if the patient is on nitro IV what is going to be on continuous
ECG
114
what is the key point with IV nitro
do not stop abruptly
we must taper
115
what to assess before and after giving morphine
respirations
BP
sedation/LOC
pain
116
morphine does
1-5mg every 5-30 mins
117
antiplatelet therapies (3)
aspirin
ADP-receptor inhibitors
glycoprotein IIb/IIIa inhibitors
118
patients who are on anti platelet are at risk for
bleeding and fall
119
ADP-receptor inhibitors
action
decrease platelet aggregation
120
ADP-receptor inhibitors
can it be used with aspirin
yes
121
ADP-receptor inhibitors
- drugs (2)
Plavix (clopidogrel)
Effient (Prasugrel)
122
ADP-receptor inhibitors
risk
bleeding
123
glycoprotein IIb/IIIa inhibitors
- drugs (2)
eptitibatide (intergrilin)
abciximab (repro)
124
glycoprotein IIb/IIIa inhibitors
- action
potent inhibitors of platelet aggregation
125
glycoprotein IIb/IIIa inhibitors
- indications
NSTEMI
unstable angina
ACS undergoing cath lab procedure
126
anti ischemia therapies
4 classes
beta blocekrs
ACEI
ARBS
calcium channel blockers
127
beta blockers
- ending
olol
128
beta blockers
- reduce (4)
HR
BP
myocardial oxygen demand
myocardial work load
129
beta blockers
- contraindications
heart failure
low CO
increased risk of cariogenic shock
130
beta blockers
- drug examples (3)
metropolol
propranolol
atenolol
131
calcium channel blockers
- action
vasodialtion
prevent ischemia
132
calcium channel blocekers
- drugs (2)
verapamil
diltiazem
133
ACEI
- action (3)
decrease BP
lower peripheral vascular resistance
decrease O2 demand
134
ACEI drugs
enalapril
captopril
135
ACEI
- what should we monitor for
orthostatic hypotension
syncope
serum potassium levels
renal function studies
136
ACEI
- side effects (2)
dry nagging cough
angioedema
137
what is the major anticoagulation drug that you will encounter in the hospital
heparin
138
heparin
- class
antithrombin
- prevents formation of thrombi
139
reversal for heparin
protamine sulfate
140
heparin
- contraindications/cautions
active bleeding
following recent surgery
recent bleed
severe hypertension
141
drugs that decrease the activity of coagulation systems with anti platelet therapy
aspirin
clopidogrel
142
drugs increase ventricular filling time and decrease heart rate
beta blockers
143
drugs that decrease preload
nitrates
diuretics
morphine
144
drugs that decrease afterload
ACEI
hydralazine (?)
145
drugs that decrease myocardial oxygen consumption
beta blockers
146
2 ways we can destroy the clot
cath lab
fibrinolytic therapy
147
what is the gold standard
-cath lab or fibrinolytic therapy
cath lab
148
cath lab/PCI uses dye, what do we assess for
allergies
kidney function (BUN, CR before and after)
149
STEMI door to balloon
90 mins
150
fibrinolytic therapy door to drug
30 mins
151
why might fibrinolytic therapy be used over PCI
rural setting that has no cath lab
152
major risks of fibrinolytic therapy
hemorrhage
stroke
allergy
153
what can be done on a STEMI
- PCI
- fibrinolytic
both
154
what can be done on a NSTEMI
- PCI
- fibrinolytic
fibrinolytic is not recomended
155
NSTEMI PCI time frame
24 hours
156
MI teaching
recognize and take action for recurrent symptoms
lifestyle changes
- stop smoking
- reduce stress
- decrease caffeine
- modify intake of calories, sodium, fat
157
ischemia is what wave
inverted T wave
158
injury is what wave
elevated ST wave
159
infarction is what wave
Q wave
160
