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Flashcards in ACS Deck (32):
1

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

2

ACS is a ...

Critical stage of IHD with differing degrees of occlusion and embolisation

3

What is the pathophysiology for a stable angina?

Stable intact lesion

4

What is the pathophysiology of unstable angina?

Breached endothelium with or without superimposed fibrin clot and coronary spasm

5

What is the pathophysiology of an MI?

Plaque rupture with superimposed fibrin clot leading to total coronary occlusion and coronary spasm

6

How do you diagnose ACS?

Pt history
Typical symptoms
ECG changes
Biochemical markers

7

What is the rational for the assessment of ACS?

Diagnostic
Therapeutic
Humanistic concern
Improve and maintain pt nurse relationship
Accountability

8

What are the possible differential diagnosis for a of presenting with ACS?

Angina pectoris
MI
Pericarditis
Dissecting aortic aneurysm
Tracheobronchitis
Pleural pain
Reflux oesphagitis
Chest wall pain
Anxiety

9

What is the PQRST assessment of chest pain?

Precipitating factors
Qualitative factors
Region and radiation
Severity and associated symptoms
Timing

10

What is included in precipitating factors for Chest pain assessment?

What factors precipitated discomfort?
What was happening at symptom onset?

11

What is included in qualitative factors in chest pain assessment?

Describe pain
What does pain feel like in own words
How did or feel at time of pain?

12

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

13

What is included in severity and associated symptoms for chest pain assessment?

How bad is the pain?
0-10
Aware of any other pain?

14

What is included in timing for the chest pain assessment?

How long did it last?
What makes the pain better?

15

What are the or groups with atypical presentations of ACS?

Women
Elderly
Diabetes
Ethnic minority

16

What are the risk factors for ACS?

Smoking
Hypercholestraemia
Diet
Sedentary lifestyle
Alcohol consumption
Hypertension
Obesity
Socioeconomic deprivation
Diabetes

17

What are the symptoms of ACS?

Chest pain
Hypotension
Autonomic nervous system activation
Pallor
Sweating
Rhythm disturbances

18

What does ST depression mean?

Ischaemia, left ventricular hypertrophy,
Digoxin toxicity

19

What does ST elevation mean?

Acute MI

20

What does T wave flattening mean?

Ischaemia and hypokalaemia

21

What are the STEMI ECG changes?

Total coronary occlusion
Ongoing chest pain
Persistent ST elevation
New LBBB
Raised biochemical markers

22

What are the non STEMI ECG changes?

Acute ishaemic event
Chest pain
Various ECG changes: persistent ST depression and/or T wave inversion, flattened T waves, normal ECG
Raised biochemical markers

23

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

24

What is the treatment for an MI?

Immediate treatment
ECG
Aspirin 300 mg chewed
Clopidogrel
Pain relief

25

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

26

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

27

What is the treatment for MI?

Primary angioplasty reduces death, stroke and non fatal infarction
CABG of diffuse disease
PTCA
PCI = reperfusion and stroke reduction benefits after 3 hrs
Thrombolysis where no PCI available

28

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
Improved survival
Reduction in hospital stay

29

What is the continuing care of a pt with an MI?

Monitor for arrhythimas
Pain management
Secondary prevention/rehab (lifestyle, cardiac rehab, drug therapy, cardiologist review)

30

What is cardiac rehab?

Tailored to individual needs
Culturally sensitive
Includes: health education, stress management and exercises

31

What is the drug therapy for pts post MI?

ACE inhibitors
Aspirin indefinitely
Clopidogrel
Beta blockers
Statins

32

What is the definition of ACS?

A combination of clinical signs and symptoms resulting from myocardial ischaemia
Includes: unstable angina, STEMI and non STEMI