Term
| Acute coronary syndromes umbrella term for |
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Definition
unstable angina
non-Q wave MI
Q wave MI
ST elevations MI
Non ST elevation MI |
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Term
| how much of vessel must be occluded in order for us to experience symptoms |
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Definition
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Term
| What happens when plaque in arteries ruptures |
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Definition
| plaque (calcium build up) ruptures then the body sees this as injury and sends in platelets that stick tother and make clots that cause occlusion. |
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Term
| What is angina pectorals? what causes it |
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Definition
| chest pain caused by myocardial ischemia caused by lack of oxygen to the myocardium. More oxygen demand than supply causing lactic acid build up. |
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Term
| Clinical descriptors of Chest Pain? 7 |
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Definition
substernal epigastric heavy constricting crushing pressure tightness
often associated with nausea or heart burn |
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Term
| Three places chest pain commonly radiates |
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Definition
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Term
| Chest pain is usually associated with |
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Definition
SOB
Palpitations
Diaphoresis
N/V |
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Term
| what determines where chest pain radiates? |
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Definition
| where the infection is in the heart |
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Term
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Definition
| pt knows they have calcium in coronary vessels, come to ED first time but are sent home with nitroglycerin and advised to stop smoking and drinking and start exercising. means if things don't change there will be problems in future. |
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Term
| Three times when people experience stable angina? |
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Definition
| 3 E's exertion, eating, emotional excitement. |
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Term
| what relieves stable angina symptoms? |
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Definition
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Term
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Definition
| change in previous pattern of angina or new onset of severe angina, usually more intense. |
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Term
| When is severe angina considered a medical emergency |
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Definition
| when it lasts longer than 20 minutes and is not relieved by nitroglycerin |
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Term
| ischemia and injury cause changes is what part of the ECG? |
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Definition
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Term
| What does ischemia look like on ECG? |
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Definition
| ST depression (once ischemia goes away then the ST will return to normal on ECG) |
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Term
| what does injury look like on ECG |
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Definition
| elevated ST segment (following injury the st wave will go back to normal and no longer look elevated on ECG) |
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Term
| What does necrosis of myocardium look like on ECG |
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Definition
| Q depression, necrosis causes permanent damamge, once it dies then it will never come back to life, so ECG following heart attack will always show this Q depression. |
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Term
| Non ST Elevation MI (NSTEMI) |
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Definition
| abnormal levels of serum enzymes released but no q wave. this MI has lower in-hospital mortality and complication rates. |
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Term
| NSTEMI pt have increased incidence of what later on ? |
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Definition
| subsequent cardiac events. |
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Term
| what does NSTEMI ECG look like |
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Definition
no Q wave
ST deviation or T wave changes occur |
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Term
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Definition
abnormal levels of cardiac biomarkers
tend to be larger
higher pre-hospital and in hospital mortality |
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Term
| What is STEMI associated with |
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Definition
| more prolonged and complete coronary thrombosis |
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Term
| three ways to diagnosis ACS |
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Definition
History
ECG
Enzyme Markers |
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Term
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Definition
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Term
Cardiac Enzyme marker: CK-MB (Creatinine kinase, myocardial band).
Where does it occur?
onset?
Peak?
Duration? |
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Definition
occurs predominately in cardiac muscle
4-8 hours
10-24 hours
48-72 hours |
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Term
Cardiac Enzyme Marker: Troponin (T/I)
where does it occur
% sensitivity
onset, peak, duration |
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Definition
occurs in unique structure in cardiac muscle ([art of actin-myocin unit)
100% sensitivity
2-4 hours
24-36 hours
7-14 days |
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Term
| in what order is MONA given |
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Definition
ONMA
oxygen before morphine because when you come in with chest pain, it is supply and demand, readily available, nitrates next you want to see what happens following nitrate admin. morphine may change action of heart so given next, vasodilation reduces preload, helps with anxiety aspirin is given last because it helps to prevent problems in the future. |
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Term
| Why is Oxygen given with ACS? |
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Definition
| monitor for adequate arterial oxygenation |
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Term
| why is aspirin given with ACS |
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Definition
| anti-platelet effect (NOT ENTERIC COATED) |
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Term
| Why are nitrates given with ACS |
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Definition
| dilates coronary arteries, vasodilator |
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Term
| why is morphine given with ACS |
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Definition
| pain relief, vasodilatior |
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Term
| how much morphine do you admin with ACS |
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Definition
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Term
| Why do you give morphine to some ACS patients |
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Definition
| antithromboitc -prevents further clot formation |
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Term
| what drug do you commonly give to those with NSTEMI |
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Definition
| low molecular weight heparin with NSTEMi |
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Term
| WHy do you give Plavix to ACS patients (ticlid) |
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Definition
| inhibits platelet aggregation |
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Term
| You administer plavix with aspirin in what three situations |
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Definition
unstable angina
NSTEMI
PTCA |
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Term
| Why do you administer integrilin/Reopro/Aggrastat with ACS |
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Definition
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Term
| When do you give calcium channel blockers with ACS |
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Definition
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Term
| What patients is it important to give ACE inhibitors with ACS |
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Definition
| Those at risk for heart failure |
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Term
| when do you give ACE inhibitors with ACS |
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Definition
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Term
| Three effects of beta blocks with ACS |
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Definition
decreases O2 demand
decreases heart rate
decreases BP
(will decreases intact size) |
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Term
| when do you give beta blockers following ACS |
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Definition
| intravenously within first few hours. |
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Term
| How long is forgiveness of heart muscle |
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Definition
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Term
| two indications for fibrinolytic therapy (therapy to break up big clots) |
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Definition
chest pain for less than 12 hours
st segment elevation of at least 0.1mv in at least 2 continuous leads |
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Term
| Three repercussion therapies |
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Definition
fibrinolytic therapy
percutaneous coronary intervention (PCI)
Coronary artery bypass graft |
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Term
| five catheter interventions for CAD |
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Definition
percutaneous coronary intervention (PCI)
percutaneous transluminal coronary angioplasty (PTC)
atherectomy
stents
radiation therapy for intrastent stenosis |
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Term
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Definition
| catheter with balloon at distal end placed into after with plaque buildup, balloon inflated to open up plaque, stent added at this site. |
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Term
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Definition
| excision and removal of atherosclerotic plaque by cutting shaving or grinding. |
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Term
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Definition
| expandable stent placed in coronary artery to prevent restenosis, requires antiplatelet therapy post procedure because you are putting metal into the vessel, |
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Term
| drugs following stent placement |
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Definition
integrilin for 12 hours
Ticlid or Plavix (anticoagulant ) for 4-6 weeks
aspirin for rest of life |
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Term
| Complications with heart catheterization and repercussion therapy |
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Definition
ARF
Hematoma formation
bleeding at site
retroperitoneal bleeding
femoral artery occlusion
coronary artery vessel injury
coronary artery vessel perforation |
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Term
| Angioplasty on diabetic patients? |
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Definition
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Term
| Preferred invasive approach evascularization on pt with DM is? |
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Definition
| CABG using internal mammary artery (bypass surgery) |
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Term
| Reprofusion Ectopy associated with what? |
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Definition
dysrhythmias
abnormal beats
successful reprofusion of coronary after
vtach
vfib
SVT
AV block |
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Term
| What is coronary artery bypass graft |
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Definition
| myocardial revascularization using a conduit to bypass an occluded coronary artery. takes internal mamarry artery and bypasses an occluded vessle |
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Term
| complications of cardiopulmonary bypass |
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Definition
Emboli (1-5%)
destruction of RBC and platelets
activation of inflammatory response ----> capillary leak, organ failure
myocardial depression
post operative diuresis --> electrolyte depletion |
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Term
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Definition
| new technique to open heart valve (mitral valve) by stretching the valve leaflets apart |
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Term
| risk of ballon valvuloplasty |
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Definition
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Term
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Definition
monitor:
-HR EKG, temp, bp, pap, pawp, cvp, co/CI
-fluid balance
-pain management
-pulmonary toilet
-prevention of infection
rapid weaning for mech. vent.
temp pacer at bed |
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Term
| five post op complications |
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Definition
bleeding
dysrhythmia
electrolyte imbalance
infection
emboli with prosthetic valves |
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