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375 Exam 2

Acute Coronary Syndrome

TermDefinition
unstable angina caused by reduced blood flow to the heart muscle due to narrowed coronary arteries caused by atherosclerosis
unstable angina troponin not elevated
unstable angina symptoms new in onset, occurs at rest, worsening pattern and increasing frequency; crescendo and easily provoked
unstable angina EKG St depression and T wave inversion depending on how much ischemia occurs
NSTEMI occurs due to a partial coronary blockage or a blockage off of the main coronary artery; may or may not show EKG changes; reversible if reperfused within 6 hours
NSTEMI symtpoms pain lasting longer than 10 minutes and radiates to arm, neck, jawline
NSTEMI troponin elevated
STEMI total occlusion of a coronary artery that causes no perfusion to the cardiac muscle
STEMI EMERGENCY artery must be opened within 90 minutes to restore blood flow and oxygen to the heart; immediate PCI and thrombolytic therapy
STEMI EKG ST elevation
troponin cardiac biomarker; released in the blood from necrotic heart muscle; increased 4 - 6 hours after onset, peak 10 - 24, return to baseline 10 - 14 days later
echocardiogram visualize damage to the heart
exercise or pharmacological stress testing only with a STEMI because you have time before intervention is needed
cardiac catheterization goal is to open the occluded artery to limit infarct size; needs to be within 90 minutes for STEMI and 12 - 72 hours for NSTEMI
ACS pain severe, immobilizing chest pain not relieved by rest, position or nitrates; heaviness and pressure, constriction and crushing, substernal or epigastric, neck, jaw
ACS sympathetic response catecholamine release, diaphoresis, vasoconstriction, tachycardia, tachypnea, hypertension, ashen and cool, clammy skin
ACS cardiovascular crackles, JVD, peripheral edema, hepatomegaly, s3 and s4
catheterization benefits faster and less invasive, local anesthesia, faster reperfusion, decreased length of stay
thrombolytic therapy limit infraction size by dissolving thrombus, goal is to give within 30 minutes of arrival; IV atlepase, streptokinase
thrombolytic inclusion criteria chest pain less than 12 hours with EKG findings consistent with an acute STEMI
thrombolytic protocols draw blood to obtain baseline, start 2 large bore IV, give as IV bolus over 30 to 60 minutes, document time beginning
reperfusion assessment ST segment at baseline, resolved chest pain, rise of cardiac biomarkers within 3 hours of therapy
nitroglycerin reduce pain and improve coronary blood flow, immediate onset, monitor for hypotension
morphine sulfate vasodilator, decreases workload of the heart; side effects respiratory depression
ACE inhibitors started within first 24 hours or when BP is stable; ER is less than 40%; prevent ventricular remodeling
heart failure complication right or left ventricle pumping action is reduced
cardiogenic shock complication inadequate oxygen to tissue due to severe left ventricular failure
papillary muscle dysfunction complication massive mitral valve regurgitation causes dyspnea, pulmonary edema and decrease cardiac output, blood back up in the atria; causes different heart sounds and clinical deterioration
ventricular aneurysm complication myocardial wall becomes thinner and bulges out during contraction; leads to HF, arrhythmia and angina; fatal if ruptures
acute pericarditis complication inflammation of visceral and parietal pericardium results in cardiac tamponade, decreased left ventricular filling and heart failure, occurs 2 to 3 days after MI
acute pericarditis findings diffuse ST elevation; pericardial friction rub, chest pain worse with cough and inspiration
dressler syndrome complication pericarditis 1 to 8 weeks after an MI; treat with NSAIDs, corticosteroids or high dose aspirin
Created by: ahommel
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