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  1. Chronic Stable Angina
    • Onset: exertion or emotional stress
    • after 10 secs, contractility stops, lactic acid builds up
    • after 20 min, cardiac cells die, irreversible damange
    • 4-6 hrs necrosis of entire myocardium
  2. Chronic Stable Angina Pain
    • intermittent over long period
    • same pattern of onset, duration, intensity
    • c/o pressure in chest
    • located: neck, jaw, shoulders, down arms, btwn shoulders
  3. Chronic Stable Angina ECG
    ST depression and/or T wave inversion
  4. Chronic Stable Angina Drugs
    • Take same time of day prior to occurence of pain
    • wait 30-60 min before starting activities
  5. Which Chronic stable angina occurs in diabetics?
    • Silent ischemia
    • neuropathy=decrs. nerves in heart
  6. Which chronic stable angina occurs at night?
    • Nocturnal Angina
    • not always when asleep or in recumbent position
  7. Which chronic stable angina occurs when lying down?
    • Angina decubitus
    • pain relieved by standing or sitting
  8. Which chronic stable angina relieved by standing or sitty
    Angina decubitis
  9. Which chronic stable angina occurs at rest or during REM sleep?
    • Prinzmetal's
    • common in pt w hx of migraine HA, raynaud's phenomenon
    • triggered by smoking, histamine, angiotension, E, drugs that cause vasoconstriction
  10. ECG for Prinzmetal's Angina?
    ST elevation
  11. relief for prinzmetal's?
    by moderate exercise, spontaneously or with drugs (Ca2+ blockers, nitrates)
  12. Dx Test for Chronic Stable Angina
    • Cardiac cath
    • PCI (not for pt with 3 blocked CAD)
    • Coronary angio
    • Labs: troponin, CK-MB, myoglobin, lipid, CBC C-reactive, homocysteine
  13. Chronic Stable Angina Pt teaching
    • Anitplatelet agent, antianginal therapy, ace inhib
    • Beta-adrenergic blocker, BP
    • Chol, smoking cessation
    • Diet, diabetes
    • Education, exercise
    • Flu vax
  14. Chronic Stable Angina drugs--Beta blockers
    decrease HR, BP, contractility
  15. Chronic Stable Angina drugs
    Ca channel blockers
    • HR, BP control
    • decrease coronary artery spasms
    • given for Prinzmetal
  16. Chronic Stable Angina drugs--ACE inhib
    • aterial vasodilation
    • decr. BP, afterload, myocardio O2consumption
  17. Acute Coronary Syndrome (ACS) includes
    • unstable angina
    • NSTEMI
    • STEMI
  18. ACS caused by
    plaque ruptures-->blood, platelet aggregate-->thrombus
  19. Unstable angina onset?
    • at rest or minimal activity
    • worsens in increasing frequency
  20. Unstable angina sxs?
    • ECG: nstemi or stemi
    • pain unrelieved by rest or NTG
    • n/v
    • cold sweat
    • sudden SOB rather than chest pain (>65 yo)
    • fever
    • initially high bp and hr then decrease due to decre CO
    • women have prodromal sxs like an 'aura'
  21. What is an MI?
    • sustained ischemia
    • usu invovles blocked LV
  22. MI pain
    • severe, immobilizing
    • NOT RELIEVED with rest, change of position or NTG
  23. MI onset
    while active or rest, asleep, awake
  24. MI S/s
    • temp
    • skin: ashen, cold, clammy
    • Increase BP, HR, then drops
    • low CO = low urine output
    • Chest pain
    • SOB
    • ALOC
    • Crackles, rhonchi
    • Peripheral edema
    • jugular vein distention
    • RV dysfxn
    • pulmonary edema
    • epigastric discomfort w or w/o N/V
    • Diaphoresis
  25. MI ECG
    ST elevation, T wave inversion (ischemia!)
  26. ventricular remodeling occurs
    10-14 days after MI
  27. Assess angina
    • P
    • Q
    • R
    • S
    • T
    • Interventions taken (ASA, NTG)
  28. Nsg Mgmt for Ua/NSTEMI with negative cardia markers
    • no thrombolytics
  29. STEMI/NSTEMI with positive cardiac markers
  30. Thrombolytic therapy drugs
    • w/in 6 hrs of onset
    • dissolves clots
    • meds: --plase, APSAC, Streptokinase
  31. Coronary arterial bypass graft
    • when PCI failed or L main coronary artery blocked
    • 3 or more coronary arteries blocked
  32. CABG Nsg mgmt
    • 1st 24hrs in ICU
    • Telemetry
    • endo trach to ventilate
    • foley
    • NG for gastric decompression
    • would care
    • pain mgmt

    • After icu: early ambulation
    • SQD
    • incentive spirometer
    • deep breath, splinting
    • monitor LOC
  33. Sudden cardiac death caused by
    • ventricular dysrthymias
    • L ventricular fxn
    • not always with CAD
    • death within 1 hr of onset of angina, palpitations
    • implantable cardioverter-defib prevents recurrence of VT/VF
Card Set:
2011-08-22 00:34:49

Test 1
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