ACS, Angina, and Myocardial Infarction Review

Comprehensive flashcards covering ACS, chronic stable vs. unstable angina, NSTEMI, STEMI, diagnostic findings, medical management, complications, and nursing priorities.

What conditions are included under Acute Coronary Syndrome (ACS)?

Unstable angina, NSTEMI, and STEMI.

What is the underlying cause of Acute Coronary Syndrome (ACS)?

Rupture of an atherosclerotic plaque leading to thrombus formation.

What is chronic stable angina associated with, triggered by, and relieved by?

It is associated with a fixed atherosclerotic plaque, triggered by moderate exertion, and relieved by rest and nitroglycerin.

What pattern and duration define chronic stable angina?

It follows a predictable pattern with the same frequency, intensity, duration, and location, and is present for more than $3\,\text{months}$.

What is unstable angina and how long may it last?

It is new or worsening unpredictable chest pain that may occur at rest and may last more than $15\,\text{minutes}$.

What are the troponin findings and possible ECG changes in unstable angina?

Troponin is negative. ECG changes can include ST-segment depression or T-wave inversion.

What characterizes new-onset, vasospastic (Prinzmetal), and pre-infarction angina?

New-onset is the first occurrence of angina (usually after exertion); vasospastic/Prinzmetal is caused by coronary artery spasm (usually at rest); pre-infarction occurs in the days or weeks before an MI.

What does NSTEMI stand for and what ECG changes are associated with it?

Non-ST-Elevation Myocardial Infarction. ECG changes include ST-segment depression and T-wave inversion.

What happens to troponin levels in NSTEMI?

Troponin becomes elevated because myocardial cell death has occurred; however, it may initially be normal and rise over the next $3\text{--}12\,\text{hours}$.

What causes for NSTEMI are explicitly listed in the notes?

Coronary vasospasm and spontaneous coronary artery dissection.

What ECG finding indicates STEMI, and what is the major treatment goal and PCI target time?

ST-segment elevation in $2$ contiguous leads indicates STEMI. The major treatment goal is to restore blood flow ("time is muscle"), with PCI performed within $90\,\text{minutes}$.

What electrolyte imbalances and stress hormones are associated with a myocardial infarction?

Electrolytes that may become abnormal are potassium, calcium, and magnesium. Stress hormones released are norepinephrine and epinephrine.

How do heart rate and blood pressure change from early to late stages of an MI?

Early in MI, HR and BP may increase; later in MI, BP may decrease.

What MI symptoms are specifically listed for males versus females?

Males: chest pain, SOB, and discomfort/tingling in the arms, back, neck, shoulder, or jaw. Females: sudden dizziness, heartburn, cold sweat, unusual fatigue, N/V.

What do ST depression, ST elevation, and pathological Q waves signify on an ECG?

ST depression indicates ischemia (reversible); ST elevation indicates acute injury (potentially reversible if perfusion is restored); pathological Q wave indicates myocardial necrosis (not reversible).

What is the timeline for troponin elevation, peak, and return to baseline following an MI?

Increases $4\text{--}6\,\text{hours}$ after MI, peaks at $10\text{--}24\,\text{hours}$, and returns to baseline in $10\text{--}14\,\text{days}$.

How often can sublingual nitroglycerin be given, and when should it be avoided?

It can be given every $5\,\text{minutes}$ up to $3$ doses. It should not be given if the patient is hypotensive.

When is morphine indicated for cardiac chest pain, and what must be monitored?

Morphine is given when cardiac pain is unresponsive to nitroglycerin. The nurse should monitor for respiratory depression and hypotension.

What medications constitute Dual Antiplatelet Therapy (DAPT) and what is its major adverse effect?

DAPT consists of Aspirin plus a P2Y12 inhibitor (such as clopidogrel or ticagrelor). The major adverse effect is bleeding.

Why are beta blockers administered post-MI, and what side effects require monitoring?

They decrease HR and contractility to reduce myocardial oxygen demand. Monitor for bradycardia, hypotension, decreased LOC, chest discomfort, crackles, and wheezing.

Why are ACE inhibitors or ARBs used following ACS, and what is ventricular remodeling?

They are used to prevent ventricular remodeling and development of heart failure. Ventricular remodeling is a permanent change in the size and shape of the left ventricle post-MI due to scar tissue.

How quickly should a 12-lead ECG be obtained for suspected ACS, and what can it identify?

Within $10\,\text{minutes}$ of presentation with chest discomfort. It identifies ischemia, injury, necrosis, and location.

What complications are associated with Percutaneous Coronary Intervention (PCI)? (6)

Rupture of artery, abrupt closure, acute stent thrombosis, failure to cross blockage, extended infarction, and in-stent restenosis.

When are fibrinolytics/thrombolytics used, and what are four signs of successful reperfusion?

Used in STEMI when timely PCI cannot be performed (not used for NSTEMI). Signs of reperfusion: abrupt decrease/cessation of pain, resolution of ST/T-wave changes, sudden ventricular dysrhythmias, and peak of myocardial damage markers.

What clinical findings indicate right ventricular involvement versus left ventricular failure after an MI?

Right ventricular involvement / right-sided HF: JVD and peripheral edema. Left ventricular failure: Crackles.

What major complications can arise after a Myocardial Infarction?

Cardiogenic shock, papillary muscle rupture, ventricular septal wall rupture, and Dressler syndrome.

What immediate actions should be taken first when a patient presents with chest pain?

Assess ABCs, obtain vital signs, establish IV access, start continuous ECG monitoring, and obtain a 12-lead ECG within $10\,\text{minutes}$.

When should supplemental oxygen be administered in ACS?

When hypoxemia is present, to maintain $\text{SpO}_2 \ge 90\%$.

What are the 4 priority collaborative problems in ACS?

Acute pain, decreased myocardial tissue perfusion, risk for dysrhythmias, and risk for heart failure.

Do CABG, PCI, or stents cure coronary artery disease (CAD)?

No. They treat the obstruction but do not cure CAD.