Acute Coronary Syndrome Flashcards
(246 cards)
1
Q
What is acute coronary syndrome (ACS)?
A
Disorder including unstable angina and myocardial infarction; results from obstruction of the coronary artery by ruptured atherosclerotic plaque and leads to platelet aggregation, thrombus formation, and vasoconstriction.
2
Q
What causes angina pectoris?
A
Chest pain caused by a temporary imbalance between the coronary arteries’ ability to supply oxygen and the cardiac muscle’s demand for oxygen.
3
Q
What is atypical angina?
A
Angina with vague presentation such as indigestion, pain between the shoulders, an aching jaw, or choking sensation that occurs with exertion.
4
Q
What is cardiac rehabilitation?
A
The process of actively assisting the patient with coronary disease to achieve and maintain a productive life while remaining within the limits of the heart’s ability to respond to increases in activity and stress.
5
Q
What is cardiogenic shock?
A
Post–myocardial infarction heart failure in which necrosis of more than 40% of the left ventricle has occurred; also called Class IV heart failure.
6
Q
What characterizes chronic stable angina (CSA)?
A
Type of angina characterized by chest discomfort that occurs with moderate-to-prolonged exertion and in a pattern that is familiar to the patient.
7
Q
What is a coronary artery bypass graft (CABG)?
A
Surgical procedure in which occluded arteries are bypassed with the patient’s own venous or arterial blood vessels or synthetic grafts.
8
Q
What is coronary artery disease (CAD)?
A
Disease affecting the arteries that provide blood, oxygen, and nutrients to the myocardium; also known as coronary heart disease or simply heart disease.
9
Q
Define infarction.
A
Necrosis, or cell death.
10
Q
What is an intra-aortic balloon pump (IABP)?
A
Specialized catheter and balloon inserted into aorta that inflates and deflates with the cardiac cycle in order to decrease afterload and increase coronary perfusion.
11
Q
What does ischemia refer to?
A
Blockage of blood flow through a blood vessel, resulting in a lack of oxygen.
12
Q
What is metabolic syndrome?
A
Collection of related health problems with insulin resistance as a main feature; increases the risk for cardiovascular disease.
13
Q
What is a myocardial infarction (MI)?
A
Injury and necrosis of myocardial tissue that occurs when the tissue is abruptly and severely deprived of oxygen.
14
Q
What is new-onset angina?
A
Cardiac chest pain that occurs for the first time.
15
Q
What distinguishes a non–ST-elevation myocardial infarction (NSTEMI)?
A
Myocardial infarction in which the patient typically has ST- and T-wave changes on a 12-lead ECG; this indicates myocardial ischemia.
16
Q
What is percutaneous coronary intervention (PCI)?
A
Nonsurgical method of improving arterial flow by opening the vessel lumen; a balloon is inserted in the coronary artery and inflated to open blood vessels; procedure may include insertion of a coronary stent.
17
Q
What does pulmonary artery occlusion pressure (PAOP) measure?
A
Measurement of pressure in the left atrium using a balloon-tipped catheter introduced into the pulmonary artery.
18
Q
What is ST-elevation myocardial infarction (STEMI)?
A
Myocardial infarction in which the patient typically has ST elevation in two contiguous leads on a 12-lead ECG; this indicates myocardial infarction (necrosis).
19
Q
What is vasospastic angina?
A
Angina caused by coronary artery vasospasm that often occurs at rest or during the early morning hours; also called variant or Prinzmetal angina.
20
Q
What is ventricular remodeling?
A
After a myocardial infarction, permanent changes in the size and shape of the left ventricle due to scar tissue; such remodeling can decrease left ventricular function and cause heart failure.
21
Q
What is coronary artery disease (CAD)?
A
A broad term that includes chronic stable angina and acute coronary syndrome (ACS) affecting arteries supplying blood to the myocardium.
22
Q
What can occur when blood flow through the coronary arteries is blocked?
A
Ischemia and infarction of the myocardium may result.
23
Q
Define ischemia.
A
A condition where insufficient oxygen is supplied to meet the requirements of the myocardium.
24
Q
What is infarction?
A
Necrosis, or cell death, occurring when severe ischemia is prolonged.
25
What is another name for coronary artery disease?
Coronary heart disease (CHD) or simply heart disease.
26
What is the significance of CAD in terms of mortality?
It is the single largest killer of American men and women in all ethnic groups.
27
What are the consequences of impaired perfusion in CAD?
Life-threatening signs and symptoms and possibly death.
28
Has the death rate from CAD increased or declined over the past decade?
Declined.
29
What factors contribute to the decline in CAD death rates?
* Increasingly effective treatment
* Increased awareness of reducing major cardiovascular risk factors
30
What is angina pectoris?
Chest pain caused by a temporary imbalance between the coronary arteries’ ability to supply oxygen and the cardiac muscle’s demand.
31
What are the two main types of angina?
* Stable angina
* Unstable angina
32
Define chronic stable angina (CSA).
Chest discomfort occurring with moderate-to-prolonged exertion, familiar pattern, slight limitation of activity, usually relieved by nitroglycerin or rest.
33
What is unstable angina?
Chest pain occurring at rest or with exertion, causing severe activity limitation and may be poorly relieved by rest.
34
What does acute coronary syndrome (ACS) include?
* Unstable angina
* Acute myocardial infarction (MI)
35
What happens to the atherosclerotic plaque in ACS?
It ruptures, leading to platelet aggregation, thrombus formation, and vasoconstriction.
36
What is the threshold of coronary artery occlusion that impairs blood flow?
50% occlusion.
37
What is the definition of unstable angina (UA)?
Chest pain or discomfort that occurs at rest or with exertion, causing severe activity limitation.
38
What are some types of unstable angina?
* New-onset angina
* Vasospastic angina
* Pre-infarction angina
39
What is myocardial infarction (MI)?
A condition where myocardial tissue is abruptly and severely deprived of oxygen.
40
What are the two types of myocardial infarction?
* Non–ST-segment elevation myocardial infarction (NSTEMI)
* ST-elevation myocardial infarction (STEMI)
41
What are the ECG changes associated with NSTEMI?
ST segment depression and T-wave inversion.
42
What indicates myocardial cell death or necrosis in NSTEMI?
Changes on the ECG and elevation in cardiac troponin.
43
What ECG finding is characteristic of STEMI?
ST elevation in two contiguous leads.
44
What causes STEMI?
Rupture of the fibrous atherosclerotic plaque leading to platelet aggregation and thrombus formation.
45
What is the medical emergency associated with STEMI?
Abrupt 100% occlusion of the coronary artery requiring immediate revascularization.
46
What often begins with infarction of the subendocardial layer of cardiac muscle?
Myocardial infarctions (MIs)
## Footnote
The subendocardial layer has the greatest oxygen demand and the poorest oxygen supply.
47
What is the zone of necrosis?
The initial area of infarction in the subendocardium
## Footnote
This zone indicates tissue death due to lack of oxygen.
48
What are the two other zones surrounding the zone of necrosis?
1. Zone of injury
2. Zone of ischemia
## Footnote
The zone of injury consists of tissue that is injured but not necrotic, while the zone of ischemia consists of oxygen-deprived tissue.
49
What characterizes the zone of injury?
Tissue that is injured but not necrotic
## Footnote
This zone is adjacent to the zone of necrosis.
50
What characterizes the zone of ischemia?
Tissue that is oxygen deprived
## Footnote
This zone is also adjacent to the zone of necrosis.
51
What is infarction?
A dynamic process that evolves over a period of several hours.
52
What can hypoxemia from ischemia lead to?
Local vasodilation of blood vessels and acidosis.
53
Which imbalances may cause changes in normal conduction and contractile functions?
* Potassium
* Calcium
* Magnesium
* Acidosis
54
What are catecholamines and when are they released?
Epinephrine and norepinephrine released in response to hypoxia and pain.
55
What effect do catecholamines have on the heart?
They may increase the heart's rate, contractility, and afterload.
56
What can increased oxygen requirements in already deprived tissues lead to?
Life-threatening ventricular dysrhythmias.
57
What factors determine the extent of the zone of infarction?
* Collateral circulation
* Anaerobic metabolism
* Workload demands on the myocardium
58
When do obvious physical changes occur in the heart after an infarction?
6 hours after the infarction.
59
What color does the infarcted region appear after 6 hours?
Blue and swollen.
60
What changes occur in the infarcted area after 48 hours?
Turns gray with yellow streaks as neutrophils invade.
61
What forms at the edges of necrotic tissue 8 to 10 days after infarction?
Granulation tissue.
62
What is ventricular remodeling?
Permanent change in the size and shape of the entire left ventricle due to scar tissue.
63
What can ventricular remodeling decrease?
Left ventricular function.
64
What complications can arise from scarred tissue in the heart?
Chronic ventricular dysrhythmias.
65
What factors influence a patient’s response to a myocardial infarction (MI)?
Which coronary artery or arteries were obstructed and the part of the ventricle wall damaged.
66
What does obstruction of the left anterior descending (LAD) artery cause?
Anterior or septal MIs.
67
Why do patients with anterior wall MIs (AWMIs) have the highest mortality rate?
They are most likely to have left ventricular failure and dysrhythmias.
68
What does the circumflex artery supply?
The lateral wall of the left ventricle and possibly portions of the posterior wall.
69
What can obstruction of the circumflex artery lead to?
Posterior wall MI (PWMI) or lateral wall MI (LWMI) and sinus dysrhythmias.
70
What does the right coronary artery (RCA) supply?
* Most of the SA and AV nodes
* Right ventricle
* Inferior or diaphragmatic portion of the left ventricle
71
What is a common complication of obstruction of the RCA?
Inferior wall MIs (IWMIs).
72
What is a common risk factor for the development of coronary artery disease (CAD)?
Atherosclerosis.
73
What is metabolic syndrome also known as?
Insulin resistance syndrome or syndrome X.
74
What three factors indicate a diagnosis of metabolic syndrome?
* Central obesity
* High blood pressure
* Hyperglycemia
75
Who has a higher prevalence of metabolic syndrome?
Females.
76
What is the likely cause of the increasing incidence of metabolic syndrome?
Physical inactivity and the current obesity epidemic.
77
What is the aim of management for metabolic syndrome?
Reducing risks, managing hypertension, and preventing complications.
78
What is the most important risk factor for developing CAD in women?
Age
## Footnote
The older a woman is, the more likely she is to have CAD.
79
How much older are women, on average, when compared to men at the time of CAD diagnosis?
10 years
## Footnote
Women are usually 10 years older than men when they have CAD.
80
What percentage of women are aware that heart disease is the leading cause of death in women?
56%
## Footnote
Only 56% of women are aware of this fact.
81
Who has a greater risk of dying after a myocardial infarction (MI)?
Women
## Footnote
More women than men die within a year after a MI.
82
What complications are more likely to develop in women who survive a MI?
Heart failure or stroke
## Footnote
More women develop associated complications after MI.
83
Are women more or less likely to participate in cardiac rehabilitation programs compared to men?
Less likely
## Footnote
Women are less likely to participate in these programs.
84
What is the average age of a person having a first MI for men?
65 years
## Footnote
This is the average age for men experiencing their first MI.
85
What is the average age of a person having a first MI for women?
72 years
## Footnote
This is the average age for women experiencing their first MI.
86
How often does a person in the United States have a major coronary event?
Every 40 seconds
## Footnote
This statistic highlights the frequency of coronary events.
87
How often does an American die from CAD?
Every 84 seconds
## Footnote
This shows the mortality rate associated with CAD.
88
What are the indicators for hypertension in metabolic syndrome?
Either blood pressure of 130/85 mm Hg or higher OR taking antihypertensive drug(s)
## Footnote
These indicators help identify hypertension in patients.
89
What HDL-C level indicates a risk factor for metabolic syndrome in women?
Less than 50 mg/dL
## Footnote
This level is a risk factor when associated with high LDL-C.
90
What triglyceride level is considered a risk factor for metabolic syndrome?
150 mg/dL or higher
## Footnote
This level indicates increased risk for metabolic syndrome.
91
What fasting blood glucose level indicates a risk factor for metabolic syndrome?
100 mg/dL or higher
## Footnote
This can be caused by diabetes, glucose intolerance, or insulin resistance.
92
What waist size indicates excessive abdominal fat in men for metabolic syndrome?
40 inches (102 cm) or greater
## Footnote
This measurement indicates central obesity.
93
What waist size indicates excessive abdominal fat in women for metabolic syndrome?
35 inches (88 cm) or greater
## Footnote
This measurement indicates central obesity in women.
94
What should you do if you smoke or use tobacco?
Quit smoking or using tobacco.
## Footnote
If you don’t smoke or use tobacco, don’t start.
95
What is the recommended percentage of calories from saturated fats?
5% to 6% from saturated fats.
## Footnote
Avoid trans fatty acids.
96
What is the limit for daily cholesterol intake?
Less than 200 mg/day.
97
What is the recommended sodium intake according to health care providers?
Limit sodium intake as specified, or under 1500 mg/day if possible.
98
How often should you have your lipid levels checked?
Regularly.
99
What should you do if your cholesterol and LDL-C levels are elevated?
Follow your health care provider’s advice, including taking statin medications as indicated.
100
What should middle-aged or older individuals do before starting an exercise program?
Check with your health care provider.
101
What is the minimum recommended duration for exercise periods?
At least 40 minutes long.
102
What should be included in a warm-up and cool-down period for exercise?
10-minute warm-up and 5-minute cool-down.
103
If you cannot exercise moderately three to four times each week, what should you do?
Walk daily for 30 minutes at a comfortable pace.
104
If you cannot walk 30 minutes daily, what is an alternative?
Walk any distance you can, such as parking farther away or using stairs.
105
Who should manage diabetes?
With your health care provider.
106
How often should blood pressure be checked?
Regularly.
107
What should you do if your blood pressure is elevated?
Follow your health care provider’s advice.
108
What should you avoid when managing obesity?
Severely restrictive or fad diets.
109
What dietary restrictions should be followed to manage obesity?
Restrict intake of saturated fats, sweets, sweetened beverages, and cholesterol-rich foods.
110
What should be increased to help manage obesity?
Physical activity.
111
What is the incidence of myocardial infarction (MI) in premenopausal women compared to men?
Lower incidence than men.
112
At what age does the incidence of MI in postmenopausal women equal that of men?
In their 70s or older.
113
What family history risk factor increases susceptibility to CAD in women?
Having parents who had CAD.
114
What body shape is associated with increased risk for CAD in women?
Abdominal obesity (androidal shape).
115
What is a modifiable risk factor that increases cardiovascular disease risk in LGBT adults?
Increased incidence of smoking, alcohol use, and drug use.
116
What is the leading cause of premature, permanent disability in the United States?
Coronary Artery Disease (CAD)
## Footnote
CAD is a significant health issue globally, affecting many individuals and their ability to work.
117
What percentage of sudden cardiac arrest victims die before reaching the hospital?
Ninety percent
## Footnote
Many of these deaths are attributed to ventricular fibrillation.
118
Where are automatic external defibrillators (AEDs) commonly found?
Public places such as shopping centers and airplanes
## Footnote
Employees are trained to use AEDs in case of sudden cardiac arrest.
119
What is the main focus of health promotion efforts for patients at risk for CAD?
Controlling or altering modifiable risk factors
## Footnote
Individualized health teaching plans are essential for risk reduction.
120
What should be assessed if symptoms of CAD are present during an interview?
Delay collecting data until interventions relieve symptoms
## Footnote
Pain management is prioritized before comprehensive assessment.
121
What type of pain do patients often describe during a myocardial infarction?
Tightness, burning sensation, pressure, or indigestion
## Footnote
Pain assessment includes characteristics such as onset, location, and intensity.
122
What is atypical angina?
Angina that manifests as indigestion, pain between shoulders, or choking sensation
## Footnote
Symptoms may occur during exertion and can include unusual fatigue and shortness of breath.
123
How does angina pain typically respond to rest or nitroglycerin?
It usually improves
## Footnote
Myocardial infarction pain does not resolve with these measures.
124
What may older adults experience instead of typical chest pain during an MI?
Atypical symptoms such as shortness of breath or disorientation
## Footnote
Cognitive impairment may also hinder their ability to recognize pain.
125
What is a common complication of myocardial infarction?
Heart failure
## Footnote
The S3 heart sound is often heard in patients with heart failure.
126
What should be assessed in patients with unstable angina or MI?
Blood pressure, heart rate, cardiac rhythm, and peripheral pulses
## Footnote
Diminished pulses and cool skin may indicate poor cardiac output.
127
What temperature elevation may occur after a myocardial infarction?
Temperatures as high as 102°F (38.9°C)
## Footnote
This indicates an inflammatory response due to myocardial necrosis.
128
Fill in the blank: The presence of associated symptoms without chest discomfort in older adults is significant, as they are more likely to have _______.
Atypical symptoms
129
True or False: Most older patients with MI will present with the typical chest pain.
False
## Footnote
Older patients often present with atypical symptoms instead of typical chest pain.
130
What are the most common coping mechanisms in patients experiencing chest pain?
Denial, anger, and depression
## Footnote
These mechanisms are crucial for understanding patient responses to acute myocardial infarction (MI) or angina.
131
On average, how long does a patient with an acute MI wait before seeking medical attention?
More than 2 hours
## Footnote
This delay is often due to rationalizing symptoms as indigestion or overexertion.
132
What is the importance of reporting chest pain to a healthcare provider?
To ensure timely diagnosis and treatment of potential myocardial infarction
## Footnote
Denial that interferes with recognizing symptoms can be harmful.
133
What laboratory tests are most commonly used to diagnose myocardial infarction?
Troponins T and I
## Footnote
These tests are specific for myocardial infarction and cardiac necrosis.
134
What imaging test is not diagnostic for angina or MI unless there is cardiac dysfunction?
Chest x-ray
## Footnote
It may be used to rule out conditions like aortic dissection.
135
What do areas of decreased or absent perfusion on a thallium scan indicate?
Ischemia or infarction
## Footnote
These areas are referred to as 'cold spots.'
136
What imaging technique uses a high-speed CT scanner to evaluate calcified plaque?
64-slice computed tomography coronary angiography (CTCA)
## Footnote
It quantifies plaque into a calcium score.
137
What is the significance of a calcium score higher than 400?
Higher risk of myocardial infarction and death within the next 2 to 5 years
## Footnote
This score is also known as the Agatston score.
138
What does a 12-lead ECG assess in patients with chest pain?
Occurrence and location of ischemia or necrosis
## Footnote
It examines the heart from varying perspectives.
139
What is the recommended time frame for obtaining an ECG upon patient arrival in the emergency department?
Within the first 10 minutes
## Footnote
Delay can increase damage to the heart muscle.
140
What are common ECG changes observed during an angina episode?
ST depression, T-wave inversion, or both
## Footnote
These changes usually resolve when ischemia is relieved.
141
What distinguishes ST-elevation myocardial infarction (STEMI) from non-ST-elevation myocardial infarction (NSTEMI)?
Presence of ST-segment elevation in STEMI
## Footnote
An abnormal Q wave may develop in both types depending on myocardial necrosis.
142
What is the role of cardiac catheterization in diagnosing coronary artery disease?
To determine the extent and location of coronary artery obstructions
## Footnote
It helps identify candidates for PCI or CABG.
143
Fill in the blank: The first nurse role in the emergency department aims to decrease overall _______ time.
door-to-ECG
## Footnote
This initiative was part of a quality improvement project.
144
True or False: The first nurse role in the emergency department showed statistical significance in improving door-to-ECG times.
False
## Footnote
Although data indicated improvement, statistical significance was not achieved.
145
What alternative to treadmill testing may be used for pharmacologic stress testing?
Dobutamine
## Footnote
This is particularly useful for patients unable to exercise.
146
In women with suspected coronary artery disease, what type of stress testing is recommended?
Stress echocardiography or single-photon emission CT (SPECT)
## Footnote
These methods are more accurate for women compared to traditional treadmill tests.
147
What are the two conditions a patient with coronary artery disease (CAD) may experience?
Stable angina or acute coronary syndrome (ACS)
148
What is the first priority collaborative problem for patients with acute coronary syndrome (ACS)?
Acute pain due to an imbalance between myocardial oxygen supply and demand
149
What is the second priority collaborative problem for patients with ACS?
Decreased myocardial tissue perfusion due to interruption of arterial blood flow
150
What is the potential complication related to ischemia and ventricular irritability in ACS patients?
Potential for dysrhythmias
151
What is a potential complication of left ventricular dysfunction in patients with ACS?
Potential for heart failure
152
What assessments are essential for patient care management in suspected ACS?
Timely analysis of troponin and analysis of the 12-lead ECG (or 18-lead ECG for suspected right ventricular infarction)
153
What is the expected outcome for a patient receiving collaborative interventions for pain management?
The patient will verbalize decreased pain
154
What are the goals of interprofessional collaborative care in managing acute pain?
* Decrease pain
* Decrease myocardial oxygen demand
* Increase perfusion (myocardial oxygen supply)
155
What should be assessed prior to administering emergency care for chest discomfort?
Airway, breathing, and circulation (ABCs)
156
How soon should a 12-lead ECG be obtained after a report of chest pain?
Within 10 minutes
157
What medication is commonly administered for chest pain relief in the hospital?
Nitroglycerin (NTG)
158
What is the nursing safety priority regarding NTG administration?
Ensure the patient has not taken phosphodiesterase inhibitors within the past 24 to 48 hours
159
What is the mechanism of action of nitroglycerin (NTG)?
* Increases collateral blood flow
* Redistributes blood flow toward the subendocardium
* Dilates coronary arteries
* Decreases myocardial oxygen demand by peripheral vasodilation
160
What should a patient do with a nitroglycerin tablet for proper administration?
Hold the NTG tablet under the tongue and drink 5 mL (1 teaspoon) of water if necessary
161
How quickly should pain relief be expected after administering NTG?
Within 1 to 2 minutes
162
What action should be taken if blood pressure is less than 100 mm Hg systolic after NTG administration?
Lower the head of the bed and notify the health care provider
163
What is the maximum number of NTG doses that can be administered in an attempt to relieve angina pain?
Three doses
164
True or False: Angina usually responds to nitroglycerin (NTG).
True
165
What indicates that a patient may be experiencing a myocardial infarction (MI) instead of angina?
When three sublingual nitroglycerin tablets do not relieve chest discomfort
166
What should be done if the patient is experiencing an MI?
Prepare for transfer to a specialized unit and call 911 for emergency department transfer if at home or in the community.
167
What medication may be prescribed for management of chest pain when ischemia persists?
IV NTG (Nitroglycerin)
168
How often should blood pressure and pain level be checked during NTG infusion?
Every 3 to 5 minutes.
169
What are the possible outcomes for increasing the NTG dose?
* Pain is relieved
* BP falls excessively
* Maximum prescribed dose is reached
170
What should be maintained during long-term oral and topical nitrate administration?
An 8- to 12-hour nitrate-free period.
171
What discomfort may a patient initially report when taking nitrates?
Headache.
172
What medication may be prescribed to relieve discomfort unresponsive to nitroglycerin?
Morphine sulfate (MS)
173
What are the effects of morphine in the context of myocardial infarction?
* Decreases pain
* Decreases myocardial oxygen demand
* Relaxes smooth muscle
* Reduces circulating catecholamines
174
What is the recommended dosage for morphine administration for persistent cardiac pain?
2 to 4 mg using slow IV push every 5 to 15 minutes.
175
What are some adverse effects of morphine?
* Respiratory depression
* Hypotension
* Bradycardia
* Severe vomiting
176
What should be prescribed if hypoxemia is present?
Oxygen at a flow rate of 2 to 4 L/min.
177
What is the goal for maintaining arterial oxygen saturation?
90% or higher.
178
True or False: The use of oxygen in the absence of hypoxemia is beneficial.
False.
179
What position often enhances comfort and tissue oxygenation for the patient?
Semi-Fowler position.
180
What strategies are essential for a patient experiencing a myocardial infarction?
Combining pain relief strategies with interventions to increase myocardial perfusion.
181
What are some symptoms associated with chest pain in older adults?
* Unexplained dyspnea
* Confusion
* GI symptoms
182
How does fibrinolytic therapy affect older adults with MI?
Greater reduction in mortality rate but also more severe side effects.
183
What should be assessed if beta blockers are used in older adults?
Carefully assess for the development of side effects.
184
What should be planned for older adults when increasing activity?
Slow, steady increases in activity.
185
What is important regarding warm-up and cool-down periods for older adults during exercise?
They should plan longer warm-up and cool-down periods.
186
Fill in the blank: Dysrhythmia in older adults may be a normal age-related change rather than a _______.
complication of MI.
187
What is the primary outcome expected for a patient after myocardial infarction?
Increased myocardial perfusion as evidenced by adequate cardiac output, normal sinus rhythm, and vital signs within normal limits
188
What is the recommended time frame for restoring perfusion in NSTEMI?
Within 4 to 6 hours
189
What is the recommended time frame for restoring perfusion in STEMI?
Within 60 to 90 minutes
190
What are the two main interventions used to restore cardiac perfusion after an acute coronary syndrome?
* Drug therapy
* Percutaneous coronary intervention (PCI)
191
What does aspirin (ASA) therapy inhibit?
* Platelet aggregation
* Vasoconstriction
192
What is the immediate action recommended for a patient experiencing new-onset angina at home?
Chew aspirin 325 mg and call 911
193
How long does the antiplatelet effect of aspirin begin after use?
Within 1 hour
194
What is the daily dose of low-dose non-enteric-coated aspirin recommended for patients with suspected CAD?
Daily unless absolutely contraindicated
195
What are P2Y12 platelet inhibitors and name two examples?
* Clopidogrel
* Ticagrelor
196
What is the major side effect associated with dual antiplatelet therapy (DAPT)?
Bleeding
197
What should patients on DAPT be taught regarding signs of bleeding?
Signs of bleeding and when to contact the health care provider
198
What are glycoprotein (GP) IIb/IIIa inhibitors used for?
* Prevent fibrinogen from attaching to activated platelets
* Used in unstable angina and NSTEMI
199
What should be monitored when administering GP IIb/IIIa inhibitors?
Platelet level and signs of bleeding or hypersensitivity reactions
200
What is the role of vorapaxar in antiplatelet therapy?
Decreases the risk of recurrent MI when added to aspirin and clopidogrel
201
What type of therapy may be used in addition to antiplatelet therapy to prevent clot formation?
Anticoagulation therapy
202
What is the effect of once-a-day beta-adrenergic blocking agents on myocardial infarction?
* Decrease the size of the infarct
* Decrease occurrence of ventricular dysrhythmias
* Reduce mortality rates
203
What should be monitored during beta-blocking therapy?
* Bradycardia
* Hypotension
* Decreased level of consciousness (LOC)
* Chest discomfort
204
What are some side effects of beta blockers, especially in older patients?
* Hypoglycemia
* Depression
* Nightmares
* Forgetfulness
205
What beta blockers are recommended for patients with a history or new onset of heart failure?
* Extended release metoprolol succinate
* Carvedilol
* Bisoprolol
206
What are the two classes of medications frequently prescribed after ACS?
Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs)
## Footnote
These medications help prevent ventricular remodeling and heart failure.
207
Why should all patients post-STEMI receive either an ACEI or an ARB?
They increase survival after a myocardial infarction (MI)
## Footnote
This is applicable in the absence of contraindications.
208
What should be monitored in patients receiving ACEIs or ARBs?
Decreased urine output, hypotension, cough, serum potassium, creatinine, and blood urea nitrogen
## Footnote
Monitoring is essential to detect adverse effects.
209
What type of medications may be prescribed for patients with angina?
Calcium channel blockers (CCBs)
## Footnote
They promote vasodilation and myocardial perfusion.
210
When are calcium channel blockers indicated?
For vasospastic angina or hypertensive patients with angina despite beta blockers
## Footnote
They are not indicated after an acute MI unless beta blockade is contraindicated.
211
What should be monitored in patients taking calcium channel blockers?
Hypotension and peripheral edema
## Footnote
Frequency of angina episodes should also be reviewed.
212
What is ranolazine used for?
To manage chronic stable angina (CSA) when CCBs are not successful
## Footnote
It has antiangina and anti-ischemic properties.
213
What is the role of statin therapy in patients diagnosed with ACS?
Reduces the risk of recurrent MI, mortality, and stroke
## Footnote
High-intensity statins should be started before discharge.
214
What are examples of high-intensity statins?
* Atorvastatin
* Rosuvastatin
## Footnote
These should be initiated despite lipid panel results.
215
What are the two reperfusion strategies for acute MI?
* Thrombolytic therapy
* Percutaneous coronary intervention (PCI)
## Footnote
PCI is the treatment of choice for most patients with STEMI.
216
What does fibrinolytic therapy do?
Dissolves thrombi in the coronary arteries and restores myocardial blood flow
## Footnote
It is also known as thrombolytic therapy.
217
What are some examples of fibrinolytic agents?
* Tissue plasminogen activator (tPA, alteplase)
* Reteplase
* Tenecteplase
## Footnote
These agents target the fibrin component of coronary thrombosis.
218
When should fibrinolytic therapy be administered?
Within 30 minutes of hospital arrival
## Footnote
The benefit declines as time from symptom onset increases.
219
What are absolute contraindications for fibrinolytic therapy?
* Previous intracranial hemorrhage
* Active bleeding
* Significant trauma within 3 months
## Footnote
These contraindications must be assessed before administration.
220
What should be monitored during and after thrombolytic administration?
Signs of bleeding
## Footnote
This includes documenting neurologic status and monitoring IV sites.
221
What indications should a nurse monitor for to assess the effectiveness of thrombolytic therapy?
* Abrupt cessation of pain or discomfort
* Sudden onset of ventricular dysrhythmias
* Resolution of ST-segment depression/elevation or T-wave inversion
* A peak at 12 hours of markers of myocardial damage
## Footnote
These signs indicate that the clot has been lysed and the artery reperfused.
222
What is released into the system after clot lysis with fibrinolytics?
Large amounts of thrombin
## Footnote
This increases the risk for vessel reocclusion.
223
What medications are usually prescribed after thrombolytic therapy to maintain coronary artery patency?
Aspirin and IV heparin
## Footnote
Heparin is a high-alert drug.
224
What is the target activated partial thromboplastin time (aPTT) when administering heparin?
50 to 70 seconds
## Footnote
This is 1.5 to 2 times the control.
225
For how long is the heparin drip typically continued after thrombolytic therapy?
A minimum of 48 hours or until revascularization.
226
What can low–molecular-weight heparin (LMWH) be substituted for?
IV heparin.
227
How should therapeutic dosing of LMWH be determined?
Based on weight.
228
What is the treatment of choice to reopen a closed coronary artery?
Percutaneous coronary intervention (PCI).
229
What is the goal timing for performing PCI after an acute STEMI diagnosis?
Within 90 minutes.
230
What are the components of the PCI procedure?
Clot retrieval, coronary angioplasty, and stent placement.
231
What is used to guide the PCI procedure?
Fluoroscopic guidance.
232
What device is used to retrieve a clot during PCI?
Clot retrieval device.
233
What does balloon inflation during PCI do?
Forces plaque against the vessel wall, dilating it.
234
What is the desired stenosis reduction during PCI?
To less than 50% of the vessel’s diameter.
235
What type of stents can be used during PCI?
Bare metal or drug-eluting stents (DESs).
236
What is the function of a stent?
Acts as scaffolding to hold the diseased artery open.
237
What anticoagulants may be administered during PCI?
Boluses of IV heparin or a continuous infusion of bivalirudin.
238
What is the purpose of using heparin during PCI?
To maintain an elevated activated clotting time and prevent clotting on wires and catheters.
239
What happens to anticoagulants after the PCI procedure?
They are usually stopped immediately.
240
What percentage of patients may experience restenosis within the first 24 hours after PCI?
A small percentage.
241
What factors influence the effectiveness of PCI?
Clot complexity, location, and amount of myocardium at risk.
242
What type of lesions are most likely to benefit from PCI?
Single- or double-vessel disease with discrete, proximal, noncalcified lesions or clots.
243
What type of therapy is required after PCI?
Dual antiplatelet therapy (DAPT) consisting of aspirin and a platelet inhibitor.
244
What additional medications may be prescribed after primary angioplasty?
A long-term nitrate, beta blocker, and an ACEI or ARB.
245
What electrolyte imbalance may some patients experience after PCI?
Hypokalemia.
246
What should nursing interventions for patients receiving drug therapy include?
Careful explanations of drug therapy and recommended lifestyle changes.
