Cardiovascular Alterations

Acute Coronary Syndrome

Coronary A & P
Review of heart anatomy
Coronary arteries
a. P. 294, Box 12-1
b. Coronary arteries supply the heart with
oxygenated blood
c. Problems occur when there are
occlusions/spasms
i.
Myocardial infarction
ii. Angina-note the different types
iii. Myocardial ischemia

Diagnostic exams

12 Lead EKG
Chest x-ray
Holter monitor
Exercise tolerance or stress test, incl. drugs
and nuclear
Echocardiography-EF, wall thickness, valves
TEE
MUGA
Cardiac MRI
Cardiac catheterization

Acute Coronary Syndrome

Cardiac pain caused by ischemia with EKG

changes, lab abnormalities, and dysrhythmias
that can lead to cardiogenic shock and death if
not treated
EKG changes-will show you where the damage
is and if its ischemia or infarction with tissue
death. P. 311

Acute Coronary Syndrome

MedicationsMONA
Beta Blockers
Calcium channel blockers
Anti platelets
Thrombolytics-discuss nursing considerations
a. Must be symptomatic for < 6 hrs
b. Must have ST elevation of > 1mm in 2 lead
c. Within 30-60 min after arrival
d. Obtain labs, IV lines, monitor, VS

Acute Coronary Syndrome

Labs- cardiac enzymes-CK-MB, Troponin,

Myoglobin,
electrolytes-esp K+, Ca++, and Mg++
which can lead toDysrhythmias-PVCs, loss of sinus
mechanism, 2nd and 3rd degree heart
blocks

Acute Coronary Syndrome

PTCA
Define
Stents/ meds
More effective than thrombolytics
Nursing considerations for pre and post care
a. Door to balloon time
b. Medications- NTG, BB, ASA, Morphine
c. Labs, IVs, monitor

Acute Coronary Syndrome

Post acute phase progression and care
Nursing implications with Quality Measures
Teaching for
a.) CHF
b.) pulmonary edema
c.) sodium intake
d.) weight gain
e.) lipid control with dietary teaching
f.) medications