Acute coronary syndrome

Question 1

what are the three conditions of ACS?

Answer 1

Unstable angina
NSTEMI
STEMI

Question 2

what is caused by supply ischemia and leads to vasospasm?

Answer 2

printzmetals variant angina

Question 3

unstable angina

Answer 3

New or changing chest pain caused by ischemia

Question 4

Variant/vasospastic angina

Answer 4

prinzmetal angina

Caused by coronary artery spasm and endothelial dysfunction

Question 5

when does variant angina occur?

Answer 5

Onset, timing is rest with minimal exertion may be at night

Question 6

does ST segment elevation with variant angina?

Answer 6

Yes

Question 7

treatment for variant angina

Answer 7

Nitrates to relax spasms

Question 8

unstable plaques

Answer 8

Large, lipid core, thin cap
Active inflammation
Proliferation into intima of smooth muscle cells

Question 9

t/f a small core with a thick cap is a more unstable plaque

Answer 9

False

Question 10

can an infarction occur with a partial occlusion, or a dissolved thrombus?

Answer 10

No

Question 11

ECG changes with unstable angina

Answer 11

Ischemic changes typically transient

Question 12

do cardiac enzymes elevate with unstable angina?

Answer 12

No

Question 13

theories of plaque rupture

Answer 13

increased SNS activity
Platelet aggregation
Thrombus formation

Question 14

increased SNS activity

Answer 14

Increased BP, HR, force of contraction
Increased force of coronary artery blood flow
Increased force against injured endothelium

Question 15

platelet aggregation

Answer 15

Platelets in here to ruptured plaque
Release substances that attract more platelets
Contribute to vasospasm

Question 16

ACS

Answer 16

More severe chest pain last longer
No relief from nitrates
more symptoms - accompanying
Sense of impending doom

Question 17

s/sx ACS

Answer 17

Chest pain, SOA
Discomfort in arms, back, neck, jaw, shoulders
diaphoresis, N/V

Question 18

What are atypical symptoms with women?

Answer 18

heartburn
Sudden dizziness

Question 19

s/sx MI

Answer 19

diaphoresis
Dyspnea
Extreme anxiety
Levine sign
Pale
Crushing chest pain
Weak peripheral pulses

Question 20

Acute MI

Answer 20

Ruptured plaque plus thrombus

Blood flow disrupted, prolonged or total disruption

Question 21

when do troponins levels increase with acute MI

Answer 21

With infarction, trends up

Question 22

is an acute MI reversible?

Answer 22

prolonged ischemia with no recovery
Myocardial cells suffer, irreversible, ischemic, necrosis

Question 23

Infarction

Answer 23

Tissue death

Question 24

ischemia

Answer 24

Hearts blood supply doesn’t Meet bodies demands

Question 25

transition from ischemia to infarction

Answer 25

ATP not able to be stored Irreversible injury within 30 min-4hours Tissue necrosis by four hours Necrotic tissue cleared away by one to two weeks Tough fibrous scar tissue replaces necrotic tissue by six weeks

Question 26

infarction

Answer 26

MI, DEAD CELLS Can’t recover Try to stop progression

Question 27

Injury

Answer 27

some recovery possible Can still perfuse and restore to become viable

Question 28

t/f the injury, phase of damage has dead cells

Answer 28

False

Question 29

when is a full recovery possible?

Answer 29

Ischemia

Question 30

what does the extent of an MI depend on

Answer 30

Location of occlusion Length of time of occlusion Hearts, availability of collateral circulation

Question 31

STEMI

Answer 31

elevated ST Wide, QRS Peaked T waves then inverted Elevated troponins Larger infarct Poor outcomes

Question 32

NSTEMI

Answer 32

depression/normal ST Normal QRS Inverted T-wave Elevated troponins Smaller infarct Better outcomes

Question 33

which artery supplies the left ventricle with oxygenated blood

Answer 33

Left anterior descending artery

Question 34

which artery supplies the left anterior descending artery and left circumflex

Answer 34

Left main artery

Question 35

what occurs with a blockage at the beginning of the left anterior descending artery

Answer 35

Widowmaker

Question 36

acute MI pharm

Answer 36

oxygen Aspirin Morphine Beta blockers Nitrates

Question 37

oxygen

Answer 37

Increases oxygen to ischemic myocardium

Question 38

aspirin

Answer 38

Suppresses platelet aggregation ** Chew

Question 39

Morphine

Answer 39

decreases pain Decreases pre-and afterload Helps preserve tissue

Question 40

Beta blockers

Answer 40

selective Beta one decreases HR, contractility decreases, oxygen demand Decreases infarct size

Question 41

Nitrates

Answer 41

decrees pre-and after load Decreases infarct size

Question 42

t/f nitrates affect, mortality rate with a cute MI

Answer 42

False

Question 43

myocardial stunning

Answer 43

Rapid restoration of blood flow to myocardium contributes to reperfusion injury

Question 44

Reperfusion injury

Answer 44

Oxidized, free radicals generated by wbc’s Cellular response – restore blood flow

Question 45

what type of dysrhythmias can occur from reperfusion?

Answer 45

Ventricular tachycardia Ventricular fibrillation