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ACS info
Clinical Manifestations
Types of Angina
Percutaneous Coronary Intervention (PCI)
Medications
100

Risk factors for developing ACS

  • Age
  • Biological gender (male)
  • Family history
  • Smoking
  • Diabetes
  • Hyperlipidemia
  • Obesity
  • Hypertension
  • Stress
  • Inactivity
  • Kidney disease
100
Describe the "pain" clients with ACS have.
  • Described as heavy, tight, crushing, “indigestion”
  • May radiate arm, neck, jaw, back
  • Patients with DM may have “Silent” MI due to cardiac neuropathy
100

Chest pain last 15 minutes or less. Pain relieved by rest. EKG is normal. Troponin is normal.

Stable angina

100

The timeframe goal for a client experiencing a STEMI till cath lab balloon inflation. 

the artery must be opened within 90 minutes of presentation to restore blood and O2 to the heart muscle and limit the infarct size

100

Antiplatelet

  • Aspirin (chewable) (taken forever following an MI)
  • Clopidogrel (Plavix) [NSTEMI/STEMI]

Dual antiplatelet therapy (continued for 1 year if patient gets a stent)

200
Definition of Acute Coronary Syndrome (ACS)

A type of Coronary Artery Disease (CAD). Chest pain from ischemia that is prolonged and not immediately reversible, caused by a partial or complete blockage in the coronary artery.

Includes Unstable Angina (UA), Non-ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI).

200

When the client experiences ACS, the sympathetic nervous system (SNS) is activated, releasing epi and norepinephrine. Describe the initial signs and symptoms related to the SNS activation.

Initially increased HR, increased BP, diaphoresis, peripheral vasoconstriction (cool/clammy skin)

200

Worsening, unpredictable chest pain symptoms that is poorly relieved by rest. EKG ST depression or T-wave inversion. Troponin normal. 

Unstable angina.

200

What allergy would be a contraindication for a client to have a cardiac catheterization procedure?

Allergy to IV Contrast dye, shellfish/iodine
200

Nitroglycerin

  • Administered IV, SL, or oral spray
  • Works by decreasing preload and afterload while increasing the myocardial O2 supply
  • *Monitor for hypotension and headache
  • Contraindications: increased ICP, ED drugs 24-48 hours, RV MI, hypotension
300

Pathophysiology of ACS

Heart muscle becomes hypoxic within the first 10 seconds of a total coronary occlusion. Heart cells are deprived of oxygen and glucose needed for aerobic metabolism and contractility. Anaerobic metabolism begins, and lactic acid accumulates. In ischemic conditions, heart cells are viable for about 20 minutes. Irreversible damage starts after 20 minutes if there is no collateral circulation. Folks with a long history of CAD may develop good collateral circulation. This is one reason a younger person may have a more serious first MI than an older person with the same degree of blockage.

300

Often times the client experiencing ACS has nausea/vomiting. Why does this occur?

Reflex stimulation of vomiting center by the severe pain.

300

Chest pain caused by arterial spasm.

Variant/Prinzmetal Angina

300

What is the priority assessment after a client has had a cardiac catheterization procedure?

Neurovascular assessment of extremity used in procedure. Assess catheter insertion site (hematoma, bleeding).

*Discontinue Metformin for approximately 48 hours after use of CT contrast, due to potential damage to kidneys.

300

Morphine

  • For chest pain unrelieved by nitroglycerin
  • Vasodilator, decreases cardiac workload by lowering myocardial O2 consumption, reduces contractility and decreasing BP and HR
  • *Monitor for RR depression
  • Antidote: naloxone (Narcan)
400

Knowing that hyperlipidemia is a risk for ACS, what medication does that the nurse anticipate?

  • "Statins" - Atorvastatin (Lipitor)
  • Client will take forever if an MI occurs.

Statins: Patients should report any muscle aches or pains, or dark-colored urine, which can be signs of rhabdomyolysis. 


400

Often times the client experiencing ACS has a low grade fever (up to 100.4) within 24 to 48 hours. Why does this occur?

Result of systemic inflammatory process caused by the death of myocardial cells

400

EKG with ST segment depression or T-wave inversion, or. Troponin elevated.

NSTEMI

400

Potential complications related to a cardiac catheterization procedure. 

  • dissection/rupture of coronary artery, thrombosis, stent failure
400

Anticoagulant

  • Heparin [IV Unfractionated Heparin] or Enoxaparin (Lovenox) [subcutaneous LMWH]
  • Risk of bleeding
  • Monitor aPTT
  • Antidote: Protamine Sulfate
500

Patient teaching related to ACS

  • Physical activity – 30 to 60 minutes of moderate-intensity aerobic activity at least 5 days/week
  • Low salt and low fat diet
  • Limit alcohol
  • Decrease stress
500

As a result of ACS, the client may experience decreased cardiac output (CO). How will the body compensate for the decreased CO?

Decreased CO will lead to decreased BP, which may may lead to decreased renal perfusion – decreased urine output

500

EKG with ST segment elevation. Troponin elevated.

STEMI

500

Define these terms: CABG, PTCA, atherectomy, coronary stent

  • CABG – Coronary Artery Bypass Graft – healthy leg vein used to replace damaged coronary artery
  • PTCA - Percutaneous transluminal coronary angioplasty - coronary artery opened with a balloon and stent.
  • Atherectomy – cut out the plaque buildup within the artery
  • Coronary stent – prevents recollapse, remains permanently within artery
500

Thrombolytic

  • Dissolves the clot
  • Goal = administer within 30 minutes of arrival to ED
  • Recommended only for STEMI.
  • Advantages = availability and rapid administration
  • Risk = bleeding (lyse of good [post surgical/trauma clots} and bad clots)
  • IV site, gingival bleeding (expected) – treat with ice packs or pressure