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Adult Health I > T1: Acute Coronary Syndrome (2) > Flashcards

T1: Acute Coronary Syndrome (2) Flashcards

1
Q

What area of the heart is the most frequent site of MI?

A

Left Ventricle

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2
Q

Why is the LV the most frequent site of MI?

A

It is the larger muscle, does most of the work so more blood is required there

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3
Q

Type of damage to heart muscle that involve ALL 3 cardiac layers:

A

Transmural

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4
Q

Type of damage to heart that is limited, does not involve all layers:

A

Nontransmural

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5
Q

What are the 3 cardiac layers?

A

ENDOcardium
MYOcardium
EPIcardium

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6
Q

What layers may be affected by nontransmural damage, but not all at once?

A
  • subendocardial
  • endocardium
  • epicardium
  • subepicardium
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7
Q

Anterior wall MI:

  • Major vessel
  • ECG leads
A
  • LAD
  • V3-V4
    (Remember: the “Vs” look like upside down A for Anterior)
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8
Q

Inferior wall MI:

  • Major vessel
  • ECG leads
A
  • RCA
  • II, III, aVF
    (Remember: II & III look like I for Inferior)
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9
Q

Blockage in the left main coronary artery is nicknamed the _____.

A

widowmaker

major damage - feeds the LV

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10
Q

Prominent ST elevation is nicknamed _____. Why?

A

tombstone

high likelihood of death

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11
Q

Is MI pain relieved by NTG or rest?

A

No

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12
Q

Location of MI pain?

A

beneath sternum

epigastric

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13
Q

Duration of MI pain?

A

> 30 min

Remember: 20 min is the limit for cardiac muscle

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14
Q

Quality of MI pain?

A

Pressure, burning

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15
Q

Radiation of MI pain?

A

back, neck, jaw, left arm

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16
Q

Associated symptoms of MI pain?

A

N/V

diaphoresis

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17
Q

4 Biomarkers of MI:

A
  • Troponin I
  • Troponin T
  • CK-MB
  • Myoglobin
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18
Q

Normal value of Troponin I:

A

less than 0.03 ng/L

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19
Q

Troponin I elevates after ___ hrs and peaks at ___ hrs. Returns to normal in ___ - ___ days.

A

elevates: 3 hrs
peaks: 24 hrs
normalizes: 5-10 days

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20
Q

Normal value of Troponin T:

A

less than 0.2 ng/L

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21
Q

Troponin T elevates after ___-___ hrs and peaks at ___-___ hrs. Returns to normal in ___-___ days.

A

elevates: 3-5 hrs
peaks: 12-48 hrs
normalizes: 14-21 days

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22
Q

Normal value of CK-MB?

A

0%

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23
Q

CK-MB elevates after ___-___ hrs and peaks at ___ hrs. Returns to normal in ___-___ days.

A

elevates: 4-6 hrs
peaks: 24 hrs
normalizes: 2-3 days

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24
Q

Normal value for myoglobin:

A

less than 90 mcg/L

25
Q

Myoglobin elevates after ___ hrs and peaks at ___-___ hrs. Returns to normal in ___ hrs.

A

elevates: 2 hrs
peaks: 3-15 hrs
normalizes: 24: hrs

26
Q

Which biomarker?

Proteins released from damaged cardiac cells

A

Troponin I
Troponin T
(Troponin = cardiac)

27
Q

Which biomarker?

Serum MB fraction of enzyme Creatine Kinase

A

CK-MB

CK = Creatine Kinase

28
Q

Which biomarker?

Oxygen carrying protein found in cardiac and skeletal muscle

A

Myoglobin

Myo = muscle

29
Q

Why would WBC levels rise after MI?

A

inflammation due to necrotic muscle tissue

30
Q

WBC levels elevate within ___ hrs of pain, peak in ___-___ days, normalize within a ___.

A

elevate: 2 hr
peak: 2-4 days
normalize: week

31
Q

Why would blood glucose levels rise after MI?

A

due to increased catecholamines

Remember steroids effect glucose levels

32
Q

What 4 things should be done when an MI is occurring?

A 
(Remember MONA)
Morphine
Oxygen
Nitroglycerine
Aspirin
33
Q

List long term treatments for MI:

A
  • Reperfusion
  • Cardiothoracic surgery
  • Anticoagulation
  • Dysrhythmia prevention
  • Intensive glucose therapy
  • Prevention of ventricular remodeling
34
Q

List 2 reperfusion strategies after an MI:

A
  • fibrinolytic therapy

- percutaneous coronary intervention (PCI)

35
Q

What is the purpose of “fibrinolytic therapy”?

A

bust up the clot

36
Q

Fibrinolytic therapy:

perform ____ hrs after onset of signs of MI. The goal is less than ____ min after admission.

A

less than 12 hrs

less than 30 min

37
Q

Fibrinolytic therapy:

What chemicals are used?

A 
CLOT SPECIFIC:
t-PA (tissue plasminogen activator)
-- Alteplase (t-PA)
-- Retaplase (r-PA)
-- Tenectoplase (TNKase)
NON-CLOT SPECIFIC:
-- Streptokinase (SK)
38
Q

PCI:

What is the timing goal to get the pt to cath lab?

A

Door to needle:

39
Q

PCI:

What is the procedure called when the vessel is opened with a balloon?

A

angioplasty

40
Q

T/F: Cardiothoracic surgery is a good intervention in an emergency situation?

A

FALSE:

It is not fast enough to address the blockage immediately. Usually a scheduled procedure.

41
Q

Anticoagulation:

List 3 methods of this therapy:

A
  • ASA
  • Heparin
  • Glycoprotein IIb/IIIa Inhibitors
42
Q

Anticoagulation:

What does ASA do?

A

decreases platelet aggregation

43
Q

Anticoagulation:

What does Heparin do?

A

prevents re-occlusion

44
Q

Anticoagulation:

What do Glycoprotein IIb/IIIa inhibitors do?

A
  • prevents platelet aggregation

- prevents fibrinogen from binding to receptors on platelet surface

45
Q

Anticoagulation:

Examples of glycoprotein IIb/IIIa inhibitors:

A
  • Integrelin (eptifibatide)
  • Aggrastat (tirofiban)
  • ReoPro (abciximab)
46
Q

Dysrhythmia prevention:

Name 2 types of meds for this:

A
  • amiodarone

- beta blockers

47
Q

Intensive glucose therapy:

What is a normal serum glucose value?

A

70-110 mg/dl

48
Q

Prevention of ventricular remodeling:

What types of meds are good for this?

A
  • ACE inhibitors

- ARBs

49
Q

What does NTG do in the body?

A
  • vasodilator…reduces preload & afterload

- increases coronary artery perfusion

50
Q

What should we watch for when giving NTG?

A

BP can bottom out…have pt sit/lie down

51
Q

What do beta blockers do in relation to heart dysrythmias?

A

protect heart from sympathetic stimulation which decreases risk of vent. fib.

52
Q

Beta blockers are contraindicated in pts with ____.

A

asthma

53
Q

What do calcium channel blockers do for the heart?

A
  • relieves coronary vasospasms

- decreases need for O2

54
Q

What does morphine do for the heart?

A
  • vasodilation

- decreases need for O2

55
Q

Dose and frequency of morphine administration?

A

2-10 mg every 5-15 min

56
Q

Why should people with MI be on bedrest?

A

decreases myocardial O2 demand

57
Q

How should an MI pt be monitored?

A
  • 12 lead ECG
  • vitals q15 min til stable
  • SpO2 continuously
  • Serial biomarkers
  • Monitor PT/PTT
  • Watch for hemodynamic compromise
  • Watch for signs of HF
58
Q

What drugs can be given to increase cardiac contractility?

A

dopamine

dobutamine

59
Q

What are some signs of HF to watch for?

A
  • S3, S4, rales
  • edema, weight gain
  • decreased CO
  • decreased UOP

Adult Health I (10 decks)

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