Acute Coronary Syndrome
Terms in this set (34)
What is the single leading cause of death in the US?
coronary artery disease
List some risk factors for CAD
smoking, hypertension, diabetes, dyslipidemia, family history, kidney disease, lack of physical activity, obesity, poor diet
what are the 3 types of acute coronary sydromes
1. Unstable angina
2 Non-ST segment elevation MI (NSTEMI)
3. ST-Segment Elevation MI (STEMI)
what are the features of unstable angina?
Non occlusive thrombus (plaque)
EKG: non specific (can look normal)
Cardiac enzymes: normal
what are the features of an NSTEMI?
1. occluding thrombus- sufficient to cause tissue damage and mild myocardial necrosis
2. EKG: can look normal, or ST depression +/- T wave inversion
3. cardiac enzymes: elevated
what are features of STEMI
1. Complete thrombus occlusion of vessel
2. EKG: ST elevation or new LBBB
3. cardiac enzymes: elevated
Need at least 2 of the following criteria to diagnose an Acute MI (either NSTEMI or STEMI)
1. ischemic symptoms
2. diagnostic ECG
3. serum cardiac marker elevations
To diagnose typical angina need all 3 of the following symptoms..
>90% of pts will have coronary artery disease if these 3 things
1. substernal chest discomfort
2. onset with exertion or emotional stress
3. relief with rest or nitroglycerin
To diagnose unstable angina pts have...
Patients have typical angina symptoms except it changes and now:
1. increased severity or duration
2. onset at rest or low level of exertion
3. unrelieved by nitroglycerin or rest
It patient presents with chest pain suggestive of ischemia they need...
Immediate assessment within 10 minutes (ie get an EKG), get labs, meds (Oxygen, aspirin, nitrates)
1. ST Elevation or new LBBB--> STEMI
2. ST depression or dynamic T wave inversions --> NSTEMI
3. Non specific ECG--> Unstable angina
What is the most sensitive and specific cardiac marker?
-rises 4-8 hours after injury and may remain elevated up to 2 weeks
-can provide prognostic information
higher troponin worse prognosis
STEMI cardiac care steps
STEP 1: assessment- EKG shows STEMI
1) more than 90 minutes door to balloon time? If no PCI reperfusion
If yes or if cath lab unavailable- give fibrinolysis (TPA) within 1st 12 hours
What is the Medical therapy for STEMI pts?
What does MONA BASH stand for?
what is morphine for?
Why give Oxygen?
up to 70% of pts demonstrate hypoxemia, and may limit ischemic myocardial damage
What is nitroglycerin for?
-dilate coronary vessels, inc blood flow
What is aspirin for?
-inhibit platelet aggreg (stop thrombus) and stabilize plaque
What are Beta blockers for?
what are ACEI/ARBS for
-dec remodeling and scar tissue
What are Statins for?
-decrease cholesterol (LDL)
What is heparin for?
-inhibit thrombus formation
What is Clopidodrel (Plavix) or Prasugrel (Effient)
-used in support of Catheter/PCI or if unable to take aspirin
-take for 1 to 12 months
Effient is better
What is Ticagrelor (Brilinta)?
-newer anti-platelet agent
What do Glycoprotein IIb/IIIa inhibitors do? (Integrillin)
-another option if PCI/stent
What is Bivalirudin (Angiomax)?
-direct thrombin inhibitor
-used for stents in place of heparin/Integrillin
Why use Aldosterone inhibitors?
-if LVEF <40% want to decrease some of the blood volume to decrease cardiac workload
What do you do for Unstable angina/NSTEMI?
either conservative therapy or invasive therapy depending on risk factors (low, int, high) (evaluate based on EKG, cardiac markers, PE, etc, the things we talked about earlier that suggest NSTEMI or UA)
if NSTEMI or UA with (high risk) and maybe with some intermediate risk patients...
(high risk means all these)
-ST depression/ T inversion
-flunk stress test
then... do a cath (invasive therapy)
Invasive therapy options for UA/NSTEMI
1. coronary angiography and revascularization within 12 to 48 hrs
2. MONA BASH
3. antiplatelet agents
what is the conservative therapy for UA/NSTEMI (intermediate or low risk)
1. MONA BASH
2. antiplatelet agents
3. surveillence in hospital (get EKGs and cardiac markers)
1. take care of their HTN, DM etc
2. change behaviors (smoking, diet, exercise, weight)
3. education, cardiac rehab program
4. control BP- get on Beta blocker or ACE
5. control lipids: LDL <70 (statins)
What ICE type thing do you want to monitor after discharge?
1. monitor for psychosocial impact
-social support system?