Flashcards in ACS Deck (32):
What is the pathophysiology of ACS?
Artheromstous plaque formation in coronary vasculature, exposing fibrin, collagen, cholesterol and cellular debris
This creates stimulation for: platelet adhesion, aggregation, thrombus formation and localised vasoconstriction
ACS is a ...
Critical stage of IHD with differing degrees of occlusion and embolisation
What is the pathophysiology for a stable angina?
Stable intact lesion
What is the pathophysiology of unstable angina?
Breached endothelium with or without superimposed fibrin clot and coronary spasm
What is the pathophysiology of an MI?
Plaque rupture with superimposed fibrin clot leading to total coronary occlusion and coronary spasm
How do you diagnose ACS?
What is the rational for the assessment of ACS?
Improve and maintain pt nurse relationship
What are the possible differential diagnosis for a of presenting with ACS?
Dissecting aortic aneurysm
Chest wall pain
What is the PQRST assessment of chest pain?
Region and radiation
Severity and associated symptoms
What is included in precipitating factors for Chest pain assessment?
What factors precipitated discomfort?
What was happening at symptom onset?
What is included in qualitative factors in chest pain assessment?
What does pain feel like in own words
How did or feel at time of pain?
What is included in region and radiation for chest pain assessment?
Where and how far pain spreads
Pain normally in left arm, inner aspect of arm sometimes as far as fingers, jaw (not to ear), neck, back, epigastrium
What is included in severity and associated symptoms for chest pain assessment?
How bad is the pain?
Aware of any other pain?
What is included in timing for the chest pain assessment?
How long did it last?
What makes the pain better?
What are the or groups with atypical presentations of ACS?
What are the risk factors for ACS?
What are the symptoms of ACS?
Autonomic nervous system activation
What does ST depression mean?
Ischaemia, left ventricular hypertrophy,
What does ST elevation mean?
What does T wave flattening mean?
Ischaemia and hypokalaemia
What are the STEMI ECG changes?
Total coronary occlusion
Ongoing chest pain
Persistent ST elevation
Raised biochemical markers
What are the non STEMI ECG changes?
Acute ishaemic event
Various ECG changes: persistent ST depression and/or T wave inversion, flattened T waves, normal ECG
Raised biochemical markers
What are the biochemical markers associated with ACS and how long are they present?
CK creatin kinase: released after irreversible clear injury from hypoxia, takes 4-6 hrs to rise and 24hrs to peak
Troponin: released after myocardial damage, 3-4 hrs to detect and elevated 1-2 weeks
What is the treatment for an MI?
Aspirin 300 mg chewed
What are the key priorities NICE guidelines (2010) for ACS?
12 lead ECG asap
Recording and sending ECG should not delay transfer to hospital
Don't routinely administer O2 (monitor SATs)
Don't assess symptoms of an ACS differently in ethnic groups
What is the treatment for angina?
Drugs that reduce cardiac workload: beta blockers, nitrates, calcium channel blockers
Drugs that reduce the risk of infarction: anti platelet drugs
Drugs that reduce cholesterol: statins
What is the treatment for MI?
Primary angioplasty reduces death, stroke and non fatal infarction
CABG of diffuse disease
PCI = reperfusion and stroke reduction benefits after 3 hrs
Thrombolysis where no PCI available
What are the benefits of primary angioplasty for ACS pts?
More effective restoration of patency
Improved LV function
Reduction in re-occlusion
Reduced stroke risk
Reduction in hospital stay
What is the continuing care of a pt with an MI?
Monitor for arrhythimas
Secondary prevention/rehab (lifestyle, cardiac rehab, drug therapy, cardiologist review)
What is cardiac rehab?
Tailored to individual needs
Includes: health education, stress management and exercises
What is the drug therapy for pts post MI?