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Cardio Unit 2 > Cardio - Unit 2, Medical Management and Potential Complications of ACS > Flashcards

Cardio - Unit 2, Medical Management and Potential Complications of ACS Flashcards

1
Q

Medical Management of ACS

A
  • Beta blocking drugs
  • Organic nitrates (sublingual nitroglycerin)
  • Oxygen reduces dyspnea
  • Morphine relieves pain and dyspnea
  • IV fluids if potential for BP to crash
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2
Q

What do beta-blocking drugs do to the heart?

A

Reduce the work of the heart by blocking adrenaline effects, blood vessel dilation

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3
Q

What do organic nitrates (sublingual nitroglycerin) do to the heart?

A
  • Reduce preload, thereby work, potential for excessive preload reduction - venous dilation and decreases after load by arterial dilation
  • Small effect on coronary blood flow
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4
Q

Sequencing of Drugs related to Thrombosis and Coagulation

A
  • Thrombolytic during ACS to restore blood flow
  • Heparin to reduce coagulation rapidly
  • Maintenance anticoagulation with warfarin
  • Asprin or plavix as an antithrombotic
  • Cholesterol-lowering drugs
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5
Q

What happens if there’s late administration of thrombolytics?

A

Can cause reprofusion injury

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6
Q

What do thrombolytics do?

A

Activate the natural anti clotting system which breaks down fibrin threads and dissolves any formed clot

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7
Q

Clinical Implications of Anti-thrombotic

A
  • Risk of bleeding and bruising are increased
  • Internal hemorrhage risk
  • Avoid bumping
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8
Q

Clinical implications of cardiac meds

A
  • Acute - be sure pt has drug available
  • Chronic - ensure pt is taking it
  • Cause DECREASED cardiac response to exercise
  • INCREASE exercise tolerance in pts with angina
  • May lead to peripheral vasodilation and Orthostatic intolerance
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9
Q

Management of ACS

A
  • ER to ICU to stabilize
  • Medical treatment by cardiologist - medications and monitoring
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10
Q

Surgical options for ACS

A
  • Percutaneous Translumial Coronary Angioplasty (PTCA) or Percutaneous Coronary Interventions (PCI)
  • CABG - Coronary Artery Bypass Graft
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11
Q

Why would you require a PTCA or PCI as an intervention?

A
  • Persistent chest pain or angina
  • Blockage of only 1-2 arteries with severe symptoms
  • A change in symptom severity
  • Failed medical therapy and worsening of L ventricular dysfunction
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12
Q

What are the surgical options for a CABG ?

A
  • Open heart
  • Minimally invasive
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13
Q

Why would you require a CABG as an intervention?

A
  • Presence of triple vessel disease (involves multiple vessels)
  • Severe L main artery stenosis
  • L coronary artery has a combined 70% or greater stenosis of L anterior descending and proximal left circumflex artery - particularly if L ventricular function is impaired
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14
Q

Potential results of an MI

A

MI = death of tissue
- Complications depend on extent of damage
- Arrhtyhmias
- Contractile issues
- Wall weakening
- All can lead to decreased cardiac output

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15
Q

Cardiogenic shock

A
  • Death of greater than 40% of LV
  • Heart has been damaged so much it’s unable to supply enough blood to the organs of the body
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16
Q

Ventricular Remodeling

A
  • Contractile issues and wall weakening
  • With STEMI, changes in shape, size and thickness of myocardium
  • Areas of ventricular dilation and ventricular hypertrophy
17
Q

Factors that affect remodeling

A
  • Size of infarct
  • Ventricular load/pressure
  • Patency of the artery that was infarcted - how well the artery that was infarcted was functioning
18
Q

What is the severity of functional impairment related to?

A
  • Left ventricular hypertrophy (determine progression towards HF)
  • Conduction defects (increase risk of v-fib or tendency to develop mural thrombosis)
  • Smoking, DM, HTN (can continue to accelerate and worsen atherosclerosis)
19
Q

What is the best predictor of function post ACS?

A

VO2max

20
Q

Below what VO2 max indicates the inability to perform ADLs independently and poor prognosis of survival?

A

Less than 21 mL/kg/min

21
Q

Mural thrombus

A
  • Clump of atherosclerotic plaque build up
  • Thrombi that attach to the wall of a blood vessel and cardiac chamber
22
Q

Angina and ACS Management

A
  • Control for cardiac pain (-nitrates, morphine, beta blockers)
  • Limit necrosis
  • Prevent complications
  • Thrombolytics/clot busters if within 3 hours of onset
23
Q

What is the primary concern with medical management of acute coronary syndrome?

A

Reperfuse that area of the heart not receiving enough blood and oxygen

24
Q

Sequencing of drugs related to thrombosis and coagulation

A
  • Thrombolytic during ACS to restore blood flow
  • Heparin to reduce coagulation rapidly
  • Maintenance anticoagulation with warfarin
  • Either aspirin or plavix as an Antithrombotic
  • Cholesterol lowering drugs to slow atherosclerotic process
25
Q

Persistent angina and arrhythmias (STEMI)

A
  • Especially V-fib = most common lethal complication
  • Death of tissue releases particles that interfere w/ myocardial cell repolarization
  • A-fib, heart -block, particularly when affects R side of heart
26
Q

STEMI and NonSTEMI complications

A
  • CHF: Ejection fraction less than 40%
  • Hypertrophy of areas
  • Ventricular aneurysm - ballooning out of a weekend LV
  • Ventricular wall rupture
  • Dyskinesia/Hypokinesia (increased risk of hemostasis)
  • Mural thrombus on the damaged wall of LV (Risk of later CVA)
27
Q

Prognosis for ACS

A
  • Depends on number of vessels involved
  • Degree of injury to the heart
  • Survival rate long term decreases as the number of vessels involved increases
28
Q

Signs and symptoms of MI

A
  • History of chest pain
  • Shortness of breath
  • Diaphoresis
  • N&V
  • Characteristic changes on EKG (ST segment elevation)
  • Enzymes of cardiac myocytes in blood especially CK-MB
29
Q

Why are enzymes monitored during an MI?

A
  • Either confirm suspicion of MI based on clinical signs
  • Diagnose it in the absence of clinical signs

Cardio Unit 2 (13 decks)

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