Acute Coronary Syndrome Flashcards
(55 cards)
Coronary artery disease
Accounts for most CV deaths in the US
Mostly caused by ______
_____ disease
Risk factors: nonmodifiable (genetics), modifiable (diet, smokin), contributing modifiable (_____)
atherosclerosis
Progressive
An example of contributing modifiable ~ Metabolic Syndrome criteria: large waist circumference (> 40” for men, >35” for women), triglyceride level (>150mg/dL), HDL (<40 for men, < 50 mg/dL for women), HTN, fasting blood sugar (>100 mg/dL)
In 90% of people, the ____ supplies the AV node and 55% the SA node.
What is the significance of this statement? What type of MI is this particularly concerning (causing blocks)?
RCA
STEMIs
Ischemia: increased myocardial oxygen demand (________) or decreased myocardial oxygen supply (_____) or both.
may cause ischemia->_____ (impaired perfusion) >_____ (no perfusion, tissue death). We must intervene to stop the progression.
How do we reduce ischemia?
myocardial oxygen demand - exercise, shoveling snow
myocardial oxygen supply - clot, anemia
injury
infarction
administer oxygen
_______: the culprit for most MIs
Blocked coronary artery
MI Classification
Affected area of the heart: anterior, lateral, inferior, or posterior
EKG changes produced: STEMI vs NSTEMI
Time-frame within progression of MI: acute, evolving, old
Ischemia, injury, and infarction: imbalance between myocardial blood supply and oxygen demand
Infarcted regions are _____ inactive
electrically
EKG evolution during acute STEMI
If successful _________ of the coronary occlusion is achieved, the elevated ST segments return to baseline without subsequent T wave inversion or Q wave development.”
Emphasizes the importance of early intervention, such as ________
early reperfusion
percutaneous coronary intervention.
A term used to refer to distinct conditions caused by a similar sequence of pathologic events that involve a temporary or permanent blockage of a coronary artery.
Patient presentation may be the same, but treatment varies on the diagnosis.
Acute Coronary Syndrome (ACS)
Acute Coronary Syndrome (ACS)
Unstable angina-
Partially occluded by a thrombus
Negative cardiac enzymes
NSTEMI-
Partially occluded by a thrombus
Positive cardiac enzymes
STEMI-
Totally occluded by a thrombus
Positive cardiac enzymes
Stable angina
What usually causes it? What usually relieves it?
Predictable. Can take nitro
Stable angina. Stable angina is the most common form of angina. It usually happens during activity (exertion) and goes away with rest or angina medication. For example, pain that comes on when you’re walking uphill or in the cold weather may be angina.
Stable angina pain is predictable and usually similar to previous episodes of chest pain. The chest pain typically lasts a short time, perhaps five minutes or less.
Unstable angina
New in onset, or chronic stable angina that increases in ________________
occurs at _________
pain refractory to ____
New in onset, or chronic stable angina that increases in frequency, duration, or severity
occurs at rest or minimal exertion
pain refractory to NTG
Know the difference between stable and unstable angina
Stable angina: predictable and consistent pain that occurs on exertion and is relieved by rest and/or nitroglycerin
•Unstable angina : symptoms increase in frequency and severity; may not be relieved with rest or nitroglycerin
Pain
PQRST
Precipitating events
Quality of pain
Radiation of pain
Severity of pain
Timing
Patient history of events particularly important with ACS. Why?
Time= determines treatment
Myocardial infarction (MI)
Irreversible myocardial cell death-_____ function of the heart stops in the necrotic area(s)
Cell death occurs after approximately ______ of ischemia
_______ causes 80-90% of all acute MIs (other causes?)
Role of collateral circulation
contractile
20 minutes
Thrombus formation
drugs, stress, allergic reactions, stress of surgery
Ischemic ST-segment depression of 0.5 mm (0.5 mV) or greater -OR- Dynamic T wave inversion with pain or discomfort / Transient ST elevation of 0.5 mm or greater for less than 20 minutes.”
NSTEMI
New ST segment elevation at the J point in at least two contiguous leads of ≥ 2 mm (0.2 mV) in men or ≥ 1.5 mm (0.15 mV) in women in leads V2-V3 and/or of ≥ 1 mm (0.1 mV) in other contiguous chest leads or the limb leads -OR- new or presumed new left bundle branch block.”
STEMI
Clinical manifestations of MI
Pain
severe immobilizing chest pain not relieved by rest, position change, or nitrate administration
“elephant on my chest”, “pressure”, “tightness”, “crushing”
Substernal, retrosternal, epigastric; may radiate to neck, jaw, arms or back
May occur at rest, with exertion, asleep, or awake
Clinical manifestations of MI
skin
ashen, clammy, & cool to touch, diaphoretic
Clinical manifestations of MI
cardiovascular
BP & HR increased at first.
Later, decreased BP with decreased cardiac output.
May have distant heart sounds, S3, S4, or loud holosystolic murmur
Clinical manifestations of MI
GI
N &V
Clinical manifestations of MI
fever
low grade within first 24 hrs up to 1 week
Clinical manifestations of MI
Pain
Skin
GI
Fever
Sympathetic nervous system
Clinical manifestations - atypical
Women: dizziness, SOB, unusual tiredness
Patients with diabetes mellitus: asymptomatic or atypical (dyspnea), “silent MI”
Older patient: change in mental status, dizziness, SOB, or a arrhythmia
Ignoring signs and symptoms
____ of the patients who die of ACS do so before reaching the hospital.
_____ or _____ is precipitating rhythm
VF likely to develop in first ____ after onset of symptoms
Education:
BLS: recognizing symptoms, activate EMS, early CPR, early defib with AED
Half
Ventricular fibrillation(VF) or pulseless ventricular tachycardia
4 hours
seek help early and don’t drive yourself, call 911
