worksheet 11 - acute coronary syndrome & revascularization

atherosclerosis includes 3 steps:

1. endothelial _____

2. endothelial _____

3. _____ response

atherosclerosis includes 3 steps:

1. endothelial _____

2. endothelial _____

3. _____ response

injury; dysfunction; inflammatory

endothelial _____ occurs when there’s chronic, excessive injury to the endothelial cells which initiates the process of atherosclerosis; things that can cause this include:

• tobacco smoke & other chemical irritants from tobacco

• LDL cholesterol

• HTN

• hyperglycemia & DM

• homocysteine

• infectious agents (i.e., chlamydia, pneumonia, herpes viruses)

injury

endothelial _____ is caused after the endothelial cells are continuously injured and thus, the vessel is now damaged; this may cause:

• increase adhesiveness, platelet deposition, monocyte adhesion

• increase permeability to lipoproteins and other substances in the blood

• impaired vasodilation, increase vasospasm

dysfunction

the marker of atherosclerosis is initiated during the _____ response which causes:

1. _____ to migrate to the intima wall

2. _____ then enters the arterial wall and oxidizes

3. monocytes accumulate LDL and transform it into _____

4. continued migration, proliferation, and growth of tissue causes the lesion to progress in complexity and size (_____ cell), forming fibromuscular plaque and eventual fibrous cap

inflammatory; monocytes; LDL; macrophages; foam

the 3 types of acute coronary syndrome include: _____, _____, and _____

unstable angina; NSTEMI; STEMI

_____ is when there’s transient vessel occlusion (< _____ min) followed by a spontaneous clot dissolution and vasorelaxation

unstable angina pectoris; 10

an _____ involves ST segment depression or T wave inversion persisting at least _____ hours; on bloodwork, patient would be _____ for cardiac enzymes; this has less epicardial damage than the alternative because of clot dissolution

NSTEMI; 24; positive

a _____ involves vessel occlusion persisting > _____ minutes and _____ cardiac enzymes on bloodwork; it’s shown by ST segment _____ of at least _____ mV in _____ leads or new contiguous; there’s more epicardial damage here and a worse prognosis than the alternative

STEMI; 60; positive; elevation; 1; 2

unstable angina can present in three difference ways:

• _____ resting angina

• _____ angina

• _____ angina

prolonged; new onset; accelerated

the difference between unstable angina and an acute MI is that during unstable angina, there are no _____ as there’s no heart damage yet

positive cardiac enzymes

an acute MI is diagnosed when there’s presence of _____ cardiac enzymes and one of the following factors:

• symptoms of _____

• _____ evidence (i.e., ST abnormalities, new LBBB, or new pathological Q waves)

• _____ evidence

elevated; ischemia; ECG; imaging

an acute MI evolves over time; first, things start of normal with the first sign being ST _____ and sometimes a decreased _____ wave which indicates _____ decreasing in the ventricles along with the beginning of significant _____ waves; by day 1-2, an ECG would show _____ wave inversion and a _____ significant _____ wave; days later an ECG would show the ST segment _____ while the _____ wave continues to be inverted; weeks later, the ST segment and T wave are normal but the significant _____ waves persist

elevation; R; conduction; Q; T; deeper; Q; normalizing; T; Q

an MI can be treated medically and surgically by the following:

• _____ therapy (i.e., oxygen nitroglycerine, beta blockers, ACE-I, ARB, statin)

• dual _____ therapy (i.e., aspirin & clopidogrel)

• _____ (i.e., heparin)

• _____ relief (i.e., morphine)

• _____ therapy (i.e., thrombolytic therapy, revascularization including PCI & CABG)

• medical management

anti-ischemic; anti-platelet; anticoagulant; pain; reperfusion

_____ is when a balloon catheter is inserted into the femoral or radial artery and guided to the coronary lesion; the balloon is then expanded to compress the lesion; a _____ may be placed to help maintain an open artery (a _____, DES, contains drugs like aspirin and clopidogrel to prevent in-stent re-stenosis) and overtime, it eventually becomes part of the lumen wall

PTCA/PCI; stent; drug eluding stent

_____ is when a venous graft from the arm or leg or an arterial graft like the internal mammary artery are implanted to provide blood flow distal to the occlusion

CABG

exercise considerations for PTCA/stent:

• hospital stay is generally _____ days

• post-procedure GXT can happen within _____ days post PTCA/stent

• biggest concern for these patients is _____

1-2; 1-2; in-stent re-stenosis

exercise can help decrease the risk of in-stent re-stenosis because it inhibits smooth muscle cell _____, _____ serum lipids, improves insulin _____ and glucose _____

proliferation; lower; resistance; intolerance

a sign of in-stent re-stenosis is not only angina, but also a poor response to _____ and no improvement in _____

exercise training; functional capacity

exercise considerations for CABG:

• hospital stay is generally _____ days if uncomplicated

• post-procedure GXT is best at _____ weeks to allow for patients to reach max functional capacity

2-5; 4

concerns with post-CABG patients include:

• excessive _____ and _____

• cracking, grinding, or motion in _____ region

• patient not being able to _____

• _____

soreness; stiffness; sternal; sleep; infection