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