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Exam 3

What is the difference between ischemia and infarction? Ischemia is reversible and infarction is cell death due to lack of oxygen and isn't reversible.
What is the difference between chronic stable angina vs unstable angina? Chronic: is predictable and reversible with rest and nitro Unstable: Occurs at rest or on exertion, causes severe activity restrictions. Pain lasts longer than 15 min. and is poorly relieved with rest and nitro
What are the three categories of acute coronary syndrome? STEMI, Non-stemi and unstable angina
What is the difference between a NSTEMI and a STEMI? NSTEMI: Have ST and T wave changes indicating ischemia (T wave inversion) STEMI: ST elevation and possible deep Q wave/inverted T wave. Indicates rupture of plaque and thrombus causing a 100% blockage
What is infarction? Develops over several hours, areas can become necrotic and becomes scar tissue causing HF and dysrhythmias
What causes a "widow maker"? The LAD becomes obstructed resulting in a MI which effects the left ventricle wall, has a high rate of mortality.
What type of medications are used to treat chronic stable angina? Nitroglycerin: Isosorbide, Isodril Anti-platelet aggregators: aspirin, plavix Beta Blockers: metropolol Ace inhibitors and ARB's
How do Ace inhibitors and ARB's help with Chronic angina? Reduce the injection fraction, afterload
What is the benefit of a long acting Nitroglycerin (Isosorbide or Isodril)? Not as much of a headache as compared to sublingual Nitro
What are s/s of angina? -Substernal chest discomfort: radiating to left arm, precipitated by exertion/stress, relieved by nitro or rest, lasting less then 15 minutes
What are the S/S of an MI? -Pain or discomfort: substernal chest/pain pressure radiating to the left arm, jaw, back, shoulder or abdomen. Occurs without cause, usually in the morning, relieved only by opioids , lasting 30 min or more. -Other frequent symptoms: N/V, diaphoresis, dy
What cardiac markers are commonly used for diagnosing an MI? Troponin: 1-3 hours will increase CK-MB: 4-6 hr increase Myoglobin
What ECG changes would you see with ischemia? ST segment depression and/or T wave inversion
What ECG changes would you see with a start of an injury? ST elevation
What ECG change would indicate an infarction and that an occlusion and myocardial tissue has died? Deep Q wave and inverted T wave
What are the immediate interventions for a STEMI? -Sent to cath lab for angioplasty: If not in hospital; 12 hours from start of symptoms in house: goal is 90 min. Transfer from other hospital 120 min. -If unable to get to Cath lab administer TPA with in 30 min. of arrival
What are the immediate interventions for a NSTEMI? -Serial EKG every 15-30 min for first hour -Serial Cardiac markers: 3 and 6 hours and then troponin levels daily while in hospital -PCI/Stenting if still symptomatic
What is the immediate hospital/nursing intervention for a STEMI/NSTEMI? -Oxygen: keep at 90% min, -Aspirin: chewable 162-325 mg -Nitroglycerin: Subl Q5x3 -Morphine: for pain relief if nitro not effective
What medications would you expect to be ordered for a suspected STEMI/NSTEMI? -Nitroglycerin: vasodilation -Beta Blockers: unless sign of HF/shock/asthmatic (CCB if Beta Blockers contraindicated) -Ace inhibitors: indefinitely with pt. with EF<40% and those with HTN, DM or kidney disease -Clopidogrel (plavix) or ticagrelor -Lov
Created by: mimitubbs