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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
Q

CBC

A

Leukocytosis is common (due to injury/ inflammation)

26
Q

c- reactive protein (inflammatory marker)

A

May be elevated
Usually order HS-C reactive Protein
Not definitive
Appears after MI and unstable angina

27
Q

Echo

A

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
Q

EF indicative of HF

A

<40

29
Q

therapeutic O2 for tx AMI

A

*place O2 to prevent tissue damage
esp with <95%
should be above 90%

30
Q

pain relief for pt with AMI

A
  1. nitro 2. morphine

opens vessels and relieves pain

31
Q

MONA

A

morphine, O2, nitro, aspirin

*not in order

32
Q

Angiography

A

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
Q

reperfusion strategies for AMI

A

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
Q

management for inc O2 demand

A

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
Q

complications of AMI

A 
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
Q

hx indicative for coronary risk factors

A 
CAD
Angina
Heart failure
Cardiac Surgery
Cardiac medications
37
Q

change in BP due to AMI

A

Hypotensive <90 systolic (blood loss or medication)

Hypertensive (blockage, pain, anxiety)

38
Q

change in HR due to AMI

A

< 60 can be due to brady dysrhythmia or heart block
> 100 can be due to CHF or a tachy dysrhythmia
Irregularities

39
Q

assessment of JVD

A

Distention: fluid overload

assess with HOB at 30 degrees sitting up

40
Q

best indicators of I&O?

A

weight

41
Q

variations in heart sounds with AMI

A

Pericardial friction rub can be 2-3 days after QWMI

Valvular murmurs due to papillary muscle dysfunction

42
Q

respiratory PE in pts with AMI

A

Breath Sound usually fine and clear unless CHF

43
Q

abdomen PE and AMI

A

Nausea/vomiting

44
Q

genitourinary and AMI

A

Urine Output < 30 cc/hr due to

45
Q

change in peripheral perfusion with AMI (dec)

A

Cool, pale, diaphoretic. weak, thready pulses
Decreased CO
Mottling in lower extremities

46
Q

change in temp with AMI

A

Slight increase due to inflammatory response for 48- 72 hours

47
Q

steps to take to detect sig changes in cardiovascular status or complications

A 
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
Q

decrease thrombogenicity

A

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
Q

assess for DVT

A 
color
girth
temperature of extremities
presence of tenderness 
cords in lower extremities
50
Q

pt sx that would require immediate medical attentions

A

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
Q

guideline for pts who require nitro

A

Every 5 minutes X 3, then call 911

If never had before take one and call 911

52
Q

beta blockers

A

(-olol) dec HR and BP, dec workload of heart

53
Q

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?

A

Pericarditis bc relief with anti-inflammatory and change of position

54
Q

heart healthy diet for AMI pt

A

low fat, low cholesterol, low sodium

55
Q

What percentage of deaths from coronary artery disease is directly attributable to cigarette smoking?

A

21%

NUR102 Unit 6 Cardiology (4 decks)

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