Heart 4b Flashcards
Signs if myocardial infarction
Pain-severe, immobilising chest pain not relieved by rest and medication
Sympathetic nervous system stimulation- diaphoresis, vasoconstriction of peripheral blood vessel
Increase cardiac symptoms
Nausea and vomiting
Fever
Elevated inflammatory markers
Atypical presentation mi
1/3 of pts may not present classic signs
Atypical presentation is increasingly likely in particular patient groups
Differentail diagnosis of causes of chest pain
Ischaemic cardiovascular causes
Non- cardiovascular causes of chest pain
Non-cardiovascular causes
Ischaemic cardiovascular causes
Acs
Stable angina
Aevere aprtic stenosis
Tachyarrhythmia
Non-ischaemic cardiovascular causes of chest pain
Aortic dissection
Pulmonary embolism
Pericarditis and myocarditis
Gastrointestinal cause
Non-cardiovascular causes
Musculoskeletal causes
Pulmonary
Other aetiologies
Management of chronic stable angina
Life changes
Drug therapy
Cardiac catherisation
Drug therapy chronic stable angina
Nitrates- long and short Angiotensin converting enzymes(ace 1) or angiotensin 11 receptor blockers - result in vasodilation and reduced blood volume Beta blocker- elevated lv dysfunction Calcium channel blockers Lipid lowering drugs
Cardiac catherisation
Increasing symptoms
If blockage is amenable to intervention then coronary revascularisation with percutaneous coronary intervention (pci)
Diagnosis of acs
Initial clinical evaluation and management on presentation to ed Initial rapid evaluation and dd 12 lead ecg Blood samples for biomarkers Oxygen therapy Initial pharmacology
Drug therapy for acute coronary syndrome
Anti-ischaemic therapies
Antiplatelet therapy
Anticoagulant therapy
Intravenous direct thrombin inhibitors
Anti- ischaemic therapies
Oxygen
Nitrates
Beta-blockers
Opioid analgesia
Antiplatelet therapy
Aspirin
P2y12
Glycoprotein 11b/111a
Anticoagulant therapy
Heparin and enoxaparin
Intravenous direct thrombin inhibitors
Bivalirudin
Alternate cholesterol lowering agents
Monoclonal antibodies
Pcsk9 inhibitors
Invasive and non-invasive management options for acute coronary syndrome
Percutaneous coronary intervention
Thrombolytic therapy
Coronary artery bypass graft
Transmyocardial laser revascularisation
Primary percutaneous coronary intervention
First line of treatment for patients with confirmed mi
Goal is to open up artery within 90 minutes of arrival at facility that has an interventional cardiac catherisation
Coronary surgical revascularisation indicated for
Fail medical management
Have left main disease
Are not candidates for pci
Have had pci and continue to have chest pain
Have diabetes
Are expected to have longer-tern benefits with cabg than with pci
Off pump vs on pump coronary artery bypass
Primary hypothesis was that off pump cabg would be associated with fewer major clinical events in the short term than on-pump that benefits of off-pump cabg would be maintained in the long term
No cost difference
Nursing care and considerations following coronary re-vascularisation
Patient assessment Monitor exg Monitor patient for arrhythmias or other changes Check vascular observation Monitor insertion site Administer medication as ordered Administer stool softeners Discharge teaching/education
Thrombolytic therapy
Availability and rapid administration in facilities without cardiac catherisation
Aims to stop the infarction process by dissolving the thrombus in the coronary artery and perfusing the myocardium
Given asap
Mortality is reduced by 25 percent if administered within the first 6 months
Patient selection is important as bleeding is a major complication
Transmyocardial laser revascularisation
Involves the use of high energy laser therapy to create channels in the hearrcto allow blood to flow to ischemic areas
Procedure is performed during catherisation or inctheathre as a thorcotomy
An optioncfor patientswith advanced cad who are nit candidates for cabg and have persistent angina after medical therapy
