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25 Cards in this Set
- Front
- Back
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Define ACS
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Umbrella term that includes Sx that occur d/t imbalance of myocardial oxygen demand and supply.
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Describe angina
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Caused by blockage or spasm of a coronary artery
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CAD Risk Factors
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Elevated serum lipids
HTN Smoking Impaired glucosed Tolerance High fat diet Obesity Physical inactivity Oral contraceptives Cocaine use Chronic Kidney disease DM Metabolic Syndrome Hyperhomocysteinemia (norm 5-15) Vascular inflammation (Creac protein norm <1) |
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MI Definition.
How long cardiac cells withstand ischemia |
Disruption or deficiency of blood supply to coronary arteries
Necrosis of myocardial tissue Irreversible myocardial necrosis caused by absence of coronary blood flow to area of myocardium. 20min |
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Etiology of MI
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Plaque rupture
Coronary thrombosis Coronary artery spasm |
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Describe the 3 "I"s of an MI and the changes that go along with them on the ECG.
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Ischemia- T wave inversion or tall peaked T wave, or ST depression d/t changes in tissue repolarization
Injury- ST elevation d/t decreased blood supply *returns to normal as injury heals Infarction- Pathological Q wave d/t scar tissue that cannot depolarize |
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Describe NSTEMI and STMI
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NSTEMI- Non-ST elevation MI, not full thickness, less likely to have Qwave
STEMI- ST elevation MI, allows for early id |
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What is the difference between transmural and nontransmural damage of MI? Where is most frequent site of MI?
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Transmural- involves all 3 cardiac layers; full thickness of myocardium (endo, myo, epicardium)
Nontransmural- involes a more limited amt of cardiac tissue (subendocardial, endocardial, epicardium, subepicardium) Left Ventricle (does most work, larger muscle) |
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Infarction location, vessel, ECG Leads:
Anterior Septal Lateral Inferior Posterior |
LAD, V2-V4
LAD, V1-V2 Left circumflex, V5-6, I, AVL RCA, II, III, AVF Left circumflex, V1-V2 (indirect) |
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Clinical presentation of MI: Describe
CP: Location: Duration: Quality: Radiation: Associated sx: |
Not relieved by NTG or rest
Beneath sternum, epigastric >30min w/ relief from rest or meds Sensation of pressure or heavy weight on chest, burning sensation Back, neck, jaw, down left arm N/V, diaphoresis |
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Clinical presentation of an MI on rhe ECG
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Significant pathological Qwave
Elevated ST segment T wave inversion Qwave remains evident after healing |
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Clinical Presentation of Biomarkers with MI (norm, elevation, peak, return to norm)
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Tropinin I: <0.03, 3hr, 24h, 5-10d
Tropinin T: <0.2, 3-5h, 12-48h, 14-21d CK-MB: 0%, 4-6h, 24h, 2-3d Myoglobin: <90, 2h, 3-15h, 24h |
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Clinical Presentation: Labs (MI)
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WBC: inc w/ 2h of pain d/t necrosis
Blood glucose: eleveates with MI (increased catecholamine, damage) |
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Management of MI (2 main aspects)
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Increase O2 supply
Decrease myocardial demand |
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Management of MI (Reperfusion strategies)
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Fibrinolytic therapy
-onset of sx <12h -less than 30min of admin -tissue plasminogen activator (t-PA) --clot specific ---Alteplase (t-PA), retaplase (r-PA), Tenectoplase (TNKase) --Nonclot specific ---Streptokinase (SK) Percutaneous coronary intervention (PCI) -Door to needle: <90min -Angioplasty -Stenting Cardiothoracic surgery is another intervention that could be used |
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Management of MI (Anticoagulation and dysrhythmia prevention)
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1.
ASA -dc platelet aggregation Anticoagulant: heparin -prevent re-occlusion Glycoprotein IIb/IIIa inhibitors -prevents platelet aggregation -prevents fibrinogen from binding to receptors on platelet surface -Integrelin, Aggrastat, ReoPro 2. -Amiodarone -Beta Blockers |
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Management of MI (in regards to glucose and ventricular remodeling)
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Maintain 70-110
Ace inhibitors ARBs |
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Management of MI, general interventions and drugs
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Oxygen
NTG (SL and IV) {Inc coronary perfusion} Beta Blockers (protect heart from sympathetic stimulation which dc risk of VF) (Contraindicated in pt w/ asthma) Ca Channel Blockers (relieves coronary vasospasms, dc O2 need) Morphine for pain (2-10mg q 5-15min) (dilates and dc O2 demand) Bed rest w/ bedside commode privileges (dc myocardial O2 demand) Monitor ECG, VS q15min, O2sat. troponin levels/biomarkers, PT/APTT (observe for bleeding if recieved lytic therapy), Hemodynamic crompromise (dopamine, doputamine), assess s/s of HF (S3, S4, rales, edema, wt gain, dec CO, dec UOP) |
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Name 8 Nurse Dx for MI
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Ineffective cardiopulmonary tissue perfusion, dec CO, acute pain, activity intolerance, anxiety, powerlessness, ineffective coping
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Complications with MI
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Sinus brady:
-more prevalent w/ inferior wall MI -treat if symptomatic -atropine IVP q3-5m, max of .03mg/kg Sinus tach: -anterior wall MI -inc myocardial o2 demand, which leads to further ischemia -dec LV function and SV Atrial dysrhythmias -PACs -Afib Ventricular Dysrhythmias -in presence of MI, may need to be treated if: -- >6/min --closely coupled, R on T --polymorphic --occurs in bursts Atrioventricular Heart block during MI: -inferior MI Ventricular aneurysm: -noncontractile thinned LV wall -most often occurs w/ acute LAD artery occlusion -complications of aneurysm --heart failure --angine --ventricular tach Ventrical septal defect (VSD) -severe chest paine, syncope, hypotension -holosystolic murmur -high mortality rate Cardiac wall rupture Papillry muscle rupture -acute mitral valve regurgitation -partial or complete Pericarditis Pulmonary edema Pericarditis -pericardial friction rub -pain inc w/ resp effort -sitting dec pain -treat w nonsteroidals -late s: dressler's syndrome Thromboembolism Cardiogenic shock Heart failure |
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Describe the aspects of the causes of pulmonary edema
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Cardiogenic
-most common cause -severe LV failure Non-cardiogenic -drug OD -rapid IVF admin -pleural effusion Neurogenic -post head injury |
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Sx of pulmonary edema
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Persistent cough w/ pink frothy sputum
Tachypnea, dyspnea, orthopnea Restlessness Hypoxemia Crackles S3 heart sound Increased PAOP |
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Management of pulmonary edema
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Suction, maintain airway
HOB in high-fowlers O2, high flow Fluid restriction Meds: diuretics, morphine vasodilators, inotropic agents antihypertensives Emotional support |
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Describe PT education in regards to MI
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Diet
-AHA Step II diet -Reduce fat intake to <30% total cal/day -Reduce total serum cholesterol to <200 -Reduce salt intake Stop smoking Control HTN & Diabetes Achieve ideal body wt Avoid valsalva maneuver Inc physical activity gradually Refer to cardiac rehab program Sexual activity Med teaching: beta blockers, ACE inhibitors, antilipemics, antiplatelts |
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Describe the CORE MEASURES for AMI
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ASA @ arrival and discharge
Beta blocker prescribed @ discharge ACE or ARB @ discharge for LVSD if EF <40% Statin at discharge Smoking cessation counseling PCI within 90min of arrival if STEMI |
