Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
51 Cards in this Set
- Front
- Back
|
What are the four Primary Coronary Arteries?
|
1. LMCA- left main
2. LAD- left anterior descending 3. LCX- left circumflex 4. RCA- right coronary artery |
|
|
What are the two types of coronary artery disease?
|
Chronic Ischemic and Acute Coronary Syndromes
|
|
|
What are the types of Chronic Ischemic Heart Disease?
|
Stable angina, variant angina
|
|
|
What are the types of Acute Coronary Syndromes?
|
ACS represents a continuum of atherosclerotic processes.
1. Unstable Angina 2. Myocardial Infarction |
|
|
What is Angina?
|
chest pain associated with ischemia. the result of a decrease in O2 supply to the myocardial cells. it is NOT cell death, but can be a precursor
a simple supply and demand principle with O2. it is a symptom of coronary artery disease, or it could also be caused by coronary artery spasms. |
|
|
What is stable angina?
|
occurs with exertion and is relieved by rest or nitroglycerin within 5-20 minutes. The demand from exertion exceeds the bloods oxygen supply, so it starts to hurt. It is typically predictable in occurrence, strength, and relieving factors.
|
|
|
What causes stable angina?
|
"fixed lesions" of more than 75% of the coronary artery lumen.
|
|
|
What is variant (Prinzmetal's) angina?
|
This angina is not predictable and is not related to physical activity. It often occurs at night, and the cause for the coronary spasms is unknown.
|
|
|
What is Acute Coronary Syndrome?
|
AKA Unstable Angina
This is a prelude to a MI (NOT a heart attack in itself) -it is an imbalance between myocardial oxygen supply and demand. The angina is usually more intense. EKG changes can suggest ischemia, but there are no biomarkers (aka the troponin is NOT elevated) |
|
|
Characteristics of Acute Coronary Syndrome
|
**severe angina that persists for more than 5 minutes, worsens in intensity, and is NOT relieved by ONE nitro
-a change in a previously established pattern of angina -usually more intense than stable and may not be cured with nitrates |
|
|
Clinical presentation of acute coronary syndrome.
|
Pain (retrosternal/left pectoral/epigastric) that radiates.
Burning/squeezing/heavy/smothering feelings. Lasts 1-5 minutes Clenched fists |
|
|
Women with acute coronary syndrome
|
Women tend to present differently. Fatigue, SOB, edema, and or nonspecific chest discomfort.
they are more of a 'i just dont feel well' than an 'omg my heart' |
|
|
Nursing MGMT of ACS
|
full evaluation of pain
vital signs mentation lung sounds |
|
|
Nursing Interventions with ACS
|
relieve CP, and monitor for increase/decrease of pain, admin O2, cardiac monitoring, ASA (reduce mortality, chew the pills), nitrates (SL or IV), alagesia (morphine), monitor EKG changes, hypotension, headaches, provide a calm environment
|
|
|
Medication Interventions with ACS
|
Beta Blockers- block the adrenergic receptors, therefore decreasing HR, BP, contractility.
Calcium Channel Blockers- increases coronary blood flow and perfusion |
|
|
Medical Interventions with ACS
|
revascularization via cardiac catheterization, angioplasty, stenting, and bypass surgery
|
|
|
Goals of ACS Therapy (6)
|
1. maintain adequate CO
2. maintiain tissue perfusion/oxygenation 3. decreased or absent pain 4. decreased anxiety 5. modify behavior 6. describe the disease process |
|
|
What is a Myocardial Infarction?
|
irreversible myocardial necrosis secondary to a decrease/total interruption of blood flow to a specific area of the myocardium.
|
|
|
What causes a myocardial infarction?
|
plaque rupture, new coronary artery thrombosis, or coronary artery spasm
|
|
|
What is the time frame for treating an MI?
|
within two hours of onset of angina
|
|
|
What is a transmural MI?
|
Ischemic necrosis of the full thickness of the affected muscle segments, extending from the endocardium, through the myocardium, to the epicardium.
-associated with atherosclerosis involving a major coronary artery. subclassified to anterior, posterior, or inferior. |
|
|
What is a non-transmural MI?
|
the area of ischemic necrosis is limited to the endocardium, or endocardium and myocardium. It is the endocardial and subendocardial zones of the myocardial wall segment that are the least perfused regions of the heart and the most vulnerable to conditions of ischemia.
|
|
|
What is a subendocardial MI?
|
It is a non-transmural MI that is relatively rare and ZONAL. This means it involves a small area in the subendocardial wall of the left ventricle, ventricular septom, or papillary muscles.
|
|
|
Types of Transmural MIs
|
Anterior, posterior, inferior
|
|
|
Q-Wave MI
|
an older subclassification of MI, based on clinical diagnostic criteria, is determined by the presence or absence of Q waves on the EKG, however the presence or absence of Q waves do not distinguish a transmural from a non-transmural.
|
|
|
Location of MI: Anterior Wall
(causes) |
Left Anterior Descending.
-may be associated with left ventricle pump failure, cardiogenic shock, and death |
|
|
Location of MI: Left Lateral Wall
|
Left Circumflex
|
|
|
Location of MI: Inferior Wall
|
Right Coronary Atery
-anticipate heart block and more rhythm changes |
|
|
Location of MI: Right Ventricular
caused by what clinical condition? |
Cardiogenic Shock
|
|
|
Location of MI: Posterior Wall
|
Right Coronary Artery or Circumflex
-difficult to detect! |
|
|
What is an NSTEMI?
|
a nontransmural, non-q wave,
subendocardial MI. -pts that have an NSTEMI and still have infarction and CAD still need to be treated aggressively and appropriately |
|
|
Complications associated with an MI?
|
dysrhythmias, pericarditis, heart failure/cardiogenic shock
|
|
|
What is pericarditis?
|
Inflammation of the pericardial sac, associated with a transmural MI. pain is the most common symptom- will hear a friction rub on auscultation.
|
|
|
Presentation of an Acute MI
|
tachycardia, bradycardia, ectopy, normo/hypotensive, tachypneic, diminished heart sounds, may have a gallop, systolic murmur, crackles, pulmonary edema, air hunger, orthopnea, decreased CO, decreased peripheral pulses, decreased capillary refill, restlessness, confusion, anxiety, agitaition, denial, anger
|
|
|
Initial MGMT of patients with CP/Suspected MI
|
rapid triage, O2, 12 lead, ASA, IV access, nitroglycerin, moprhine
|
|
|
Pharmacological MGMT of an MI
|
Oxygen, ASA, nitrates, beta blocekrs, morphine, heparin, ACE inhibitors, inotropes
|
|
|
What is cardiogenic shock?
|
a state in which a weakened heart istn able to pump enough blood to meet the body's needs. It is a potentially fatal emergency. The most common cause is damage to the heart muscle from a severe heart attack.
|
|
|
What are the appropriate Medical MGMT measures of an Acute MI?
|
-angioplasty, atherectomy (cutting/shaving/grinding the plaque), and stent placement.
Remember: -Recanalization of the coronary artery is KEY! -Fibrinolytic therapy or percutaneous interventions are also used. -Anticoagulate! -Dysrhythmia prevention (includes amniodarone and beta blockes) -Glucose control -Reduce risk of heart failure (use ACE inhibitors or Angiotensin Two Receptor Blockers) |
|
|
What is fibrinolytic therapy?
|
for an acute STEMI, the goal is to limit the size of the infarction. Therefore, lysis of the acute thrombosis (it is composed of aggregated platelets with fibrin strands) so fibrinolytics dissolve those fibrin strands.
|
|
|
Inclusion criteria for fibrinolytic therapy in an acute MI. (5)
|
1. no more than 12 hrs from onset of CP
2. ST elevation or new left BBB 3. Ischemic CP of 30 minutes duration 4. CP no responding to sublingual nitro 5. No risk for hemorrhage! |
|
|
Exclusion criteria for fibrinolytic therapy in an acute MI. (4)
|
1. any pt with bleeding risks
2. recent surgery 3. trauma 4. CVA |
|
|
Nursing measures for an acute MI
|
Identify candidates for an acute MI, and start the protocol to determine if they have it! (EKG, IV access, labs)
|
|
|
Types of Cardiac Surgery
|
CABG, Valvular, Mechanical, Biologic/Tissue, Transplantation
|
|
|
Valvular Cardiac Surgery
|
-posthetic vlaves are used!
mechanical vs. biological |
|
|
Mechanical Cardiac Surgery (what is the required INR rating?)
|
-made from metal alloys. require lifelong anticoagulation therapy
(keep INR between 3-5) |
|
|
Biological/Tissue Cardiac Surgery
|
-less durable than mechanical, but does not require lifelong anticoagulants
|
|
|
Heart Transplantation Surgery
|
*Open Chest*
Requires lifelong immunosuppresive medication to prevent rejection. |
|
|
Cardiac Surgery Complications
|
dysrhythmias
decreased contractility intra-op MI or CVA pericardial tamponade respiratory insufficency pain renal impairment GI dysfunction impaired peripheral circulation infection delirium poor nutrition |
|
|
What is Cardiac Tamponade, and what are its symptoms?
|
blood accumulates in the mediastinal space and impairs pumping.
S/Sx: decreased CO, hypotension, JVD, pulsus paradoxus, muffled heart sounds, sudden cessation of CT drainage. **requires surgical repair to remove the clot** |
|
|
Pacer Errors
-Failure to pace -Failure to capture -Undersensing |
Failure to pace- pacemaker loses contact with the heart and fails to generate electric impulses in the heart.
Failure to capture- pacemaker is firing on the heart, but the heart does not generate an impulse. Undersensing- pacemaker fails to sense intrisnic QRS complexes, and fires and impulse during the refractory period, therefore it is unable to generate another heart beat. |
|
|
What causes cardiac tamponade?
|
Dissecting Aortic Aneurysm (thoracic)
End stage lung cancer MI Heart Surgery Pericarditis Wounds to the heart Heart tumors Invasive heart procedures |
