management of a Patient with Acute Coronary Syndrome Flashcards
What artery comes off the aorta and runs down the right lateral aspect of the heart and to the posterior side of the heart. It
supplies blood to the right ventricle, SA, and AV node
Right coronary artery
What artery is small segment off the aorta and then branches into the Left Anterior Descending artery (LAD)
Left main coronary artery
What artery supplies the anterior and septal part of the left ventricle and the Left Circumflex artery (LCx) which supplies the left lateral aspect of the left ventricle.
Left main coronary artery
What artery supplies blood to the right ventricle, SA, and AV node.
Right coronary artery
The coronary veins will all drain their deoxygenated blood into the ____
coronary sinus
Oxygenated blood enters either the right or left coronary vessels from what?
the Aorta
Coronary sinus then drains its blood into what?
right atrium
Most tissues extract only about 25% of the
oxygen in arterial blood. However, the myocardium extracts about ____ of the oxygen resulting in a saturation of only about 30%.
65%
The myocardium, unlike many other tissues, (CAN/CANNOT) compensate for a reduction in blood flow by extracting more oxygen from hemoglobin
CANNOT
____is chest pain due to myocardial oxygen demand exceeding delivery (aka ischemia). It is commonly caused by atherosclerotic disease.
Angina
Definition of what
Chest pain while resting. Initially this presents the exact same as NSTEMI until 4-8 hours after the symptoms begin when you will start to get elevated cardiac markers.
Unstable Angina
what type of angina
Rare, caused by coronary vasospasm often without any CAD. DRUGS?
Prinzmetal’s Angina
Myocardial ischemia is due what?
oxygen demand exceeding supply
Because myocardial tissue extracts the maximum amount of oxygen (65%) from hemoglobin increased oxygen requirements must be met by what?
.
increased coronary blood flow
Coronary blood flow occurs only during what phase?
ventricular diastole
These will do what to myocardial oxygen requirements?
1) Increased HR
2) Increased afterload
3) Increased contractility
4) Increased amount of muscle (from left ventricular or right
ventricular hypertrophy)
5) Increased left ventricular end diastolic volume.
6) Increased Preload
increase……
What can increase myocardial oxygen content?
What is the most important durring AMI
- Increased coronary blood flow either by coronary dilation or by increased diastolic blood pressure
- Decreasing HR (most important)
- Increasing hemoglobin if it is < 10 g/dL
What can increase myocardial oxygen content?
What is the most important durring AMI
- Increased coronary blood flow either by coronary dilation or by increased diastolic blood pressure
- Decreasing HR (most important)
- Increasing hemoglobin if it is < 10 g/dL
In young individuals with NSTEMI or STEMI without any risk factors, what would you suspect?
cocaine use
cocaine use can cause what ?
intense vasoconstriction or coronary dissection leading to myocardial necrosis
These symptoms may indicate what?
- Substernal chest pain
- Diaphoresis
- Nausea and vomiting
- Anxiety
- Intense feeling like they are going to die
Acute Coronary Syndrome
Can hear a S3 heart sound indicates what?
large amounts of blood entering the LV quickly into a compliant ventricle indicating volume overload (CHF)
Chest Radiograph is used to look for what?
Check for signs of CHF, but may lag behind other physical exam findings
what is the #1 goal of treatment
prevent further cardiac tissue damage
What is the treatment of acute coronary syndrome
Administer 4L NC oxygen if saturation < 94%,
ONAM protocol
What the meds and doses in the ONAM protocol?
- O2 4L NC if sat <94%
- Nitroglycerine 0.4 mg sublingual q5min prn chest pain, max dose 3 doses in 15 min
- Aspirin 160-325 mg daily chewable
- Morphine 4-8 mg IV for chest pain unresponsive to Nitroglycerine
Lovenox in the event of STEMI dosage
30 mg IV bolus followed by 1 mg/kg SC q12 hours given 15 minutes after the IV bolus
Lovenox in the event of NSTEMI dosage
1 mg/kg SC q 12 hours with ASA
You can tell in which area of the heart and which coronary vessel is blocked in an STEMI based on which what?
leads have the ST elevation.
Metoprolol dosing for
STEMI
NSTEMI
- STEMI with tachycardia in absence of hypotension give 5mg IV q 5 minutes to a max dose of 15 mg
- In the event of a NSTEMI start with 50mg PO BID.
NSTEMI vs STEMI EKG
NSTEMI may show ST segment depression, T wave inversion, or no changes at all.
STEMI will show a classic evolution of changes from ST segment elevation, T wave inversion, and finally Q wave development
How would you treat a PT with a new left bundle block with symptoms of AMI?
Same as STEMI
