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375 Exam 2
Acute Coronary Syndrome
| Term | Definition |
|---|---|
| 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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