ACS

Question 1

acute coronary syndrome (ACS)

Answer 1

a progression of coronary events
stable angina or unstable angina
STEMI or NSTEMI

Question 2

unstable angina EKG

Answer 2

can be:

1. normal
2. inverted T waves
3. ST depression

Question 3

unstable angina etiology

Answer 3

chest pain caused by ruptured or thickened plaque with platelet and fibrin thrombus causing increased coronary obstruction

Question 4

unstable angina symptoms

Answer 4

irregular/unpredictable chest pain of increasing intensity, frequency, or duration
occurs at rest or with minimal activity
unresponsive to NTG

Question 5

unstable angina pharmological treatment

Answer 5

NTG
beta blockers
tissue plasminogen activators (tPA)
O2
clopidogrel
morphine
statins
aspirin

Question 6

coronary artery disease (CAD)

Answer 6

leading global cause of death
number 1 cause of death in US
leading cause of death for women

Question 7

acute coronary syndrome (ACS) patho

Answer 7

clinical manifestation of coronary disease
development of fatty plaques in artieries
narrows coronary vasculature and limits blood flow and oxygen delivery to coronary muscle

Question 8

acute coronary syndrome modifiable risk factors

Answer 8

alcohol/tobacco use
HTN
sedentary lifestyle/obesity
dyslipidemia
DM

Question 9

acute coronary syndrome innate risk factors

Answer 9

age
gender
heredity
stress
menopause

Question 10

angina pectoris

Answer 10

“strangling chest”

chest pain caused by myocardial ischemia

Question 11

ischemia

Answer 11

occurs when oxygen supply > oxygen demand

Question 12

angina pectoris precipitating caues

Answer 12

exertion
temperature extremes
emotional stress
large meal
tobacco
sexual activity 
stimulant use
circadian rhythm patterns

Question 13

stable angina etiology

Answer 13

myocardial ischemia

Question 14

stable angina symptoms

Answer 14

episodic pain lasting 5-10 minutes
aggravated by exertion, cold, eating, emotional stress
relieved by rest, NTG

Question 15

stable angina pharmacological treatment

Answer 15

NTG
aspirin
beta blockers
calcium channel blockers
ACE inhibitors

Question 16

variant angina causes

Answer 16

coronary vasospasm

Question 17

variant angina symptoms

Answer 17

occurs at rest without provocation
triggered by smoking
occurs with or without the presence of CAD
transient ST-segment elevation during pain
often associated with AV block or ventricular arrhythmias

Question 18

variant angina treatment

Answer 18

calcium channel blockers

Question 19

myocardial infarction (MI)

Answer 19

occurs when heart muscle is abruptly deprived of oxygen
ischemia is the first phase
injury occurs when tissue is injured from lack of O2
necrosis = death of myocardium tissue

Question 20

location of MI

Answer 20

mostly occurs in left ventricle and categorized by the wall of left ventricle it occurs upon
anterior wall is caused by occlusion left anterior descending artery (LAD) and is 25% of MIs with highest mortality rate
lateral wall occurs with occlusion of circumflex artery
inferior wall occurs with occlusion of right coronary artery (RCA)

Question 21

NSTEMI

Answer 21

associated with ST segment depression or T wave inversion on ECG
occurs as a result of subtotal occluding thrombus
may be undistinguishable from unstable angina without serologic evidence of myocardial necrosis

Question 22

NSTEMI assessment and treatment

Answer 22

admission
serial EKGs, cardiac enzymes
rest 24-48 hrs
continuous bedside EKG
analgesics
supplemental O2
pharmacological therapy

Question 23

STEMI

Answer 23

ST segment is elevated
most common cause is reduced myocardial perfusion 2/2 occlusive thrombus
reperfusion therapy should be initiated within 12 hours of symptom onset

Question 24

APQRST

Answer 24

Associated sx
Precipitating factors
Quality
Region/radiation/risk factors
Severity
Timing

Question 25

ACS nursing actions

Answer 25

``` place pt in semi-Fowlers EKG within 10 minutes draw blood, start IV initiate treatment frequent vitals ```

Question 26

ACS nursing actions (meds)

Answer 26

``` NTG if systolic >90 supplemental O2 morphine IV beta blockers ACE inhibitors ```

Question 27

ECG manifestations

Answer 27

crucial within 10 min deviation of ST segment will determine amt of damage to heart muscle prolonged ST elevation, new LBBB or new Q waves indicate STEMI NSTEMI may present with ST depression or T wave inversion

Question 28

ischemia ECG changes

Answer 28

T wave inversion ST depression > 0.5mm ST that remains at baseline for > 0.12 seconds

Question 29

injury ECG

Answer 29

ST segment elevation of 1mm or more above baseline | T wave may be taller and pointed

Question 30

infarction ECG

Answer 30

>3mm ST segment elevation in 2 contiguous leads

Question 31

troponin I

Answer 31

most accurate marker of myocardial injury increase in blood 4-12 hrs peaks in 12 hrs and remains elevated for 4-10 days

Question 32

troponin T

Answer 32

may be predictive of MI size | >0.01 ng/mL considered elevated

Question 33

exercise testing

Answer 33

focuses on ECG during exercise | gives info about dysrhytmias, HR, BP, exertion rate, exercise capacity, myocardial O2 update, VO2, ventilator threshold

Question 34

cardiac catheterization

Answer 34

used to determine exact location of the myocardial injury and specific obstructions to coronary vasculature

Question 35

anti-ischemic meds

Answer 35

NTG morphine beta blockers

Question 36

anti-thrombotic therapy

Answer 36

aspirin P2Y12 inhibitor (clopidogrel or ticagrelor) unfractionated heparin low molecular weight heparin

Question 37

percutaneous transluminal coronary intervention (PTCI)

Answer 37

placement of stent into narrowed coronary artery percutaneous balloon angioplasty (PTCA) reperfuse myocardium antiplatelet therapy required