Exam 2 Flashcards
(76 cards)
___________ angina is causes by exertion and relieved with rest or nitro.
Stable
___________ angina usually occurs at rest and is more prolonged and severe.
Unstable
What causes Angina?
Ischemia resulting from an imbalance of oxygen demand and myocardial oxygen supply
What are the risk factors for Angina?
- Smoking
- Obesity
- Sedentary lifestyle
- CAD
- HTN
- DM
- Hyperlipidemia
What are the clinical manifestations associated with Angina?
Chest pain (substernal, left-sided, or epigastric) that is usually described as heaviness, squeezing, or choking and may radiate to arm, neck, back, or jaw
What is the treatment goal for Angina?
Restore balance between O2 supply and demand
What is the immediate management for Angina?
MONA
- M - morphine
- O - oxygen
- N - nitro
- A - aspirin
What medications are used for the long-term management of Angina?
Beta-blockers or calcium channel blockers
__________ is characterized by ST elevation and indicated full coronary blockage.
STEMI
In an __________ there is no ST elevation and partial coronary blockage is indicated.
NSTEMI
________ means decreased oxygen supply
Ischemia
__________ means complete loss of oxygen resulting in cell death
Infarction
What causes a MI?
Prolonged ischemia (lack of oxygen supply) to the cardiac tissue that leads to an infarction (irreversible cell damage and tissue death), usually the result of a thrombotic occlusion
How is an MI diagnosed?
- EKG changes - changes in T wave, ST segment, Q wave
- Labs - myoglobin and troponin
- X-ray or angiography
What are the clinical manifestations associated with an MI?
Chest discomfort, diaphoresis, dyspnea, weakness, fatigue, anxiety, confusion, SOB, n/v, cool & moist skin, HTN, tachycardia, irregular pulse
What is the treatment goal of MI management?
Reperfusion
What is the initial management for an MI?
- MONA
- Serial ECG’s
- Serial troponins
- PTCA or fibrinolytic therapy
What is the ongoing management following an MI?
- daily aspirin
- IV heparin for STEMI patients
- ACE inhibitors - prevent ventricular remodeling and preserve ejection fraction
- Beta-blockers, nitrates, statins, antiplatelets
Nitroglycerin Patient Education
- Carry with you at all times
- Keep in a dark-colored glass bottle to protect from sunlight
- Sublingual - place under the tongue and let dissolve
- Take one tablet every 5 minutes for a total of 3 tablets
- If pain continues, seek immediate care
- Side effects: headache, flushing, dizziness
____________ is the best lab indicator of infarction and is released into circulation after necrosis and rupture of myocardial cells.
Peaks at ___ hours
Troponin
24
Acronym for CV assessment
- N - normal
- O - onset
- P - precipitating and palliative factors
- Q - quality and quantity
- R - region and radiation
- S - severity
- T - time
_____ is the hormone released by the heart in response to stretching, indicates _________ __________.
BNP
Heart Failure
Pre-operative Care for a PTCA
- Monitor labs - cardiac enzymes, coagulation, electrolytes, Creatinine and BUN
- May need to administer aspirin or antiplatelet
- Discontinue Coumadin (risk of bleeding) and Metformin (if contrast dye is being used, renal)
Post-Operative Care for a PTCA
- Monitor labs
- Monitor chest pain
- Incision site (bleeding, hematoma, pain, swelling)
- Assess distal pulses
- Keep extremity straight and bed lowered
- Meds - aspirin and plavix, calcium channel blockers
