Acute Coronary Syndromes Flashcards
(53 cards)
What is a Type I Acute Coronary Syndrome (ACS)?
vascular occlusion ischemia (blockage)
What is a Type II Acute Coronary Syndrome (ACS)?
demand ischemia, “overworking” (wall tension, heart rate, contractility)
What are the indicators of unstable angina?
no ST elevation and no biomarkers
What are the indicators of NSTEMI?
no ST elevation(usually) with biomarkers
What are the indicators of STEMI?
ST elevation and maybe biomarkers
What are the cardiac biomarkers?
TROPONIN, myoglobin, creatine kinase(CK)
Describe NSTEMI vs STEMI
-NSTEMI= ST depression, white clots, partial coronary occlusion, reperfusion, not urgent
-STEMI= ST elevation, red clots, total coronary occlusion, reperfusion urgently needed
What is the PQEST of Angina?
-Precipitating factors= pain at rest with NO exertion
-Palliative measures= rest and nitrates won’t relieve pain
-Quality of pain= crushing chest tightness
-Region of pain= substernal (right in the middle)
-Radiation of pain= arms, jaw, neck, abdomen, or back
-Severity of pain= 8-10/10
-Temporal pattern= > 20 minutes
What does MONA stand for?
-Morphine
-Oxygen
-Nitroglycerin
-Aspirin
What is the concern with morphine for initial treatment of acute coronary syndromes?
studies showed increased death and length of hospitalizations so not generally given unless symptoms persist despite therapy
When would oxygen be considered for acute coronary syndromes (ACS) pt?
SaO2 < 90%
What is the MOA of Nitroglycerin?
increased nitric oxide release resulting in venous dilation and arterial dilation (decrease afterload= decrease BP= decrease demand and coronary vasodilation = increased coronary supply)
What is the indication of Nitroglycerin?
-SL preferred for acute angina
-IV preferred for unstable refractory angina
What drug should every patient with ACS receive once admitted to the hospital?
aspirin
What is the benefit of Aspirin in ACS pt?
reduce death, MI, or stroke by up to 50%
What dose of Aspirin should be given to pt initially upon admittance into the hospital for ACS?
160-325mg chewed and swallowed
What does THROMBINS2 stand for?
-Thienopyridine
-Heparin
-RAAS
-Oxygen
-Morphine
-Beta blocker
-Intervention (PCI)
-Nitroglycerin
-Statin
-Salicylate (aspirin)
Describe TIMI:
used to score patients to assist on deciding whether a pt is a candidate for percutaneous coronary intervention (PCI) aka “cardiac catheterization”
How does the point system work for TIMI?
one point for each of the following risk factor predictors:
-age > 65
-3 or more CAD risk factors
- > 50% stenosis of major coronary artery
-ST segment elevation
-2+ angina episodes in past 24h
-ASA used within past 7 days
-elevated biomarkers
What pt would be a candidate for early invasive therapy (PCI)?
-TIMI score > 3
-recurrent angina/ischemia with low activity
-elevated troponin levels
-new ST depression on EKG
-angina/ischemia + HF
-hemodynamic instability
-sustained ventricular tachycardia
Describe Coronary Patency
dye is injected into coronary artery and blood flow is assessed (angiogram/angiography) and is graded:
-3= normal
-2= moderate
-1= minimal
-0= none
What are examples of percutaneous coronary intervention (PCI)?
-balloon angioplasty
-cardiac stenting
What is the MOA of P2Y12 Inhibitors?
prevent platelet aggregation by irreversibly blocking P2Y12 component of the ADP receptor -> preventing platelet activation
What drugs are P2Y12 Inhibitors?
-clopidogrel
-prasugrel
-ticagrelor
-cangrelor
