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Flashcards in Acute Coronary Syndrome Deck (5)
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1
Q

Angina

A

Temporary chest pain of sensation of pressure when the heart muscle is not receiving enough oxygen causing ischemia (May lead to necrosis)

  • Narrowed arteries
  • Usually occurs first during physical exertion or stress
  • Heart works harder and increases the need for O2 but can’t get it through the arteries
  • If arteries narrowed 70% or more, may have angina even at rest
  • Worse in the cold

Types
Silent, Nocturnal, Variant, Unstable

Symptoms
Pain (discomfort/heaviness) in either shoulder, inner arm, through to the back, in the throat , jaw or teeth

Unstable angina = worsening and more frequent attacks which can lead to MI

2
Q

Diagnostics for Angina

A
  • Symptoms and presence of risk factors
  • EKG – sometimes of no use
  • Give Nitroglycerine - relief within 3 minutes
  • Exercise/Drug Stress tests
  • Echocardiogram
  • Angiography
  • Cardiac caths
  • Holter monitor
3
Q

Treatment for Angina

A

Goal is to prevent or slow ischemia –by slowing the progression of CAD

  • Treat HTN and cholesterol
  • Lifestyle changes

Drugs:

  • Beta blockers
  • Nitrates
  • Calcium channel blockers
  • ACE inhibitors
  • Antiplatelet
  • Other – anticoags, thrombolytics, opioids
  • ***Cannot give rectal suppositories
4
Q

Myocardial Infarction (MI)

A

Irreversible myocardial cell damage usually due to thrombus formation

MI takes time – unstable angina then MI

  • Days to weeks ahead – fatigue, SOB intermittent chest pain
  • These become more frequent even with less exertion
  • Cardiac cells begin to die in 20 min of no O2: Starts on the inside of the muscle & progresses to the full thickness in 4-6 hours

Symptoms
Pain – heaviness, tightness, burning, constriction, crushing
- Location
- Substernal, retrosternal, epigastric areas
- Some have no pain
Nausea/Vomiting
Fever
CV - Abnormal heart sounds, elevated BP then a drop, decreased urine output, crackles, jugular distention, peripheral edema

Diagnostics
- Goal is to differentiate between unstable angina and MI
EKG
- To look at the ST segment and T wave – Elevate =extensive damage
- May look normal if just happening – repeat for changes

Serum Cardiac Markers

  • Troponin - protein released from necrotic heart muscle- if they have this, they have an MI
  • Isoenzymes – CK-MB
  • Myoglobin protien – Injury
  • C-Reactive protien
  • Cardiac Natriuretic Peptide Markers (ANP, BNP, NT-Pro-BNP)
  • Homocysteine
  • Serum Lipids

Treatment

  • Position upright
  • Oxygen – keep sat at 93%
  • Get VS and 12 Lead and continuous monitoring
  • Start an IV
  • Don’t give a suppository
  • Sublingual Nitroglycerine and ***chewable ASA- needs to be chewed so that it disolves better and quickly to make the platelets more slippery, morphine, beta blockers- should happen right away, and ACE inhibitors- may not have to happen right away
  • Obtain diagnostic Lab tests within 10 minutes of admission to the ED.
  • Angina is telling you that the heart isn’t getting enough oxygen
  • **Clot busters need to be given within the first 6 hours of pain starting. **Do not give clot busters to patients with GI bleeds, strokes, b/p problems, or fresh post op

The doctors may consider opening the vessel (PCI- cath) or even thrombolytic therapy. There are surgical interventions also

If pt. came in by ambulance, a lot of this would have already been done but you need to find out the time of treatments from EMT

5
Q

ACS Care

A
Nursing Diagnosis:
Ineffective cardiac tissue perfusion- can sit patient up and make sure they are getting a good amount of oxygen. 
Risk for fluid imbalance
Risk for ineffective peripheral tissue perfusion
Death anxiety
Deficient knowledge
Pain
Activity Intolerance

Rehab:

  • Up in a chair
  • Walk to Bathroom and non stressful activity– 2/3
  • Lifestyle changes- diet and exercises, stop smoking
  • Increase activity
  • After discharge, amount and intensity of activity is increased slowly to full range
  • Outpatient rehab is usually 12 weeks- Usually go the full 3 months for cardiac rehab, but usually after about 6 weeks they are in better shape
Collaborative Problems:
Acute pulmonary edema
Dysrhythmias and cardiac arrest
Scar tissue = weakened muscle action
Heart failure
Cardiogenic shock
Pericarditis and cardiac tamponade
Ventricular aneurysm
Clots

Patient Teaching:
Diet- DASH diet, low fat (chicken, fish, veggies, fruit, diabetic diet)

Physical activity (761)- increase physical activity

Lifestyle changes

Sexual activity (760)- encourage the patient and sexual partner to talk to the doctor about safe sexual activity