Coronary Heart Disease 2 - Acute Coronary Syndromes Flashcards Preview

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Flashcards in Coronary Heart Disease 2 - Acute Coronary Syndromes Deck (18):
1

Do veins or arteries have less smooth muscle?

Veins

2

What does ACS stand for?

Acute Coronary Syndromes (also known as a heart attack)

3

What are the 3 types of ACS?

-Unstable Angina
-STEMI
-NSTEMI

4

Describe the progression of ACS (8 steps).

1. destabilization of plaque (fibrous cap) due to blood flow (shearing)
2. lining is disrupted, collagen exposed triggering platelets
3. platelets adhere to exposed collagen and change their shape
4. after activated, the platelets give off thromboxane A2 and ADP
5.ADP binds to P2Y12 receptor which activates GpIIb/IIIa receptor on the platelet
6. neighbouring platelets can crosslink fibrinogen as part of the clotting cascade
7. more platelets aggregate due to TxA2, serotonin, thrombin
8. fibrinogen converted to fibrin using thrombin

5

What are the 3 receptors involved in the progression of ACS?

P2Y12
GPIIb/IIIa
Fibrinogen

6

Explain the difference between white clots and red clots.

White:
-more platelets than fibrin
-incomplete artery occlusion
-more common in NSTEMI
Red:
-more fibrin than platelets
-usually complete artery occlusion
-more common in STEMI

7

What is the main difference between stable angina and ACS (symptoms)?

ACS symptoms do not go away if you rest! Stable angina symptoms do go away if you rest.

8

What does an EKG do?

Measures the electric activity of the heart. Has different waves (PQRST)

9

Explain the purpose of a Troponin T test.

The release of troponin T is a marker of cardiac cell (myocyte) death. High results of troponin T indicate that there has been damage to the heart

10

What does PCI stand for? Explain it.

Percutaneous Coronary Intervention: Also known as an angioplasty or stenting. A catheter and tube is inserted into the coronary arteries. A balloon is inflated which pushes the plaque to the wall of the blood vessel. A metal stent can be put in to hold the artery open or a drug-releasing stent can be put in. This is done to correct blockage that has taken place in the coronary arteries.

11

What does CABG stand for? Explain it.

Coronary Artery Bypass Graph:
A great blood vessel is harvested (great saphenous vein or LIMA (left internal mammary artery) and cut into pieces. One end is sewn to the aorta and the other end is sewn downstream of the blockage. The number of blockages determined how many bypasses need to be done.

12

What is the difference between STEMI and NSTEMI?

STEMI - shows ST elevation on an EKG
NSTEMI - shows ST depression and/or T inversion as well as elevated troponin T levels

13

What is an unstable angina?

Shows ST depression and/or T inversion as well as non-elevated levels of troponin T

14

What test is done to differentiate between what type of ACS something is?

EKG

15

What is a myocardial infarction ?

Also known as a heart attack. It is when blood flow to a part of the heart is stopping which causes damage to the heart muscle.

16

What are symptoms of an ACS?

-If pain happens when the person is at rest
-If nitroglycerin doesn't help
Other symptoms that are consistent with stable angina are:
-shortness of breath
-nausea
-fatigue
-pain (chest or referred)
-swelling

17

Describe the flow chart of the EKG tests and diagnoses when determining what type of ACS something may be.

-If the EKG shows ST elevation you know it is a STEMI.
-If it shows ST depression and/or T inversion then you have to do a Troponin T to further diagnose.
-If the Troponin T levels are elevated you have an NSTEMI.
-If the Troponin T levels are not elevated you have an UNSTABLE ANGINA.

18

What types of medication would help prevent a heart attack?

-Asprin - prevents thromboxane A2 which causes platelets to be sticky and makes clots bigger
-Statin's (rosuvastatin, atorvastatin) - it will lower your LDL cholesterol levels
-Warfarin - thins the blood
-Beta blocker - B1 receptors are found in the heart. We use specific beta blocker stop block B1 receptors in the heart which decreases heart rate. (If you decrease heart rate you decreases oxygen demand which in turn decreases oxygen supply)
-epitifibatide - GPIIb/IIIa inhibitor
-alteplase or tenectiplase (these are fibrinolytic and break fibrin clots)
-clopidogrel - blocks P2Y12 receptor therefore the GPIIb/IIIa is not activated
-heparin and low molecular weight heparins - disrupts clotting cascade and LMWH