CAD: Acute coronary syndrome (MI, unstable angina)

Question 1

Unstable chronic angina= ?

Answer 1

Impending MI

Question 2

Patho

Decreased blood flow to myocardium leads to what?

Answer 2

Ischemia and necrosis

Question 3

Patho

Does the client have to be doing anything to bring the pain on?

Answer 3

No

Question 4

Patho

Will rest or nitro relieve the pain?

Answer 4

No

Question 5

S/s

Pain

Answer 5

• Pain may be crushing (elephant sitting on chest)
• Pressure radiating to left arm and left jaw
• NV
• Pain between shoulder blades

Question 6

S/s

How do women present?

Answer 6

GI signs and symptoms–epigastric complaints or pain between the shoulders, an aching jaw or choking sensation

Question 7

1 sign of MI in elderly?

S/s

Answer 7

SOB

Question 8

S/s

Skin

Answer 8

Cold

Clammy

Question 9

S/s

BP

Answer 9

Drops (CO is decreasing!)

Question 10

S/s

Heart

Answer 10

ECG changes

Question 11

S/s

GI

Answer 11

Vomiting (acute pain stimulates vagus nerve, which drips HR and BP so decrease in CO)

Question 12

Troponin T levels?

Answer 12

Less than 0.10

Question 13

Troponin I level?

Answer 13

Less than 0.03

Question 14

STEMI

Answer 14

Client is having MI and goal is to get to cath lab for PCI in less than 90 min

Question 15

NSTEMI

Answer 15

Less worrisome

Question 16

CPK-MB

What is this?
Increase when?
Elevated and peaks?

Answer 16

Cardiac specific isoenzyme

Levels increase with damage to cardiac cells

Elevates in 3-6 hrs; peaks 12-24

Question 17

Troponin

What is it?
Elevates?
Stays elevated for how long?

Answer 17

Cardiac biomarker with high specificity to myocardial damage

Elevates within 3-4 hours

Remains elevated for up to 3 weeks

Question 18

Troponin levels are good for who?

Answer 18

Those who delayed seeking care

Question 19

Myoglobin

Increases?
Peaks?
What results are good thing: positive or negative?

Answer 19

Increases within 1 hr
Peaks at 12 hours
NEGATIVE results= good thing

Question 20

What cardiac biomarker is most sensitive indicator for MI?

Answer 20

Troponin

Question 21

Which enzymes or biomarkers are most helpful when client delays seeking care?

Answer 21

Troponin

Question 22

Complications?

Answer 22

Major arrhythmias

Question 23

Complications

What untreated arrhythmias will put client at risk for sudden death?

Answer 23

Pulseless v-tach
V-fib
Asystole

Question 24

Complications

Priority assessment for v-fib?

Answer 24

Defibrilate q

Question 25

Complications If the first shock doesnt work and the client remains in v-fib what is the first vasopressor we give?

Answer 25

Epi

Question 26

Complications What is the anti-arrhythmic used for V-fib and pulseless VT that is resistant to tx?

Answer 26

Amiodarone *also used for fast arrhythmias

Question 27

Complications Check what function if pt. gets amiodarone and lives?

Answer 27

Thyroid function (amidarone has a lot of iodine)

Question 28

Complications What anti arrhythmic drugs are commonly give to prevent second episode of V-fib?

Answer 28

Amiodarone | Lidocaine

Question 29

Complications Lidocaine toxicity?

Answer 29

Numb | Neuro changes

Question 30

Complications What is the first anti-arrhythmic of choice? Important SE?

Answer 30

Amiodarone | HYPOtension--this could lead to further arrhythmias!

Question 31

Treatment What meds are used for chest pain when they get to ED?

Answer 31

Morphine Oxygen (over 90) Nitroglycerin Asprin (chewable)

Question 32

Treatment What position

Answer 32

Head up to decrease workload of heart and increase CO

Question 33

Treatment: Thrombolytics Goal?

Answer 33

Dissolve the clot that is blocking blood flow to heart muscle -- decreases size of the infarction

Question 34

Treatment: Thrombolytics Meds?

Answer 34

Alteplase (t-PA) Tenecteplase (TNKase--one time push) Reteplase Streptokinase

Question 35

Treatment: Thrombolytics How soon after the onset of myocardial pain should these drugs be administered?

Answer 35

Within 6-8 hours

Question 36

Treatment: Thrombolytics Stroke ---

Answer 36

Time is brain

Question 37

Treatment: Thrombolytics Major complications?

Answer 37

Bleeding!!! | get good bleeding hx

Question 38

Treatment: Thrombolytics Absolute contraindications

Answer 38

Intracranial neoplasm Intracranial bleed Suspected aortic dissection Internal bleeding

Question 39

Treatment: Thrombolytics During and after administration we take ____

Answer 39

Bleeding precautions * draw blood when starting IVs to decrease the number of puncture sites * use electric razor, soft toothbrush * No IMs

Question 40

Treatment: Thrombolytics Antidote for dabigatran?

Answer 40

Idarucizumab

Question 41

Percutaneous coronary intervention (angioplasty) Major complication?

Answer 41

MI *dont forget the client may bleed from heart cath site or they could re occlude --> any problems go to surgery

Question 42

Percutaneous coronary intervention (angioplasty) Chest pain after procedure

Answer 42

Call doc ASAP!!! --reoccluding

Question 43

Percutaneous coronary intervention (angioplasty) What are thrombolytic or anti-platelet meds?

Answer 43

Asprin Clopidogrel Abciximab Eptifibatide

Question 44

Percutaneous coronary intervention (angioplasty) Who gets the abxicimab or eptifibatide?

Answer 44

High risk clients who have been stunted to keep artery open and those waiting to go to cath lab

Question 45

CABG When to get? Used with what? What supplies L.V?

Answer 45

Scheduled or emergent Used with multiple vessel disease or left main coronary artery occlusion Left main coronary artery supplies entire LV

Question 46

CABG Left main coronary artery occlusion think?

Answer 46

Sudden death or widow maker

Question 47

Cardiac rehab Stop what? How to increase activity? Diet changes?

Answer 47

Stop smoking Increase gradually (stepped care plan) Decrease fat, decrease salt, decrease cholesterol

Question 48

Cardiac rehab No what? (3)

Answer 48

No isometrics No valsalva No straining/suppository ---(can give docusate)

Question 49

Cardiac rehab When can sex be resumed?

Answer 49

For clients w/o complications when they can walk up flight of stairs

Question 50

Cardiac rehab Best time for sex?

Answer 50

Morning (8-9)

Question 51

Cardiac rehab Best exercise for MI client?

Answer 51

Walking

Question 52

Cardiac rehab--Teach s/s of HF What are they?

Answer 52

Weight gain Ankle edema SOB Confusion