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66 Cards in this Set
- Front
- Back
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What are the non modifiable risk factors for MI?
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Age
Race Heredity Sex |
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What are the major modifiable risk factors for MI?
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High cholesterol (Low HDL, high LDL
fasting triglycerides >150mg/dL) HTN Cigarette smoking Diabetes Mellitus Physical inactivity Weight |
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What are minor modifiable risk factors for MI?
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Stress
Personality |
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What are risk factors of MI that only effect women?
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Loss of estrogen
Oral contraceptives |
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What is the chief diagnostic tool to identify those who will benefit from repercussion therapy?
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12-lead ECG
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What are the clinical manifestations of atrial thrombosis for UA/Non-STEMI?
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Partially occlusive thrombosis (primarily platelets)
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What are the clinical manifestations of atrial thrombosis for STEMI?
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Occlusive thrombus
(Platelets, red blood cells, fibrin) |
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What is the difference between UA and NSTEMI?
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NSTEMI- occlusion is significant enough to release biochemical markers signifying myocardial injury
UA- occlusion is transient and biochemical markers are negative |
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How is myocardial ischemia reflected on ECG?
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ST depression or T wave inversion
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How is myocardial injury reflected on ECG?
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ST elevation
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How is myocardial infarction/necrosis reflected on ECG?
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Q wave
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Which myocardial damage can be reperfused?
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Myocardial Ischemia and injury can be reperfused
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Which myocardial tissue damage cannot be reperfused?
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Myocardial infarction/necrosis cannot be reperfused
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How soon should a 12 lead ECG be done on a pt with ongoing chest pain?
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Within 10 minutes
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What does a pathological Q wave look like?
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At least 1 box wide, 0.4 seconds across or at least 1/3 the height of R wave
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If one of these features are present; a NSTE pt is at high risk if death of MI.
(List features) |
Prolonged ongoing rest pain >20 min
Elevated troponin >0.04 New ST depression Sustained V tach Pulmonary edema New/worsening MR murmur S3 or new/worsening rales Hypotension/bradycardia/tachycardia Age >75 yrs |
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What is the most specific cardiac marker for cardiac damage?
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Troponin (>0.04 not good)
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What is normal troponin levels?
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<0.04
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Which cardiac marker is useful in detecting damage when it is more than minor damage?
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CK-MB (0.0-7.0)
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Which cardiac marker predicts the risk if mortality in ACS?
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Higher troponin levels
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Which cardiac marker helps rule out infarction if it is negative (not specific for cardiac damage)? Appears early (6hrs) with myocardial injury.
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Myoglobin
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What are normal CPK levels?
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35-232
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What should be assessed in chest pain?
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P- pain (what causes)
Q- quality (describe) R- radiate (does it?) S- severity (rate 0-10) T- timing |
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What are some manifestations that may occurs instead of cheat pain (chest pain equivalents)?
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SOB
Faintness/weakness Diaphoresis Nausea/vomiting Hiccups |
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What should be assessed what determining hemodynamic stability?
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Vital signs (HR/BP)
Heart sounds Dysrhythmias Jugular veins (fluid overload) Breath sounds O2 sats |
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Who may present with atypical AMI manifestations?
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Women and elderly
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Why are some atypical AMI presentations?
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Fever
Nausea/Vomiting |
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When are fibrinolytics contraindicated?
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Recent major surgery
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What are the Joint commission core measure for ACS at discharge?
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Smoking cessation
Aspirin ACH Inhibitor for EF <40% Beta Blocker Lipid lowering therapy if LDL>100 |
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What is the general tx for chest pain?
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M- morphine (low dose, watch BP)
O- oxygen (only if needed, <90%) N- Nitro (hold if low BP) A- aspirin |
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How does morphine sulfate help chest pain?
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Relieves pain
Decreases preload and after load Should be given IV in small incremental doses |
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How does nitroglycerin/tridil IV help with chest pain?
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Dilates peripheral vessels
Decreases preload Monitor BP closely for hypotension |
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How does aspirin help tx chest pain?
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Anti platelet against
Should be administered as soon as ACS suspected Blocks thromboxane A2 Potent platelet activator |
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What should a patient on plavix be taught about having surgery?
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Plavix should be held 5-7 days before surgery.
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What beta blocker would be administered in the ER and what is the dosage?
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Lopressor (metoprolol) 5mg IVP x3 doses
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How is the effectiveness of lovenox tracked?
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There are no blood markers.
Drug has very predictable dosing curve Rises quickly, peaks, starts to wane at 12 hours |
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Which Indirect Thrombin Inhibitors are used in AMI?
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Heparin
Lovenox (Enoxaparin) |
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When are ACE inhibitors used in AMI?
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Persistent HTN and LV dysfunction despite NTG and BB
Sustained tach or DM |
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When is Bivalirudin (Angiomax) used?
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Often used in the cath lab during a PCI percutaneous coronary intervention
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This classification is indicated for intermediate or high risk ACS or with percutaneous coronary intervention.
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Glycoproteins IIb/IIa Inhibitors
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What condition is fibrinolytics indicated?
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ST elevated ACS only
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When should fibrinolytics be given?
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Most effective when given within 6hours of onset symptoms
Usually not given after 12 hours |
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What is nursing considerations when administrating fibrinolytics?
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Monitor for bleeding/reocclusion
Monitor clotting studies Avoid invasive procedures after infusion Type and match Avoid agents that contain strep (allergic reaction) Avoid rough handling (BP techniques) If puncture is necessary, small gauge and sites that are easily compressible |
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What are signs of successful reperfusion?
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Return ST segment to baseline
Reperfusion dysrhythmias Resolution of CP Rise of CK-MB within 3 hrs Pain is gone |
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What is the standard care of patient with Acute MI?
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Take it to cath lab
STEMI cath lab ASAP if hospital does not have cath lab; STEMI pt can get fibrinolytics |
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What will happen if the cardiac cath does not show CAD?
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Discharge from protocol
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What will happen if the cardiac cath shows left main disease?
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CABG is the best option
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What will happen if the cardiac cath shows only 1 or 2 vessel disease?
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Pt will prob get a stent or 2 or 3
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What will happen if the cardiac cath shows 3 vessel disease, proximal LAD involvement complicated by diabetes?
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Prob needs CABG
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What is a percutaneous coronary artery angioplasty?
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Involve balloon dilation and coronary stenting
Stenting reduces acute vessel closure and late restenosis May be used in all ACS |
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What is a serious complication of percutaneous trabsluminal coronary angioplasty (PTCA)?
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Aortic dissection, must have CABG capability
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What are nursing considerations for percutaneous transluminal coronary angioplasty (PTCA)?
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Monitor for bleeding at access site
Check peripheral perfusion Minute for successful reperfusion Monitor for bradycardia during sheath removal |
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What med is used to prevent restenosis?
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Plavix
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Immuno-suppressive agent for pts undergoing renal transplant. Released over 30 days from stent.
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Sirolimus (Cypher stent)
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Anti-neoplasticism agent found within stents which inhibits cell migration and proliferation
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Paclitacel (Taxus Stent)
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When/why are coronary stents, stents of choice?
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Abrupt closure following PTCA
More routine to reduce restenosis |
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What are some complications of AMI?
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Dysrhythmias
CHF Pericarditis Ventricular Aneurysm Pulmonary Embolism Papillary Muscle Dysfunction Cardiogenic Shock |
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What is the most common complication of AMI?
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Dysrhythmias- occurs in 80% of MIs
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Pericarditis that occurs 1-4 weeks after AMI is called?
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Dressler's syndrome
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Pericarditis that occurs 1-2 days post MI is called?
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Post MI Syndrome
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What ECG changes are seen with UA?
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ST depression and/or T wave inversion
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What ECG changes are seen on NSTEMI?
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ST depression and/or T wave inversion
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What ECG changes are seen in STEMI?
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ST elevation
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How is UA tx?
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MONA
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How is NSTEMI tx?
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MONA
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How is STEMI tx?
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MONA
BB Heparin/lovenox GP IIb/IIa inhibitors ACE inhibitors CCB Fibrinolytics |
