Acute Coronary Syndrome
What is the difference between STEMI and NSTEMI?
-NSTEMI- non ST elevation
-STEMI- ST elevation
Who is more likely to have vague symptoms?
What does MONA stand for?
-Morphine
-O2
-Nitroglycerin
-Aspirin
What procedure is indicated when:
-there is complete occlusion-multivessel disease
-left main coronary artery disease
-failed PCI
-severe LV dysfunction
-DM
Coronary artery bypass grafting (CABG)
What is the most common dysrhythmia post CABG?
A fib
What is the clinical assessment for ACS?
-Pain (heaviness, pressure, burning, tightness) (substernal, may radiate to neck, arm and jaw) (can also feel like indigestion)
-Skin (ashen, cool, diaphoresis)
-Dyspnea
-Cardiovascular (initial elevation of BP and HR- later can drop with decreasing cardiac output) (abnormal heart sounds= S3, S4)
-N/V
-Fever
-Anxiety (impending doom or denial)
What are the cardiac markers?
-Troponin (most reliable)
-CKMB= cardiac muscle injury (>5% indicates MI)
-Increased CK= muscle injury
What is the goal with clot busters?
PERFUSION
What is the best bypass performed during a CABG?
What are some complications of a CABG?
-Bleeding
-Pneumothorax
-Cardiac tamponade
-Stroke
-Delirium
-Ileus
-Renal failure
-Infection
-Pneumonia
ECG changes over course of MI, what does it look like?
-ST depression= ischemia
-ST elevation= injury
-Q wave= infarction (shows up later, but not always)
-T wave inversion= ischemia
What is the gold standard for looking at coronary anatomy (most invasive)?
Dye and fluoroscopy visualization.
Name this revascularization approach.
-Angioplasty (balloon inflation of artery)
-Vacuum extraction of thrombus
-Atherectomy (removal of plaque)
-Stents
Percutaneous Coronary Intervention (PCI)
What is most common practice for the patient to have received post CABG?
Temporary pacer (right atrial, left ventricular)
If a patient ends up with a chest tube post CABG what are some nursing interventions?
-Patency
-Output
-Air leaks
What is the diagnostic test that is used with a treadmill and what do they inject to evaluate uptake into heart muscle?
What med is used to induce stress?
-Stress test
-Thallium
-Dobutamine
What test shows vessels and occlusions?
Determine location and severity of blockages.
Arterial puncture, typically wrist or groin.
Left heart cath
What is the baseline assessment post PCI?
-Neuro (CVA risk, hemorrhagic stroke)
-Access site
-Distal circulation
-Pain/Symptoms
-Cardiac rhythm
-Early mobilization
-Pulmonary rehab
-Bowel regimen
-Multimodal pain management
-Oral care TID with tooth brushing
-Gum chewing (prevents ileus)
-IPC's
-Assess and manage delirium
Name some thrombolytics (clot busters) commonly used for PCI.
-Alteplase (tPA)
-Reteplase (rPA)
-Tenecteplase
-Streptokinase
(within the first 6 hours of symptom onset)
What shows pressures and hemodynamic readings?
Venous puncture, typically groin.Right heart cath
What measures left ventricular function and requires additional dye?
Ventriculogram
How long should the patient be on bedrest post PCI when entering through the groin and radial?
-4-8 hours with leg straight and HOB flat (groin)
- pressure bands but no mobility restrictions (radial)What is another name for a graft?
Conduit
Name some complications to monitor for post PCI.
-Dissection
-Vasospasm
-Dysrhythmias
-Restenosis
-CVA
-CIN (contrast induced nephropathy)