Chapter 32 Iggy - Critical Care of Patients With Acute Coronary Syndromes (Exam 3)

Coronary Artery Disease (CAD)

-includes stable angina, acute coronary syndromes

CAD - Treatments

Lifestyle Changes: Healthy diet, exercise, smoking cessation.

PCI (Stenting): Opens blocked arteries.

CABG Surgery: Bypasses blocked arteries.

Cardiac Rehab: Supervised exercise, education, counseling.

CAD - Treatments (Drug Therapy)

Antiplatelets (Aspirin, Clopidogrel): Prevent clot formation.

Statins (Atorvastatin, Rosuvastatin): Lower cholesterol.

Beta-blockers (Metoprolol, Atenolol): Reduce heart workload.

ACE Inhibitors/ARBs (Lisinopril, Losartan): Lower BP, protect heart.

Nitrates (Nitroglycerin): Relieve chest pain.

CAD - Assessments

Evaluate risk factors (smoking, diabetes, hypertension, family history).

Assess symptoms (chest pain, dyspnea, fatigue).

Conduct physical exam (BP, heart sounds, signs of heart failure).

CAD - Diagnostic Studies

ECG: Detects ischemia, arrhythmias.

Stress Test: Assesses cardiac function under exertion.

Echocardiogram: Evaluates heart structure and ejection fraction.

Coronary Angiography: Identifies arterial blockages.

Labs: Lipid profile, troponin, hs-CRP, HbA1c.

Ischemia

insufficent oxygen supply to meet requirements of myocardium

Infarction

necrosis or cell death that occurs when severe ischemia is prolonged and decreased perfusion causes irreversible damage to tissue

Chronic Stable Angina Pectoris

-"strangling of the chest"

-Temporary imbalance between coronary artery's ability to supply oxygen and cardias muscle's demand for oxygen.

-Ischemia limited in duration and does not cause permanent damage to myocardial tissue.

Acute Coronary Syndrome (ACS)

-Unstable angina

-Acute myocardial infarction

-Believed that atherosclerotic plaque in coronary artery ruptures, resulting in platelet aggregation, thrombus formation, or vasoconstriction.

Unstable Angina Pectoris

New-onset angina

Variant (Prinzmetal's angina)

Pre-infarction angina

Patients present with ST changes on 12-lead ECG, but will not have changes in troponin or CK levels

Myocardial Infarction

Most serious acute coronary syndrome

-when bloodflow is quickly reduced by 80-90%, ischemia develops

o Myocardial tissue abruptly and severely deprived of oxygen

Two Types of MI

NSTEMI and STEMI

NSTEMI

non-ST elevation myocardial infarction

STEMI

ST elevation MI, real-time ongoing death of heart tissue due to ischemia