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NUR102 Unit 6 Cardiology > MI > Flashcards

MI Flashcards

1
Q

coronary arteries of the heart

A

RCA, acute marginal, posterior descending, left anterior descending, diagonals, oblique marginal, circumflex, LCA

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2
Q

ischemia

A

lack of O2

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3
Q

infarct

A

death of cells due to lack of oxygen

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4
Q

causes of acute MI

A

lumen narrowing, reduced blood flow, dec O2 delivery to muscle

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5
Q

consequences of dec O2 to the heart

A

plaque fissure or hemorrhage, coronary artery thrombosis (WBC, platelets, lipids), coronary artery spasm

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6
Q

factors influencing the amount of ischemia

A 
Size of the artery
Degree of collateral flow
Status of fibrinolytic system (anticoagulants: lovonox, aspirin, etc.)
Vascular tone
Myocardial oxygen demand
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7
Q

phase 1/4 of AMI

A

Ischemic Insult – lasts 4 hrs form the time the blood stops. Some of the area can be saved if perfused

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8
Q

phase 2/4 of AMI

A

Coagulation Necrosis – 4-48 hrs after blood has stopped, the cell is dead and there is no recovery

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9
Q

phase 3/4 of AMI

A

Healing – 48- 72 hours

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10
Q

phase 4/4 of AMI

A

Scarring – 1 wk after the infarct and can last 2 wks to several months

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11
Q

1 goal of treatment of AMI

A

early dx and re- perfusion!, time = muscle, preserve myocardial function

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12
Q

Q- wave MI

A

Usually full-thickness of myocardium involved (transmural) usually when ST elevation occurs
Sent straight to cath lab

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13
Q

non Q- wave MI

A

Usually partial thickness (subendocardial)

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14
Q

mechanisms for dx of AMI

A 
History (fam and health)
Physical Exam
ECG
Serum Markers
ECHO
Angiography
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15
Q

pertinent hx for dx of AMI

A

Chest Pain / Discomfort (75-80% of people experience sx with MI)
May occur at rest (Usually severe, prolonged)
May radiate
May feel like GI problem
***25% don’t have discomfort!

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16
Q

most common associated sx of AMI

A 
Indigestion
Nausea / Vomiting
Diaphoresis
Palpitations
Dyspnea / Fatigue
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17
Q

other sx to consider for AMI with elderly, DM, and women

A

Atypical Presentations

Anginal equivalents may mimic other conditions

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18
Q

AMI and PE

A

*extremely variable

important to est hx and monitor closely

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19
Q

12- lead EKG importance

A 
Confirmatory in ~80% of AMI’s
Obtain STAT if MI is suspected
Serial ECG’s 
ST segment elevation is indicative of acute injury
ST segment depression may indicate NQWMI
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20
Q

Myocardial injury criteria

A

injured area remains electrically + causing elevated ST segment, causes no blood flow

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21
Q

myocardial infarct

A

causes deep Q wave

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22
Q

AMI serum marker: creatine kinase MB isoenzyme (CK-MB)

A

specific to heart muscle and lower sensitivity, not as reliable as trop

appears: 3-12 hrs
peaks: 24 hrs
returns: 48-72 hrs

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23
Q

AMI serum marker: troponin

A

gold standard in dx, downside is delayed reading

appears: 3-12 hrs
peaks: 24-48 hrs
returns: 5-14 days

24
Q

AMI serum marker: myoglobin

A

highly sensitive but not specific to the heart (indicates breakdown of skeletal muscle)

appears: 1-4 hrs
peaks: 3-15 hrs
returns: 20-24 hrs

25
CBC
Leukocytosis is common (due to injury/ inflammation)
26
c- reactive protein (inflammatory marker)
May be elevated Usually order HS-C reactive Protein Not definitive Appears after MI and unstable angina
27
Echo
Can detect regional wall motion abnormalities Can define extent of infarction and assess overall LV or RV function Helps when the ECG is non diagnostic but is more time consuming Left Ventricular Function=Ejection fraction (normal 55-70) EF <40 = heart failure
28
EF indicative of HF
<40
29
therapeutic O2 for tx AMI
*place O2 to prevent tissue damage esp with <95% should be above 90%
30
pain relief for pt with AMI
1. nitro 2. morphine | opens vessels and relieves pain
31
MONA
morphine, O2, nitro, aspirin | *not in order
32
Angiography
Defines coronary anatomy / extent of disease Most acute MI’s go to Cath Lab for emergency intervention PTCA (Percutaneous coronary angioplasty) Stents Atherectomy – remove plaque
33
reperfusion strategies for AMI
Primary Angioplasty / Stent Fibrinolytic Therapy within 12 hours of symptoms onset in patient with STEMI Aspirin and Antiplatelet Therapy (Antiplatelet: Plavix, GP IIb/IIIa receptor antagonists (Integrilin, Aggrestat, ReoPro)) Heparin / Lovenox CABG (coronary artery bypass graft)
34
management for inc O2 demand
Supplemental Oxygen BP control Heart Rate control Nitroglycerin (common assoc HA “nitro HA” Beta-Blockers early (2- 24 hours) ACE Inhibitors if LVSD (left ventricle systolic dysfunction) (<40)
35
complications of AMI
``` Sudden Cardiac Death Dysrhythmias (cause of sudden death) *v-fib Left Ventricular Failure causing poor organ perfusion Hemodynamic Alterations Infarct Expansion / Remodeling LV Aneurysm Valve Rupture Ventricular Septum or Free Wall Rupture Pericarditis ```
36
hx indicative for coronary risk factors
``` CAD Angina Heart failure Cardiac Surgery Cardiac medications ```
37
change in BP due to AMI
Hypotensive <90 systolic (blood loss or medication) | Hypertensive (blockage, pain, anxiety)
38
change in HR due to AMI
< 60 can be due to brady dysrhythmia or heart block > 100 can be due to CHF or a tachy dysrhythmia Irregularities
39
assessment of JVD
Distention: fluid overload | assess with HOB at 30 degrees sitting up
40
best indicators of I&O?
weight
41
variations in heart sounds with AMI
Pericardial friction rub can be 2-3 days after QWMI | Valvular murmurs due to papillary muscle dysfunction
42
respiratory PE in pts with AMI
Breath Sound usually fine and clear unless CHF
43
abdomen PE and AMI
Nausea/vomiting
44
genitourinary and AMI
Urine Output < 30 cc/hr due to
45
change in peripheral perfusion with AMI (dec)
Cool, pale, diaphoretic. weak, thready pulses Decreased CO Mottling in lower extremities
46
change in temp with AMI
Slight increase due to inflammatory response for 48- 72 hours
47
steps to take to detect sig changes in cardiovascular status or complications
``` Complete and document cardiovascular assessment q 4 hours and PRN Assess and document HR and rhythm Assess for new murmur or S3 or S4 Assess for new crackles Assess for reduced activity tolerance ```
48
decrease thrombogenicity
Administer anticoagulants Usually Plavix and Aspirin For heparin has PT and PTT and may also be on coumadin For coumadin need INR of 2-3 (therapeutic range)
49
assess for DVT
``` color girth temperature of extremities presence of tenderness cords in lower extremities ```
50
pt sx that would require immediate medical attentions
Increase in frequency or duration of angina Shortness of breath, diaphoresis, change in quality or duration of pain Recurrent angina previously controlled by medications Heart palpitations or fainting Side effects of difficulty in maintaining medication regimen
51
guideline for pts who require nitro
Every 5 minutes X 3, then call 911 | If never had before take one and call 911
52
beta blockers
(-olol) dec HR and BP, dec workload of heart
53
A client is c/o substernal pain that spreads to the left side and back and is usually relieved with sitting upright and taking an anti-inflammatory drug. You suspect the client is most likely experiencing?
Pericarditis bc relief with anti-inflammatory and change of position
54
heart healthy diet for AMI pt
low fat, low cholesterol, low sodium
55
What percentage of deaths from coronary artery disease is directly attributable to cigarette smoking?
21%

NUR102 Unit 6 Cardiology (4 decks)

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