Acute Coronary Syndrome
The main stem of the LAD/circumflex artery is “fondly” known as the Widowmaker?.
The three parameters used to diagnose a myocardial infarction (MI) are: patient _History?, EKG with ST elevation in two contiguous leads and serial measurement of cardiac markers.
Physical _Activity three times/week for 30″ causing sweating and an increase in HR 30-50 b/m, may increase HDL levels and collateral circulation.
The syndrome of acute coronary syndrome (ACS) includes unstable angina, S_T elevation MI (STEMI),
and non _S T elevation MI (NSTEMI).
Women have a much higher mortality rate within one _Year following MI than men. They are also more likely to reinfarct. Older age and smaller vessels are thought to be contributory.
Abdominal __obesity is a waist circumference > 40″ and is considered to be a risk factor for cardiac disease
Angina is termed _unstable when there is a change in pattern and occurs anytime (even at rest).
IV fibrinolytics are given if a patient meets strict guidelines. Dissolving the clot within a coronary artery resolves chest pain and brings ST segment back to baseline. As a nurse you must watch for bleeding and dangerous __Reperfusion? arrhythmias.
Major modifiable MI __Risk factors are smoking, HTN, diabetes, and hyperlipidemia.
AMI means acute myocardial __Infarction.
When patients _Smoke they inhale nicotine which increases epinephrine release, HR, peripheral vasoconstriction, BP, cardiac workload, O2 needs, and platelet adhesion.
If your patient is unable to ___Kick? the habit they will also decrease O2 carrying capacity of their blood due to increased carbon monoxide (CO). Nicotine is also thought to be a chemical irritant and may injure vessel epithelium.
Nursing care of a rule-out (R/O) MI patient on admission includes: begin __Oxygen therapy, pain relief with NTG/MS, take VS and an EKG, assess heart sounds, start an IV, and put patient in a position of comfort.
A complication that may occur 2-3 days after a MI is pericarditis. Assess the patient’s heart with the stethoscope’s diaphragm q8h for the leathery, rubbing sound of a pericardial _Friction rub.
High BP (_Hypertension) causes a shearing stress on blood vessels and denudes endothelium lining which can lead to formation of a clot.
Expected care for an angina patient includes obtaining a 12 lead _EKG
within 10 minutes of the patient’s arrival.
A complication of a large MI may be a ballooning out of the heart muscle called a ventricular __Aneurysm.
When assessing a patient’s pain use PQRST questioning. This stands for: precipitates, quality, _Radiation, severity and timing.
A serum marker (muscle protein) highly specific for cardiac damage is _Troponin T. It elevates in 3-12 hours, remains in circulation up to 10-15 days and is particularly useful in diagnosing AMI at later stages.
HDL stands for high _Density lipoproteins which have a high protein content and carry lipids away from arteries to the liver for metabolism.
If fibrinolytics are used an _IV heparin infusion must be started to prevent reclotting. Maintain PTT 1-2x normal.
During the pain of a MI the __Sympathetic nervous system increases diaphoresis and vasoconstriction of blood vessels making skin ashen, cool and clammy.
An echocardiogram is often done after a MI to assess for cardiac damage. An _Ejection fraction of < 40% is considered abnormal and makes the patient a high risk for heart failure.
The most common cause of death after a MI is from cardiac Arrhythmias (80%).
When a MI patient is able climb two flights of stairs, he/she may resume _Sexual activity with their usual partner. Encourage the use of prophylactic nitrates.
A MET (metabolic _Equivelant) is the amount of O2 needed by the body at rest. In cardiac rehab a MET is the measure used to identify levels of safe physical activity. A patient can be discharged if they can tolerate moderate-energy activity of 3-5 MET.
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Acute Coronary Syndrome