Acute coronary syndrome

Question 1

What is acute coronary syndrome?

Answer 1

Spectrum of conditions resulting from impairment of blood to the heart (myocardial ischemia and myocardial infarction)

Question 2

What is myocardial ischemia?

Answer 2

Decreased blood (oxygen/energy) to the heart muscles (not heart cell death or complete occlusion)

Question 3

What relieves stable angina?

Answer 3

Rest or nitroglycerin

Question 4

What activities can cause stable angina

Answer 4

Lying supine, cold, emotional stress, sexual activity, and physical activity

Question 5

Can unstable angina be relieved by rest and nitroglycerin?

Answer 5

No, occurs at rest without any obvious precipitating factors or with minimal exertion. Requires immediate medical attention.

Question 6

What is myocardial infarction?

Answer 6

Death of cardiac muscle cells due to a lack of blood flow

Question 7

What causes myocardial infarction

Answer 7

Complete occlusion of one or more coronary arteries

Question 8

What is the components of the myocradial infarction evaluation triad?

Answer 8

1. Symptoms
2. ECG changes
3. Cardiac biomarkers

Question 9

ECG changes if ischemia (decreased perfusion) present

Answer 9

1. ST-segment depression or inverted T wave

Question 10

ECG changes for Large acute myocardial infarction with injury to myocardial tissue

Answer 10

1. ST-segment elevation
2. Pathological Q-wave
   Referred to as ST-segment elevation myocardial infarction (STEMI)

Question 11

Myocardial infarction sounds like fart (gas elevates)

Myocardial ischemia

Answer 11

(Infarction) ST-segment elevation

ST-segment depression

Question 12

Cardiac biomarkers

Answer 12

Troponin I, Troponin T, Myoglobin, Creatine Kinase

Question 13

What do beta blockers do?

Answer 13

Decrease HR, decrease contractility (decrease BP)

Question 14

Calcium channel blockers?

Answer 14

Decrease BP

Question 15

Nitrates

Answer 15

Vasodilator

Question 16

ACE inhibitors, ARBs (angiotensin receptor blockers)

Answer 16

Decrease BP

Question 17

Phases of cardiac rehab

Answer 17

1. Acute phase
2. Subacute phase
3. Intensive rehab phase
4. Maintenance phase

Question 18

Phase 1: Acute/Inpatient

Answer 18

Begun in the hospital
Prepare for discharge, monitor activity tolerance, education, build self efficacy
Focus on interventions is on assessing hemodynamic responses to activity and independence in functional mobility activities (bed mobility, transfers, stairs, ADL, ambualtion)
Intensity should be low level

Question 19

Phase 1 levels (acute phase)

Answer 19

Level 1 (1 METs) - medically stable 24hrs, upper and lower gentle ROMs
Level 2 (2 METs) - allow sitting up in chair, performing ADLs and walking to bathroom
Level 3 (3 METs) - AMbulate up to 250 ft a few times/day
Level 4 (4 METs) - Perform ADLs independently and ambualte 1000 ft a few times a day, allow climbing of 1 flight of stairs

Question 20

Phase 2 (subacute phase)

Answer 20

Begins after discharge from hospital in outpatient setting
conditioning exercises done with close cardiac monitoring

Question 21

Phase 3 (intensive rehab phase)

Answer 21

Exercise in large groups
Resistance training is typically initiated

Question 22

Phase 4 (maintenance phase)

Answer 22

Patient encouraged to continue exercise training in a group setting or self-monitored program

Question 23

Education for patients with heart disease

Answer 23

1. Activity guidelines
2. Self-monitoring
3. Symptom recognition and response
4. Nutrition
5. Medications
6. Sexual Activity
7. Psychological/Social Issues