Angina and ACS Basics
What causes the chest pain in angina?
Lactic acid buildup from anaerobic metabolism when O₂ demand exceeds supply.
What ECG finding indicates ischemia?
ST depression or T-wave inversion.
What does MONA stand for?
Morphine, Oxygen, Nitroglycerin, Aspirin.
What is the main goal of thrombolytic therapy?
Reperfusion (restore blood flow to the myocardium).
What is the most frequent complication of acute MI?
Dysrhythmias.
What are two key differences between stable and unstable angina?
Stable angina is predictable, occurs with exertion, and relieved by rest/nitroglycerin. Unstable angina is unpredictable, may occur at rest, and not relieved by rest/nitroglycerin.
What ECG finding indicates myocardial injury?
ST elevation.
Which MONA medication reduces pain and anxiety while lowering workload?
Morphine.
What are two complications of PCI (angioplasty/stents)?
Dysrhythmias, restenosis, kidney injury, CVA, or site bleeding.
What type of dysrhythmias often cause sudden cardiac death post-MI?
Ventricular tachycardia (Vtach) and ventricular fibrillation (Vfib).
What is the most common cause of decreased O₂ supply to the heart?
Atherosclerosis (plaque buildup in coronary arteries).
Which lab test is the most specific indicator of myocardial infarction?
Troponin I or T.
Why are beta-blockers used after MI?
Decrease O₂ demand by lowering HR, BP, and contractility; reduce reinfarction and arrhythmias.
After a femoral PCI, what position must the patient maintain?
Bedrest 4–8 hrs, leg straight, HOB flat.
What are classic symptoms of pericarditis?
Sharp chest pain worse with inspiration, relieved by leaning forward, pericardial friction rub.
What type of angina is caused by coronary artery spasms without plaque?
Prinzmetal’s (variant) angina.
Why should an ECG be done within 10 minutes of arrival for chest pain?
To quickly identify ischemia or infarction and guide treatment (time = muscle).
A 64-year-old male is admitted with chest pain and diagnosed with a STEMI. He undergoes PCI with stent placement via the femoral artery. Two hours later, the nurse notices the patient’s right leg is pale, cool to the touch, and the dorsalis pedis pulse is faint compared to the left leg.
Question: What is the nurse’s priority action?
A. Elevate the affected leg on a pillow
B. Notify the provider immediately
C. Encourage the patient to ambulate
D. Apply a warm compress to improve circulation
Answer: B. Notify the provider immediately
Rationale: Post-PCI patients are at risk for bleeding, hematoma, or arterial occlusion at the insertion site. Pale, cool extremity with weak pulse indicates compromised circulation and possible occlusion or pseudoaneurysm. Immediate provider notification is necessary. Elevating or ambulating could worsen bleeding, and warm compresses are inappropriate.
What is CABG and when is it indicated?
Coronary Artery Bypass Graft; indicated for complete occlusion, multivessel disease, failed PCI, or severe LV dysfunction.
What are signs of left-sided heart failure post-MI?
Crackles, dyspnea, cough, S3 gallop, weak pulses, confusion.
What spectrum does Acute Coronary Syndrome (ACS) include?
Ischemia → injury → infarction → necrosis (Unstable angina, NSTEMI, STEMI).
What test is considered the “gold standard” for identifying coronary anatomy and blockages?
Cardiac catheterization.
A patient in a rural hospital presents with chest pain lasting 90 minutes, ST elevation on ECG, and elevated troponin. PCI is not available, and the patient is started on IV alteplase (tPA).
Question: Which finding would require the nurse to stop the infusion and notify the provider?
A. Oozing blood at the IV site
B. Mild headache
C. Sudden onset of confusion and difficulty speaking
D. Prolonged clotting time on labs
Answer: C. Sudden onset of confusion and difficulty speaking
Rationale: The greatest risk with thrombolytic therapy is intracranial hemorrhage. Neurological changes such as confusion, aphasia, or sudden headache require immediate intervention. Minor bleeding at IV sites is expected, and prolonged clotting times are anticipated during therapy.
A 72-year-old patient underwent CABG surgery yesterday. The nurse notes urine output of 20 mL/hr for the last 2 hours, BP 84/60 mmHg, HR 112 bpm, and cool extremities.
Question: What is the nurse’s priority action?
A. Notify the surgeon immediately
B. Administer an IV fluid bolus as ordered
C. Document the findings and recheck in one hour
D. Administer a diuretic to improve urine output
Answer: A. Notify the surgeon immediately
Rationale: Post-CABG, urine output <30 mL/hr can indicate decreased cardiac output or renal hypoperfusion, possibly due to cardiogenic shock or bleeding. Immediate provider notification is priority. Fluids may be ordered, but the nurse must report these critical findings first. Diuretics would worsen hypovolemia.
What structural defect can occur due to papillary muscle rupture?
Sudden mitral valve regurgitation.