Exam 3
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| 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.
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| 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
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| What are the three categories of acute coronary syndrome? | STEMI, Non-stemi and unstable angina
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| 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
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| What is infarction? | Develops over several hours, areas can become necrotic and becomes scar tissue causing HF and dysrhythmias
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| 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.
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| 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
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| How do Ace inhibitors and ARB's help with Chronic angina? | Reduce the injection fraction, afterload
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| What is the benefit of a long acting Nitroglycerin (Isosorbide or Isodril)? | Not as much of a headache as compared to sublingual Nitro
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| 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
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| 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
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| What cardiac markers are commonly used for diagnosing an MI? | Troponin: 1-3 hours will increase
CK-MB: 4-6 hr increase
Myoglobin
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| What ECG changes would you see with ischemia? | ST segment depression and/or T wave inversion
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| What ECG changes would you see with a start of an injury? | ST elevation
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| What ECG change would indicate an infarction and that an occlusion and myocardial tissue has died? | Deep Q wave and inverted T wave
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| 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
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| 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
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| 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
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| 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
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