AH III Exam 2 - CAD & ACS

What is CAD? (2)

• Atherosclerosis forms & occludes coronary arteries; can l/t an MI

• Reduced blood flow through coronary microvasculature; can damage vessel walls

What is stable angina? (2)

• Chest pain that is caused by physical activity

• Symptoms are alleviated w rest/meds

What is unstable angina? (3)

• Chest pain that occurs at rest (can also be caused by phys activity)

• Does NOT go away w rest/meds

• This is an ***EMERGENCY***

What is Prinzmentals angina? (2)

• Vessel wall closes & spasms

• Typically occurs at night

Labs for CAD (7)

• Cholesterol

• Triglycerides

• LDL/HDL

• CK

• CK-MB

• Tropnin

How do we dx CAD? (2)

• ****ECG; 12-lead, tells us what’s going on in the heart****

• Stress test - conservative way

Gold standard for CAD dx? (3)

• Coronary angiography; INVASIVE

• Need to do b4 complete occlusion!!!!!

• Determines if we can place a stent

PTCA/PCI notes (2) (what is it)

• Stent placement

• Done in cardiac cath lab; conscious sedation

Coronary artery bypass grafting

• Use saphenous vein to make new path for heart & create blood flow again

What is a STEMI? (2)

• Infarction with complete obstruction

• ST elevation of 1mm > in 2+ leads in 12-lead ECG

• EMERGENCY

What is a NON-STEMI

• Ischemia with partial obstruction

• Still damage!!!

MI S/S specific/nonspecific (7)

• Unstable angina

• Epigastric discomfort → common in women

• N/V

• Diaphoresis

• Syncope

• SOB

• Pain between shoulders/jawline

Troponin lab test for MI dx (3)

• Detects cardiac muscle damage

• Track & trend if elevated

• Series of at least 3

Why is CK lab not the best to use?

It’s nonspecific & detects heart & skeletal muscle

What is the GOLD STANDARD for dx of an MI?

• *****ECG******

• Determines the next steps

If there is an ST-elevation in the ECG what is next?

Coronary Angiography!!!! (heart cath)

Other diagnostic tests for MI (2)

• Echo

• Stress test

Enzymes for MI (2)

• Troponin I*

  • Most sensitive indicator bc from myocardium

  • MI = > 0.04 ng/mL

  • Norm < 0.04 ng/mL

• Troponin T

  • Skeletal & heart muscle

  • < 0.01 ng/mL

ASA for STEMI tx (4)

• 1st LINE!!!

• Initial dose 325 mg CHEWED then 81 mg indef

• Anti-platelet

• DO NOT TAKE WITH NSAIDS!!!

Nitroglycerin for STEMI tx (5)

• Potent vaso/veno dilator

• Reduces PRELOAD

• Need to know pt’s BP

• Subling 0.4 mg Q5 min x 3

• Monitor for HYPOTEN, HA is common

Who should NOT get nitro (2)

• Pts with R ventricular infarction

• Use of other PDE-5 inhibitors - Viagra or Cialis

Morphine for MI tx (4)

• Use if Nitro doesn’t control CP

• 1-2 mg IV Q 5-15 min

• Reduces preload

• AVOID in R Ventricular MI

Oxygen for MI (3)

• Use ONLY if O2 falls BELOW 90%

• Or if resp distress or hypoxemia (PaO2 less than 85)

• Damages myocardium

Acute STEMI PCI (3)

• Door to balloon time goal: 90 mins

• Goes through the radial artery

• Monitor kidneys bc hella dye used

  • Clears through kidneys

  • Monitor creatine, urinary output, kidney function

What is Retroperitoneal Bleed & Hematoma? (2)

• Seen with the femoral approach

• Pt bleeds into retroperitoneal (internal bleeding)

S/S of Retroperitoneal Bleed & Hematoma (3)

• Tachycardia

• **Hypoten**

• Back pain, groin pain, flank ecchymosis (late sign)

Retroperitoneal Bleed & Hematoma Tx (4)

• STAT H/H

• Hold pressure

• Balloon tamponade (internal tourniquet)

• Prepare for blood transfusion

When would we use fibrinolytic therapy? (3)

• If pt can’t get to a chest pain hosp fast - rural areas

• Temp care to buy time

• RISKYYY

Fibrinolytic drugs & indications (3)

• TNKase & rtPA (Activase)

• Pain < 6 hrs

• ST elevation > 1mm in 2 + leads (active STEMI)

Nursing considerations w fibrinolytics (4)

• Bleeding in most common side effect ESP BRAIN BLEED!!!!

  • Reversal: cryoprecipitate & platelets

• Frequent neuro assessments

• Avoid punctures/invasive devices/compressive

• Monitor renal function

The “Big 5” discharge meds following ACS (MI)

• ASA - indef, 81 mg

• Plavix at least 1 year

• Beta blocker - indef

• ACE-I or ARB ; EF <40%, cardioprotective

• Statin

What are the dual antiplatelet therapy drugs?

• ASA & Plavix

• Use for at least 1 year