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43 Cards in this Set
- Front
- Back
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Define Acute Coronary Syndrome
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when ischemia is prolonged and not immediately reversible. It encompasses unstable angina, non-ST-segment-elevation-MI (NSTEMI) and STEMI.
i. From notes: Continuum from stable angina to unstable angina leading to acute MI. Difference is death to tissue that is occurring – not reversible. Unstable can be reversed w/angioplasty but death to tissue is not reversible. |
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Define unstable angina
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chest pain that is new in onset, occurs at rest, or has a worsening pattern
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define acute MI
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sustained ischemia causing irreversible myocardial cell necrosis
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What is the most common cause of ACS?
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A patient’s lifestyle is the most common cause. Primary prevention of atherosclerosis is controlling the risk factors: healthy eating, exercise, treatment for hypertension and diabetes, avoiding smoking and controlling cholesterol levels
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Define metabolic syndrome
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Metabolic syndrome is a collection of risk factors that puts a patient at higher risk of developing CVD.
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factors that need to be present to be diagnosed with metabolic syndrome
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Waist size >40” in men and >35” in women AND 2 of the following:
Triglyceride levels - > 150 mg/dl or undergoing treatment HDL levels - <40 mg/dl in males & <50 in females BP – systolic > or = to 130 or diastolic > or = 85 or undergoing tx Fasting plasma glucose levels > or = to 100 or diagnosed Type II DM |
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what is the purpose of an echocardiogram in detecting coronary artery disease?
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provides information about abnormalities in the valves, chamber size, thickness of ventricular muscle, and the aorta.
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what is the purpose of an exercise stress test (w/ or w/o thallium) in detecting coronary artery disease?
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evaluates the CV response to physical stress/activity.
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what is the purpose of an resting thallium scan in detecting coronary artery disease?
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looks at heart function and blood flow if patient is unable to tolerate physical activity
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What would be seen on a thallium scan indicating coronary arteries are not dilating in response to exercise?
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a. Any areas of the heart that have blocked or partially blocked arteries during exercise will be seen on the scan as "cold spots," because these areas will be unable to absorb the thallium into the heart muscle.
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What are the purposes/uses of cardiac catheterization?
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a. Done to evaluate the presence and degree of coronary artery blockage
b. PTCA – percutaneous transluminal coronary angioplasty – involves inflating a balloon to dilate the vessel and adhere the plaque, thus widening the vessel. A stent may be placed to prevent restenosis. |
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7. What are the differences between a right-sided and left-sided cath in terms of access to the heart and their uses in diagnoses and interventions?
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a. Right-sided cath - incision in femoral vein, cath threaded into pulmonary artery (same as PAC without risk of infection by it staying in). Used to assess the function of the left side of the heart.
b. Left-sided cath - If pt suspecting of having unstable angina or MI. similar procedure – in femoral artery (usually) or brachial artery, against pressure through aorta into coronary arteries. Coronary angiography can be done with a left heart catheterization. |
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What is important in preparing a patient for a catheterization?
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a. small incision in vein/artery
b. may see video or booklet beforehand/teaching c. bedrest w/leg immobilized 4-6 hrs d. signs of bleeding e. frequent VS checks & assessments f. NPO after midnight g. Hold Coumadin/Lovenox h. Are they allergic to shellfish i. Drink lots of fluids to flush out dye j. sedated but not asleep k. given Versed (midazolam) for anxiety l. may be shaved m. Abnormal lab results to report PT/INR, low H&H (low blood, oxygen), WBCs infection, positive UA infection, potassium level, blood glucose, renal function for CT dye elimination – BUN, Creatinine, abnormal VS –incr temp for infection |
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What are the most important nursing assessments and interventions post cath?
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a. LOC, vitals, neuro-vascular checks (color, sensation, movement, capillary refill, pulses – q 15 min x 4, q30 min x 4, q 1 hr x 4, q 4 hr
b. Bedrest w/leg immobilized 4-6 hrs as ordered c. Pain & anxiety d. Bleeding e. Dysrhythmias f. Reaction to contrast media g. infection |
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What’s the most serious complications post cath?
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clotting
bleeding |
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What should be done first if there is bleeding at the femoral insertion site (or any other insertion site)?
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Apply pressure to the site and have someone else call the MD immediately
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beta blockers
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Lopressor (metoprolol), Inderal (propranolol), Tenormin (atenolol), Zebeta (bisoprolol)
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ace inhibitors
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benazepril (Lotensin), captopril, enalapril, lisinopril (Prinivil)
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calcium channel blockers
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amlodipine, diltiazem (Cardizem), felodipine, nifedipine, verapamil
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When a person is admitted w/clinical manifestations of acute coronary syndrome (ACS), what is the most important part of the history that needs to be evaluated to establish risk and to develop an immediate treatment plan?
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a. Time of onset and time of first medical contact (EMS) are crucial to be able to decide which treatment course is the best approach. Additionally, need to determine if patient is a good candidate for the chosen therapy – catheterization (surgery) vs fibrinolysis.
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According to the ACS algorithm, what medications are (all) patients with suspected ischemic chest pain given immediately?
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a. MONA
i. Morphine – pain, anxiety, peripheral vasodilator ii. Oxygen (4liters) iii. Nitroglycerin – peripheral & coronary vasodilator iv. Aspirin – 325 mg chewable – peripheral & coronary vasodilator b. Adjunctive treatment also: i. Heparin ii. Beta-blockers iii. Clopidogrel (Plavix) iv. Glycoprotein inhibitors v. Ace inhibitors vi. Statins |
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What characteristics in a patient presenting w/chest pain put the patient at highest risk for adverse events (acute MI, sudden cardiac death, heart failure, etc)?
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a. Chest pain that is new in onset or occurs at rest (unstable angina)
b. Severe, immobilizing chest pain not relieved by rest, position change or nitrate administration is the hallmark of an MI. c. Male gender, especially African American d. Family history of atherosclerosis e. Tobacco use f. Diabetes mellitus g. HTN h. hyperlipidemia |
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What are the actions and intended therapeutic effects of these routine meds?
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a. Morphine – pain, anxiety, peripheral vasodilator
b. Oxygen (4liters) c. Nitroglycerin – peripheral & coronary vasodilator d. Aspirin – 325 mg chewable – peripheral & coronary vasodilator e. Heparin – anticoagulant – prevent more clotting f. Beta blockers – decrease O2 demand by reducing HR, BP & contractility g. Clopidogrel (Plavix) – prevent platelet aggregation h. Glycoprotein inhibitors – prevent platelet aggregation i. Ace inhibitors – prevent changes to heart (remodeling) and slows progression of HF j. Statins – control of lipid levels |
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Definitive diagnosis of acute ST Segment Elevation MI (STEMI) is based on?
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a. EKG changes
b. Presence of specific serum cardiac markers i. Troponin ii. CK-MB iii. Myoglobin – first two more often |
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Definitive diagnosis of acute non-ST Segment Elevation MI (NSTEMI) is based on?
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a. No EKG changes
b. Troponin c. CK-MB |
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How do ischemia, injury and necrosis present on a 12 lead EKG?
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a. Ischemia – ST segment depression and/or T wave inversion
b. Injury – ST segment elevation (any patient w/ST elevation is considered to be having an MI c. Necrosis – presence of abnormal Q waves (negative deflection of Q wave) |
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what is the relationship between the area of infarction, the coronary arteries and the primary ECG changes?
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a. Anterior Wall – left anterior descending coronary artery
b. Lateral Wall – circumflex artery (left) c. Inferior Wall – right coronary artery d. Posterior wall – right coronary artery |
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What are the characteristics of the cardiac bio-markers Troponin and CK-MB and how are they used in the diagnosis of acute MI?
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a. Troponin I always rises with injury, start rising in 2-6 hrs, peak 24 hrs, hang around for about 7 days
b. CK-MB rises but won’t last as long in blood stream, 1-3 days, peak 24 hrs i. CK - Muscle tissue breakdown of any kind ii. CK-MB – specific to cardiac muscle injury c. Request labs at presentation to ED, 8 hrs & 16 hrs |
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What are the selection criteria for patients to be treated w/a thrombolytic for acute MI?
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a. No more than 12 hrs from onset of chest pain; less if possible
b. ST-segment elevation on ECG or new-onset left bundle branch block c. Ischemic chest pain of 30 minutes’ duration d. Chest pain unresponsive to sublingual nitroglycerin e. No conditions that might cause a predisposition to hemorrhage |
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What adjunctive medications are routinely used w/thrombolytics?
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a. IV Heparin, lovenox
b. Aspirin c. clopidogrel d. glycoprotein inhibitors |
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What are common/serious complications of thrombolysis and associated nursing care?
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a. Hemorrhage – assess for bleeding, if found, stop therapy, apply pressure to site and notify MD
b. Embolism c. Allergic reaction – stop therapy, administer antihistamines, notify MD, d. stroke |
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What are the most important criteria for choosing PTCA as the first line treatment of choice in acute MI?
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a. Late presentation – symptoms began >3 hrs ago
b. Skilled PCI facility available for surgical backup c. Medical contact to balloon or door-balloon is <90 minutes d. Contraindications to fibrinolysis e. High risk from STEMI f. Diagnosis of STEMI is in doubt |
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List the common/routine adjunctive medications used post-MI and their purposes.
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a. beta-blockers – reduces contractility
b. ace inhibitors – vasoconstrictor, ↓risk of heart failure c. aspirin - vasodilator d. statins – control cholesterol |
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During exercise post MI, what criteria are evaluated to determine the patient’s response to increasing levels of activity?
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a. SOB
b. chest pain c. heart monitor d. fatigue |
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28. What medications are patients who have had PTCA and stenting likely to be discharged on?
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anticoagulants
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What are the clinical manifestations of left sided heart failure and the underlying Pathophysiology associated with those symptoms.
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a. Left-sided heart failure – inadequate left ventricle (cardiac) output and consequently inadequate tissue perfusion.
i. Signs: alternating pulses-strong-weak, incr HR, displaced PMI, ↓PaO2, slight ↑PaCo2, crackles ii. Symptoms: weakness, fatigue, dyspnea, orthopnea, frothy pink-tinged sputum |
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What are the clinical manifestations of right sided heart failure and the underlying Pathophysiology associated with those symptoms.
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b. Right-sided heart failure – inadequate right ventricle output and systemic venous congestion. (peripheral edema)
i. Signs: murmurs, JVD, edema, weight gain, ↑HR, hepatomegaly ii. Symptoms: fatigue, anxiety, dependent bilateral edema, nausea |
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What are the first & second line meds used to treat acute left ventricular failure and their actions and intended effects?
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a. Diuretics- mobilize fluid
b. Vasodilators – incr venous capacity i. Ace inhibitors – incr CO ii. Nitroglycerin |
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Identify the circulatory assist devices used to treat heart failure.
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a. Intraortic ballon pump (IABP) – temporary balloon in the aorta that pumps to assist the heart until heart transplant
b. Left Ventricular Assist Device (LVAD) – replaces pumping action of heart (longer term temporary and allows for more mobility than IABP) c. AICD - small battery-powered electrical impulse generator which is implanted in patients who are at risk of sudden cardiac death due to ventricular fibrillation and ventricular tachycardia. |
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Discuss the use of internal device therapy in the long-term treatment of heart failure.
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The IABP and VADs are used to sustain HF patients with deteriorating conditions until they receive a new heart or for those who are not candidates for heart transplants.
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What is sudden cardiac death?
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a. Death in a person w/ or w/o known heart disease that occurs suddenly w/out warning and within 1 hr after onset of symptoms
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What is the usual cause of sudden death in adults and the first line treatment?
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a. Usual cause is coronary heart disease (fatty buildups in coronary arteries)
b. Treatment: i. Immediate defibrillation ii. Rule out and treat AMI iii. Diagnostic & interventional cath or CABG if appropriate iv. Antidysrhythmic drugs |
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What is the primary electrical intervention for the prevention of sudden cardiac death in those at risk?
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AICD
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