CAD / ACS pt. 2 (Exam 1) Flashcards
(37 cards)
Acute Coronary Syndrome is
Unstable angina
Acute myocardial infarction
Patient has chest pain and there are ECG changes =
STEMI
Patient has chest pain and there are no ECG changes but Troponin is elevated =
NSTEMI
Patient has chest pain and there are no ECG changes and Troponin is not elevated =
Unstable Angina
Difference between NSTEMI and Unstable Angina
Heart Damage with NSTEMI
No heart damage with Unstable Angina
we can tell this by looking at troponin levels
Unstable Angina Characteristics
Often occurs at rest - more than 20 min in duration
New onset that limits physical activity
More frequent, longer in duration and occurs with less exertion
Poorly relieved by rest or NTG
Has symptoms
IS AN EMERGENCY
No elevations in serum troponin
Why is unstable angina an emergency?
Because it precedes an MI
T/F: Serum troponin is elevated with unstable angina?
False (non cardiac damage)
Serum troponin is only elevated with NSTEMI
DM & Women anginal S/S
Fatigue (most prominent)
SOA
Indigestion
Anxiety
Angina (Stable) vs MI Pain (Unstable)
Anginal Pain
-Precipitated by exertion / stress
-Relieved by rest/NTG
-Lasting > 15 min
MI Pain
-Occurring without cause
-Often Early Morning (4-6 am) (corisol)
-Relieved only by opiods
-Lasting >20 min
-Symptoms
Unstable and MI pain is only relieved by
Opioids
Unstable angina pain associated symptoms
N/V
Diaphoresis
Dyspnea
Feelings of anxiety / fear
Dysrhythmias
Myocardial Infarction process takes time
(cells can stand ischemia x 20 min before cell death)
What part of the heart is affected earliest in a MI
How long does it take for the heart to necrose?
Subendocardium layer (inside layer)
Takes 4-6 hours for entire thickness of muscle to necrose
The location of the a MI correlates with
Involved coronary circulation
Damage takes place where the blockage is.
MI’s are described based on
Location of damage
(anterior - inferior - lateral - septal - posterior)
What does MI pain feel like?
Chest pain not relieved by rest, position, change, or nitrates
Heaviness
Pressure
Tightness
Burning
Constriction
Crushing
PRESSURE (not pain)
Do all MI have pain or pressure?
No patients can have silent MI’s
Complications of MI
Dysrhythmias
Heart failure (reduce pumping)
Cardiogenic shock (loss of BP)
Papillary muscle dysfunction (murmur)
Pericarditis (Pericardial friction rub)
Most common complication of MI
Dysrhythmias
-Most common cause of pre-hospital death
If patient comes in with suspected MI they are put on ______ ASAP
Telemetry
Complication of MI: Heart failure
Occurs because of muscle death resulting in reduced pumping action of the heart
Complication of MI: Cardiogenic Shock
-Due to severe left ventricular failure
-Patient loose BP and goes into shock
-High mortality rate
Complication of MI: Papillary Muscle Dysfunction
Consequence: New murmur noted
