2)med surg: CAD

CAD risk factors

hyperlipidemia, smoking, hypertension, metabolic disorders, obesity, drugs

unstable angina lasts more than

15 min

CAD ECG

ST segment changes, T wave changes

angina med classes

nitrates, beta blockers, calcium channel blockers

angina: nitrates

nitroglycerin, isosorbide dinitrate, isosorbide mononitrate

angina: beta blockers

metoprolol, atenolol

angina: calcium channel blockers

anlodipine, dilitiazem

nitroglycerin: monitor for

headache, hypotension

nitroglycerin: caution against

ED drugs

nitroglycerin: replace every

3-5 months

angina: antiplatelets

aspirin, clopidogrel

angina: glycoprotein agents

tirofiban, eptifibatide

angina diet

low saturated fats and sodium

MI only relieved by

opioids

MI: symptoms last for

> 30 min

MI associated with

nausea, GI distress, dyspnea, anxiety, diaphoresis

most serious ACS

acute MI

MI labs

increased troponin, CK-MB; ST segment changes

ST segment change with 100% occlusion

STEMI

ST segment with 80-90% occlusion

NSTEMI

women heart disease symptoms

dyspnea, pain in lower chest/upper abdomen, dizziness, extreme fatigue, upper back pressure

MI: what lab is earliest to rise?

myoglobin

MI: myoglobin lab

< 90

MI: CK-MB lab

0%

MI: troponin I lab

7-10 days; < .03

MI: troponin T lab

10-14 days; < .1

which troponin stays in the blood longer?

troponin I

angina maintenance med

ranolazine

ECG: ST depression/T wave inversion show

ischemia

ECG: ST segment elevation show

injury

ECG: Q wave show

infarction

MI diagnostics

cardiac catherization/coronary angiography, stress test, TTE, TEE

MI management

aspirin, ACE inhibitor/ARB, beta blocker, thrombolytic therapy, PCI, statin

MI: ____ on admission or within 24 h

aspirin

MI: thrombolytin therapy within ______ of hospital arrival

30 min

MI: PCI within _____ of hospital arrival

90 min

MI: _____ prescribed at discharge

statin

_____ is priority in MI

pain

MI: meds (MONA)

morphine, O2, nitroglycerin, aspirin

MI: meds for chest pain

nitroglycerin, morphine

morpine reduces ____ and relaxes _________

myocardial O2 demand; smooth muscle

MI: morphine _____ mg IV every _____

2-10mg; 5-15 min

MI: postition

semi-fowlers

MI: O2 rate

2-4 L/min

STEMI lasts for

60-90 min

NSTEMI lasts for

4-6 h

improvind myocardial perfusion meds

thrombolytics, anti-platelets, anticoagulants, statins

thrombolytics examples

streptokinase, urokinase

thrombolitic therapy indicated with

STEMI, chest pain unrelieved by NTG and > 30 min

MI: ace inhibitors given within

48 h if ejection fraction is < 40%

MI: ace inhibitors: monitor for

dec urine output, hypotension, cough

ace inhibitor examples

enalapril, catopril

what do beta blockers do to MI

reduce size of infarct and occurance of dysrhythmias

beta blockers: assess for

bradycardia, hypotension, wheezes, hypoglycemia

aspirin prevents

clot extension

warfarin diet

low vitamin K

statins reduce

cholesterol synthesis in liver

PTCA

reopen clotted coronary artery and restore perfusion

PTCA performed within _____ after an MI

90 min

coronary artery reperfusion

new onset ventricular dysrhythmias

MI: main surgery

CABG