WEEK 3 ACS Flashcards
How is angina described to feel like?
Constrictive, squeeze, heavy, choking, suffocating, indigestion, epigastric burning
Where does angina radiate to?
Arm, jaw, back
What are the atypical angina symptoms that women often have?
Fatigue, anxiety, indigestion, SOB
What atypical angina symptoms do elderly patients often have?
Weakness, syncope, SOB, diaphoresis
What causes diabetic patients to often have atypical angina symptoms?
Autonomic neuropathy
Which 2 substances are the cause of angina?
Lactic acid and troponin
What are the differences between chronic stable angina and unstable angina?
Chronic stable angina: Predictable, lonstanding, episodic, relieved with rest or nitroglycerin
Unstable angina: New onset; increasing frequency, duration, and severity; comes on at rest or with exertion; resistant to nitroglycerin
What 3 conditions are encompassed by the term Acute Coronary Syndrome (ACS)?
- Unstable angina
- NSTEMI
- STEMI
Explain the difference between unstable angina and MI
Unstable angina has negative trop, MI has positive trop
Explain the difference between NSTEMI and STEMI
NSTEMI: Partial or transient obstruction, no ST elevation, urgent treatment
STEMI: Complete obstruction, ST elevation, immediate treatment
Why is stable angina predictable and related to exertion, while unstable angina is experienced at rest?
Stable angina = demand-led ischemia
Unstable angina = supply-led ischemia
Define acute coronary syndrome (ACS)
Prolonged, irreversible myocardial ischemia
What is the ST segment on ECG?
Segment in between ventricular depolarization and repolarization
What does a depressed ST segment indicate?
Myocardial ischemia
Name 4 complications of MI
- Heart failure
- Dysrythmia
- Cardiogenic shock
- Pericarditis
How does MI lead to cardiac dysrhythmia?
Lack of blood flow alters sensitivity to nerve impulses (e.g. v-fib: can cause sudden cardiac death)
How does MI lead to cardiogenic shock?
Result of severe LV failure post MI (i.e. reduced ejection fraction)
For clients with ACS, what are the expected diagnostic studies to be performed?
- ECG
- Trop (unless positive STEMI, then straight to angio)
- Angio
- Echo
- CXR
What is troponin, and how long does it remain in the blood?
Released from damaged myocardium, peaks at 4-6 hrs and remins in blood for 10-14 days after
What is creatine-kinase MB, and how long does it remain in blood?
Enzyme found in cardiac muscle. Peaks early and gone in 48 hrs.
Why are CBC, PT, and INR checked in ACS patients?
To assess if they can be treated with anticoagulants or clot busters
Why are kidney function tests checked in ACS patients?
To assess if they can excrete contrast medium from angio, and what drugs the patient can receive post MI
What other lab tests are screened for ACS?
INR, PT
Lip/Chol
CBC
Lytes
Kidney function tests (BUN, Cr, GFR)
Grp + screen
What is the normal range for troponin 1?
Less than 0.04 ng/ml
