CC Cardiac Disorder

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  1. 3 types of Acute Coronary Syndrome
    Unstable Angina (USA) - out pt setting

    • Non ST elevated MI (NON-STEMI) - in pt
    • ST elevated MI (STEMI)
  2. 3 types of angina
    typically caused by art sclerosis

    • stable= predictable
    • unstable= accelerating, increased severity, not helped by Nitro
    • Prinzmetals/Varient= vasospastic of coronary art and can cause heart damage
  3. Prinzmetal/Varient angina
    • high risk for vent arrythmias that can lead to sudden cardiac death.
    • can be triggered by smoke
  4. Left coronary artery name and supplies waht?
    • the "widow maker"
    • splits into the circumfelx which supplies the left ventricle
    • supplies the anterior L vent, and Posterior L Vent
  5. right coronary artery supplies the anterior and posterior right vent, the inferior wall
  6. Tx of angina

    • nitrates
    • N+ Beta blockers to dec contract and O2 demand
    • N + B + Ca chan. block
    • CABG
  7. Tx of Prinzmetals/Vraient

    • Nitrates OR Ca blocks
    • Nitrates + Ca blocks
    • CABG
  8. remember:

    Beta blocks the SNS effects on the CNS

    Ca blockers cause Arterial vasodilation, which dec afterload
  9. Location matters as the severity and what cells are affected by an Acute MI
  10. need to get to hospital w/n the first 12 hours after chest pain starts to save the tissue
  11. common MI locations
    • LAD- high mortality
    • RCA
    • L Cx
  12. Transmural
    depth of the MI

    • Trans= involves all three layers of heart
    • ST elevation or Q waves develop with MI
  13. STEMI
    elevated t wave indicate injury is occuring
  14. Non-STEMI
    subendocardial= involves on the endocardium and partial wall of myocardiam

    • No q-waves
    • ST supression or inverse T waves
  15. typical MI Sx
    chest pain or pressure
  16. atypical MI Sx
    unexplained sweating, dyspnea, and nausea

    • often unrecognized as cardiac
    • women, elderly, and diabetics present with more atypical Sx than men

    women present with N/V, jaw and/or back pain
  17. PQRST assessment for AMI
    • Precipitating pain? Pain relief?
    • Quality
    • Radiate to?
    • Severity 0-10
    • Timing w/n 12 hours
  18. Calling EMS has better outcomes than driving to hosp
    new rule is take 1 dose NTG then call instead of 3 doses
  19. when a right side MI is suspected, an 18 lead can be ordered. This is harder to diagnosis and less common
  20. ECG changes that help diagnos MI
    • ST segment elevation or depression
    • new Left BBB with QRS >1.0
    • T-waves
    • pathological Q waves
  21. summary:
    Non STEMI
    • STEMI= ST elevation, new LBBB, Q waves (long time)
    •  =Greem light, go fast to cath within first 12hrs

    • N STEMI= ST depression, Twave inversion
    •  =Yellow light, go forward with caution
    •  =not strait to cath lab, Tx with meds first
  22. higher the ST seg, greater mortality
  23. cardiac markers
    • Myoglobin first to rise, but not heart specific
    • Troponin first heart specific marker to rise
    • CPK-MB is heart specific too
  24. C reactive protein indicates what?
    systemic inflammation
  25. B Natriuretic peptide indicates what?
    it inc Na secretion from kidneys to dec fluid volume

    • it is synthesized in cardiac vents and responds to stretch
    • elevation indicates fluid overload
  26. Homocysteine
    a corrosive acid use to predict mortality of MI event

    treat with statisn
  27. mag and K levels decrease in MI
  28. golden hour, 1st 60 minutes can save a lot of muscle
  29. STEMI route if PCI (balloon and stent) hospital is <90 min
    • strait to Cath lab for primary PCI
    • supportive device
    • Dx angiogram
    • PCI
  30. STEMI route when PCI is > 120 minutes
    • go to NON PCI hospital door in/out time <30min
    • Transfer to PCI hospital, give thromblytic and supportive device <120 minutes
  31. MONA Tx of all Acute Coronary Syndromes
    • Morphine
    • O2
    • NTG
    • ASA

    "Mona" greets all MI's
  32. Goal: destress the heart
    Beta better than Ca blocks to Tx angina
  33. goal: hemodyn stability
    • fluid volume
    • vasopressor after fluid stable b/c of dec BP
  34. special considerations for R vent infarct (volume pump)
    • inc preload
    • IV fluids
    • limit NTG and Morphine
    • + inotropes as needed
  35. % of significant stenosis?
    what about LCA?
    sig >70%

    widow maker >50% is sig
  36. Before a heart cath, what about the kidney needs to be considered?
    • assess the creatinine levels
    • hydrate with IV
    • lower contrast in high risk pt's
  37. Statins (lipids lowers) are indicated pre-PCI and post ACS
  38. Anticoag before a cath is important
    use multiple anti coags
    DAPT= duel anti platelet therapy
  39. sites for heat cath
    femoral and radial arteries

    • radial has less complications
    • femoral can have a psudoaneurysm (dilated artery from injury)

    goal is increase lumen size to >50% with balloon
  40. if 3 of the major CA's are >70% blocked, open heart surg needed
  41. non medicated stent

    BMS - bare metal stent
    goal is to decrease vasospasm and help hold art open

    clotting will occur immediatly, so anti-coag important
  42. Drug-eluding stent

    medicated stent
    • coated with drugs to dec intimal (fibrotic) tissue growth
    • need to be on anticoag for longer time because the stent prevent endothelial growth which produces it's on anti-coag
  43. laser angioplasty can be done if CA is calcified instead of plaque
  44. placement of femoral cath considerations and concerns
    need to be on femoral head d/t compression after removal

    above head = Inc risk for retroperitonal hemorrhage

    below = risk for pseudoaneurysm
  45. nsng care after PCI femoral
    • make sure coag is back to nl before sheath removal of cath
    • support site when coughing
    • bedrest 6-8 hrs
    • atropine at bedside
    • reverse trendleberg to eat
    • distal pulse and site hematoma chacks
  46. Intra-aortic balloon pump
    inflates with diastole to inc CA bld flow

    deflates at QRS to help pull blood out of L vent
  47. left ventricle assist device
    bridge from L vent to Aorta until heart transplant is possible
  48. ways to prevent long term HF while in CCU
    • ACE inhibitors (prils) to dec SVR, infarct size, and ventricular remoldeling
    • limit fibrotic scare formation

    pt will have very low BP, but this helps by dec SVR
  49. complications of thrombolytics
    blding: assess nuero, bladder, bowel, back pain. No needle sticks


  50. how do you know if thrombolytics work?
    ST segment returns, enzymes normalize
  51. Why use therapuetic hypothermia?
    when pt was cardiac arrest or shock but was resuscitated, reprofused, and regular rhythm, BUT is still unconciaous
Card Set
CC Cardiac Disorder
CC cardiac disorders exam II
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