Hemodynamic Monitoring

Question 1

What is Acute Coronary Syndrome (ACS)?

Answer 1

Emergency involving sudden myocardial ischemia; if untreated → myocardial infarction (MI).

Question 2

What are the components of the spectrum of ACS?

Answer 2

Unstable Angina (USA) and Acute MI (AMI).

Question 3

What is Unstable Angina (USA)?

Answer 3

Partial occlusion, no myocardial necrosis.

Question 4

What is NSTEMI?

Answer 4

Partial occlusion + myocardial cell death.

Question 5

What is STEMI?

Answer 5

Complete occlusion + transmural infarction.

Question 6

What are the causes of reduced O2 supply in ACS?

Answer 6

Atherosclerosis, plaque rupture → thrombus → ↓ coronary perfusion; vasospasm, hypotension, anemia, acute blood loss.

Question 7

What are the causes of increased O2 demand in ACS?

Answer 7

Tachycardia, thyrotoxicosis, stimulant use (e.g., cocaine).

Question 8

What is the result of ischemia in ACS?

Answer 8

Ischemia → infarction → necrosis of heart muscle.

Question 9

What does T-Wave Inversion indicate on an EKG?

Answer 9

Indicates ischemia (delayed repolarization).

Question 10

What does ST-Segment Elevation indicate on an EKG?

Answer 10

Indicates injury (cells repolarize early).

Question 11

What does an Abnormal Q-Wave indicate on an EKG?

Answer 11

Indicates infarction (appears 1–3 days post-MI).

Question 12

What is required to track the progression of MI?

Answer 12

Serial ECGs.

Question 13

What are the clinical manifestations of ACS?

Answer 13

Pain: Sudden, unrelieved by rest/NTG; Cardiac: JVD, palpitations, new heart sounds (S3/S4), BP changes; Respiratory: SOB, dyspnea, pulmonary edema; GI: Nausea, vomiting, indigestion; Skin: Cool, clammy, pale, diaphoretic; Neuro: Anxiety, dizziness, altered LOC; Psych: Denial, fear, impending doom.

Question 14

What is the recommended diagnostic test for ACS?

Answer 14

12-lead ECG within 10 min of pain.

Question 15

What are the key lab tests for ACS?

Answer 15

CK-MB: Cardiac-specific, peaks in 24h; Myoglobin: Early marker, not specific; Troponin I/T: Most specific, rises in 1h, remains for up to 3 weeks.

Question 16

What is the purpose of an echocardiogram in ACS?

Answer 16

Assesses wall motion and ejection fraction.

Question 17

Classification of MI: Type

Answer 17

NSTEMI: Ischemia w/o biomarkers/ECG changes.
STEMI: + Biomarkers, no ST elevation.

STEMI: ST elevation + elevated biomarkers.

Question 18

Classification of MI: Location

Answer 18

Anterior, Inferior, Posterior.

Question 19

Classification of MI: Timing

Answer 19

Acute, Evolving, Old.

Question 20

Medical Management Goals

Answer 20

Minimize damage, preserve function, prevent complications.

Question 21

Medical Management Achieved via

Answer 21

Emergency PCI/PTCA, Thrombolytics, ↓ O2 demand (beta blockers, morphine), ↑ O2 supply (O2, nitrates).

Question 22

Initial Treatment (‘MONA + BAH’) - Morphine

Answer 22

↓ preload/afterload, pain/anxiety relief.

Question 23

Initial Treatment (‘MONA + BAH’) - Oxygen

Answer 23

↑ oxygenation.

Question 24

Initial Treatment (‘MONA + BAH’) - Nitroglycerin

Answer 24

Vasodilation, ↓ myocardial oxygen demand.

Question 25

Initial Treatment ('MONA + BAH') - Aspirin

Answer 25

Antiplatelet, prevents clot progression. ## Footnote Dosage: 162–325 mg.

Question 26

Initial Treatment ('MONA + BAH') - Beta Blockers

Answer 26

↓ HR/BP, myocardial O₂ consumption.

Question 27

Initial Treatment ('MONA + BAH') - ACE Inhibitors

Answer 27

↓ afterload, prevents HF post-MI.

Question 28

Initial Treatment ('MONA + BAH') - Heparin/Anticoags

Answer 28

Prevent further clot formation.

Question 29

Nitroglycerin

Answer 29

Reduces myocardial oxygen consumption via vasodilation. Routes: Sublingual, IV, paste, PO. Brands: Nitrostat, Nitro-Bid, Imdur.

Question 30

Morphine

Answer 30

Drug of choice for MI pain. ↓ preload & afterload, relaxes bronchioles. Monitor for hypotension & respiratory depression.

Question 31

Beta Blockers

Answer 31

Continued during hospitalization and post-discharge. Prevent future events by ↓ myocardial O₂ demand.

Question 32

ACE Inhibitors

Answer 32

↓ BP, sodium, fluid retention. Prevent HF, reduce mortality post-MI. Monitor: K⁺, creatinine, BP, urine output.

Question 33

Calcium Channel Blockers

Answer 33

For patients unresponsive to beta blockers. Negative inotropic effect; relieves vasospasm. Drugs: Norvasc, Cardizem, Plendil.

Question 34

Antiplatelet Therapy

Answer 34

Drugs: Aspirin, Plavix, ReoPro, Aggrastat, Integrilin. Prevent platelet aggregation, clot formation.

Question 35

Anticoagulation

Answer 35

Heparin, LMWH (Lovenox), platelet inhibitors. Prevent extension of thrombus and new clot formation.

Question 36

Thrombolytic Therapy

Answer 36

Indication: STEMI w/in 6 hours and no PCI availability. Drugs: Activase, r-PA, TNKase. Reperfusion via thrombus lysis.

Question 37

Contraindications to Thrombolytics

Answer 37

Active bleeding, recent surgery or trauma, bleeding disorder, prior hemorrhagic stroke, severe HTN, AVM, pregnancy.

Question 38

Nursing Considerations (Thrombolytics)

Answer 38

Start IVs first. Avoid IM injections and non-invasive BP cuffs. Monitor for: - Bleeding (oozing, ↓ H/H) - Reperfusion arrhythmias (PVCs, VT, VF) - Neuro changes (headache, LOC).

Question 39

Signs of Reperfusion

Answer 39

ST segment returns to baseline, resolution of pain, new arrhythmias, rapid rise in CK-MB due to washout of necrotic cells.

Question 40

Nursing Diagnoses

Answer 40

Acute pain r/t ↑ O₂ demand, ↓ cardiac tissue perfusion, risk for fluid imbalance, ↓ peripheral tissue perfusion r/t LV dysfunction.

Question 41

Nursing Process Goals

Answer 41

Relieve ischemia/pain, improve respiratory and tissue perfusion, reduce anxiety, prevent complications.

Question 42

Home & Community Care

Answer 42

Educate on lifestyle changes, rehab, and compliance. Tailor interventions to patient priorities. Support long-term recovery and prevent readmission.