Disorders of Cardiac Function & Acute Coronary Syndrome

Question 1

differentiate treatments for pericarditis, pericardial effusion, & cardiac tamponade

Answer 1

pericarditis: acute idiopathic pericarditis is best treated by NSAIDs, and can add Colchicine (if slow response to NSAIDs), and corticosteroids as a last resort if not responding to the above drugs but be careful bc side effects and etc.

pericardial effusion: treatment of pericardial effusion depends on the progression of cardiac tamponade.
SMALL PE’s or mild cardiac tamponade—> Pericardiocentesis (removal of fluid from the pericardial sac–open or closed depending on how emergent the situation is) NSAIDs, colchicine, corticosteroids to minimize fluid accumulation. Open pericardiocentesis may be used depending on how recurrent or loculated the effusion is.

cardiac tamponade: see above

Question 2

briefly describe the significance of myocardial 02 balance in relation to supply and demand

Answer 2

the myocardial 02 balance is key to maintaining a healthy heart. There has to be enough supply to meet the 02 demands and VV.

Question 3

differentiate stable vs. unstable plaque including which poses a higher risk for myocardial infarction

Answer 3

stable plaque: obstructs blood flow
unstable plaque: can rupture and cause platelet adhesion and thrombus (clot) formation

unstable plaque has a higher risk for myocardial infarction

Question 4

understand how the coronaries of the heart are perfused–passively

Answer 4

the coronary arteries are perfused passively (during diastole) by the aortic blood pressure.

Question 5

STEMI vs. NSTEMI

Answer 5

STEMI results from complEtE and prolongEd occlusion of an Epicardial coronary blood vessel and is defined based on ECG criteria. (Q-wave)

NSTEMI usually results from severe coronary artery Narrowing, transient occlusion, or microembolization of thrombus and/or atheromatous material. NSTEMI is defined by an elevation of cardiac biomarkers in the absence of ST elevation. (non-Q-wave)

Question 6

what is the significance of a Q wave for acute coronary syndrome

Answer 6

the classic changes that occur in the ECG with ACS involve T-wave inversion, ST-segment elevation, and the development of an ABNORMAL Q wave

Question 7

explain the role of MONA (Morphine, O2, Nitro, Aspirin) in relation to preventing secondary injury after ACS.

Answer 7

morphine to: decreases heart rate, blood pressure, and venous return, all of which decreases myocardial oxygen demand
OxYgen to: increase myocardial oxygen supplY
NitrO to: vasOdilate blood vessels
ASpirin to: Slow or prevent clotting

Question 8

briefly explain the significance of reperfusion therapy (fibrinolytic vs. percutaneous coronary intervention)

Answer 8

fibrinolytic therapy works to dissolve blood and platelet clots. It lyses fibrin clots, as the name suggests. Fibrinolytic therapy reduces mortality, limits infarction size, encourages infarction healing/myocardial remodeling

percutaneous coronary intervention is where a stent or balloon (balloon PTCA–stent is blown up like a balloon) is put in to keep the artery open so blood can flow through the artery. This is an invasive procedure

Question 9

define stable angina and how it is managed

Answer 9

stable angina is associated with a fixed coronary obstruction that produces a disparity between coronary blood flow and metabolic demands of the myocardium.

management: non pharmacologic strategies/lifestyle changes favored, direct Tx towards symptom reduction and prevention of MI.
NP Tx: smoking cessation, stress reduction, exercise program, limiting intake of cholesterol and saturated fats, weight reduction if obesity is present, and avoidance of cold that promotes vasoconstriction.
P Tx: statins, aspirin, PCI.