Flashcards in Cardiac - Unit 2 - Care of Patients w/ Acute Coronary Syndromes Deck (64):
Is angina a symptom or a disease? When does it occur (think O2)
Symptom - it occurs when oxygen demand is greater than oxygen supply.
What increases O2 demand?
Stress, HTN, heart failure, valvular disease, hyperthyroidism, etc.
What decreases O2 supply?
Hemorrhage, dehydration, anemia, hypoxia, atherosclerosis, etc.
What happens with chronic stable angina?
It's chest pain with a stable frequency - like it occurs every time you walk to the strip club, etc.
Is chronic stable angina relieved by rest and nitrates?
What happens with unstable angina? Is it relieved by nitrates?
It is unpredictable - it might happen when you go to the strip club, and then it might happen when you walk in to the strip club, then it might happen the minute you walk to your car to go to the strip club. It INCREASES over time. There will be no changes in troponin or CK levels - and it is NOT relieved by nitro.
What is variant angina?
Prinzmetals - it's a type of unstable - it's caused by a coronary artery spasm. Cardiac ischemia is worsening
What are the "E'S" (with one S) of precipitating factors of angina?
Exertion, Exercise, Emotional Distress, Exposure to cold, eating and smoking.
How do we diagnose angina?
Are symptoms relieved by rest?, Nitro, possible ST changes on an EKG but not always, normal enzymes, stress test and cardiac cath.
What is the treatment for angina? (Four letter word)
M - Morphine (it's a vasodilator so it helps with this pain)
O - Oxygen
N - Nitrates
A - Aspirin
What is an MI?
Myocardial Infarction - myocardial tissue abruptly becomes severely deprived of O2 which can lead to death of the myocardial tissue. So there's permanent loss, then, of contraction in the affected area.
What are the two types of MI?
Non-ST MI (NSTEMI) and ST Elevated MI (STEMI)
What is collateral circulation?
When you build more vessels in other spots - so say there's a blockage, the blood can still get around because there's another pathway.
What is the number one cause of an MI and what are some others?
#1 = Atherosclerosis.
Others include embolus, spasm, high demand for oxygen vs. inadequate supply of O2.
What are some symptoms of an MI?
Pain greater than 30 minutes, and the pain is unrelieved by rest or nitro, Anxiety, SOB, N/V, diaphoresis.
How do we diagnose an MI?
Symptoms, History, 12 lead ekg, enzyme elevation, echo, cardiac cath.
What are some ekg changes associated with a MI?
Flipped T (Ischemia), elevated ST, etc. - or the exact opposite on the reciprocal side.
What are some of the cardiac lab markers?
CK-MB, Troponin I or T (2-4 hour onset), Myoglobin (not cardiac specific)
How do we treat a MI?
Monitor pt, ekg, pain relief, o2, positioning, quiet and calm environment, etc.
What do thrombolytics do?
Dissolve the blood clots.
What do fibrinolytics do?
Dissolve thrombi in coronary arteries and restore myocardial blood flow.
What does streptokinase do?
Thrombolytic - cheap but takes longer to work.
What does alteplase do?
Thrombolytic - TPA - bolus of med with drips!
Urokinase - what does it do?
Thrombolytic - a lot of allergic reactions, though.
Anistreptace - what is it?
Tenecteplase - what is it?
Thrombolytic - one shot deal - more commonly used now.
Who are not suitable candidates for thrombolytics?
pt's with recent surgery, GI bleeeds, pregnant, etc.
What is part of the nursing care with thrombolytics?
3 IV sites, baseline EKG, assess for decrease in chest pain, monitor for reperfusion dysrhythmia's, assess minor oozing from puncture sites, assess re-occlusion or re-infarction, assess for major hemorrhage or stroke.
What is the diff between thrombolytics and anti-coagulants?
Thrombolytic's break the clot and anti-coagulant's prevent a clot from happening.
What are some anti-coagulants?
Heparin, Coumadin, Lovenox, Pradaxa
What are some anti-platelets?
Aspirin, Plavix, ersantine, Reapro, Integrillin, Xarelto, Eliquis
What is HIT?
Heparin-Induced Thrombocytopenia - abnormal reaction to heparin. Antidote is PROTAMINE SULFATE. The platelet count is less than 100,000 and you develop chills, fever, urticaria - you need to be on another drug STAT.
What are some other medications given to an MI patient?
Calcium channel blockers, beta blockers, ace inhibitors/arbs, glycoprotein.
What are some percutaneous cardiac interventions?
Angioplasty, Athrectomy, Stent, Laser
What is angioplasty?
Uses balloon to smash plaque against the lumen of the artery.
What is athrectomy?
Atherosclerotic tissue is shaved from the intima (inner layer) of the vessel.
What is a stent?
Mesh that is placed against the sides of the artery to hold it open.
What is laser therapy (in terms of percutaneous cardiac interventions)?
Laser energy is aimed and released at plaque.
Is angioplasty permanent?
Not always - that's why we have stents.
With a stent, do they need to be on aspirin/something similar?
Yup - the stent is hard on the vessels so they have a tendency to throw clots.
Sternotomy - def
Thorocotomy - def
Sternotomy = cut the chest open (saw).
Thoracotomy = get in chest, like for lungs and such.
What is CAB?
Coronary Artery Bypass.
What are two good vein or artery options for a CAB?
Saphenous or internal mammary
How long does the saphenous vein last?
10-15 years if used for CAB.
Does the internal mammary arteries last longer for a CAB?
Yes - but be careful when using these for diabetic patients.
What is CAB with gastro-epiploic artery?
It's using an artery in the stomach...it's not used as much!
What are some things to do pre-op for a CABG surgery?
Informed consent, teaching (lifestyle changes!), diagnostic cath, assessments (coags, carotids, respiratory, renal, infection)
What are some things to do post-op for a CABG surgery?
take patient to ICU, frequent assessments, CT's, PAP cath, AL, temporary pacemaker, fluid and electrolyte balance
What are some complications from a CABG surgery?
shock, sepsis, ARDS (acute respiratory distress syndrome), renal failure, CVA, MI, hypo or hypertension, bleeding, hypothermia, etc.
What are some MI core measure?
ASA on arrival, ASA at discharge, LVF/EF addressed by physician in progress notes, ACE or ARB for left ventricular systolic dysfunction, adult smoking cessation, serial troponin levels, ASA and Beta Blocker ordered at discharge.
What are some complications of an MI?
Dysrhythmia's, CHF/Pulmonary Edema, cardiogenic shock, recurrent MI, emboli, pericarditis, ventricular aneurysm, ventricular rupture.
Heart failure - does it happen with an MI?
It can - it's seen more with larger infarctions.
How do we treat mild & more severe HF in a MI patient?
Mild = oral diuretics and low salt diet.
More Severe = vasodilators and an inotropic agent (but digoxin isn't preferred here)
What is cardiogenic shock?
State of circulatory failure - like a stunned myocardium. There's a decrease in cardiac output.
How do we treat cardiogenic shock?
Rule out hemorrhage, pulmonary embolis, sepsis, etc.
Treat with inotropic agents, decrease afterload - levophed, nitro, etc.
What is IABP?
It's a balloon placed in the aorta - it is used for a short time and it helps to increase perfusion and cardiac output.
What is pericarditis?
Inflammation of the pericardial sac - caused by pain (worse on inspiration, relieved by sitting or leaning forward), dyspnea, low grade fever, pericardial friction rub, etc.
What is pericardial effusion?
Fluid accumulates in the pericardial sac
What is pericardial tamponade?
Fluid causes cardiac dysfunction.
Pericarditis - diagnosis?
EKG - T Wave Inverted.
Normal CXR & Echo
Pericarditis - treatment?
Anti inflammatory drugs, antibiotics, pericardiocentesis.
What is a ventricular aneurysm?
Occurs at the site of the infarction, usually after the patient is home, and thrombi form in the aneurysm - treatment is a surgical incision.
What happens with a rupture of a ventricular aneurysm?
IT IS RARE AND AN EMERGENCY. OCCURS AROUND 4 DAYS AFTER MI