Acute Coronary Syndromes (Week 6 Perfusion)

What is Chronic Stable Angina?

Intermittent chest pain over a long period with the same pattern of onset, duration, and intensity.

What percentage of coronary artery occlusion typically causes Chronic Stable Angina?

About 50–70% occlusion

What typically triggers Chronic Stable Angina?

Exercise or emotional stress (↑ oxygen demand on the heart).

How is Chronic Stable Angina relieved?

Rest and/or Nitroglycerin.

How long does an episode of Chronic Stable Angina usually last?

Less than 15–20 minutes

What medications are used prophylactically for Chronic Stable Angina?

Same as for HTN: ACE inhibitors, Calcium Channel Blockers (CCBs), Beta-Blockers

What is the primary goal of treatment for Chronic Stable Angina?

Decrease O₂ demand and/or increase O₂ supply

What is the #1 medication used for treating Chronic Stable Angina?

Nitroglycerin

How does Nitroglycerin work?

It is a direct vasodilator that decreases cardiac workload and increases heart muscle perfusion

How is Nitroglycerin administered during chest pain?

Sublingual tablet or spray.

What should be done if Nitroglycerin does not relieve chest pain in 5 minutes?

Call 9-1-1 and may repeat the dose every 5 minutes (max of 3 doses). More doses administer after first dose is considered unstable.

What are the important considerations when using Nitroglycerin?

Monitor BP; can cause headache (most common) and hypotension (adverse effect). Hold if BP is too low.

What defines Unstable Angina?

Chest pain that is new in onset, occurs at rest, is more frequent/longer, or occurs with less effort than usual.

When is angina considered unstable regarding nitroglycerin use?

pain is unrelieved by rest and one dose of nitroglycerin.

What is the pathophysiology behind Unstable Angina?

Atherosclerotic plaque rupture → thrombus formation → further occlusion → cardiac ischemia.

What additional symptoms may occur with Unstable Angina?

Dyspnea, nausea, diaphoresis, anxiety.

How do Unstable Angina symptoms differ in women?

Women often present with fatigue instead of typical chest pain radiating to the arm, jaw, or neck.

What is the immediate position for a patient with suspected acute coronary syndromes?

Upright position

What is the first diagnostic test that should be done for ACS?

A 12-lead ECG.

What are the components of the mnemonic “MONA” for ACS management?

Morphine, Oxygen, Nitroglycerin, Aspirin

Correct order NOMA or ONMA

What is the first drug given in ACS?

Nitroglycerin

Why is morphine given in ACS?

To relieve pain and promote vasodilation.

What is the role of aspirin in ACS?

Prevents more platelets from sticking to the clot.

What lab tests are drawn for ACS evaluation?

Troponin and electrolytes.

What does ongoing management of ACS include?

Monitoring ABCs, vital signs, telemetry, serial labs, and pain control.

What patient education topics are important after ACS?

• Risk factors for CAD

• Difference between stable and unstable angina

• When to call 9-1-1

• Precipitating factors

• Heart-healthy diet

What is cardiac rehabilitation?

A phased program from hospital activity resumption to long-term supervised exercise and dietary changes.