11. Chest Pain/Angina/Discomfort DSAs Flashcards
Someone is presenting with NonSTEMI ACS, meds specifically for this case includes aspirin, P2Y12 inhibitors, Glycoprotein IIb/III3 inhibitors, and what therapy?
Anticogulation therapy
P2Y12 inhibitors include the grels (clopigreal or ticagrel), GPIIB/IIIA inhibtors are for high risk NSTEMI ACS and include tirofiban, abxciban, and anticoags including Enoxaprin, fondaxaparin and?
IV Heparin
Next in high risk patients with NSTEMI (recurrent angina, inc. troponin, ST depression, HF, high risk stress test) one would do an angiography and?
Percutaneous Coronary Intervention to break up clot
NOTE: if the patient is not high risk of NSTEMI then the person would most likely undergo what procedure?
Stress Test
Why is distinction between ACS with and without ST segment elevation so essential?
For reperfusion with fibrinolytics!
In what situation (N or STEMI) can fibrinolytic therapy be harmful, unlike in the other situation where reperfusion saves lives?
DO NOT REPERFUSE WITH NONSTEMI INFARCATIONs
V1-V4 are supplied by what blood supply?
V1-V2 (septal) V3-4 (anterior)= Left anterior descending artery
II, III, and avF make up the inferior wall supplied by?
Right coronary artery
I, V5,V6 make up the lateral wall and are suppled by?
Circumflex A
For STEMIs, you see peaked T waves, ST elevation, Q waves, with a new LBBB. First give aspirin/P2y12 inhibitors, what are the final two steps?
PCI first, and if not availble then Thrombolytics
From door to PCI- give thrombolytics for STEMI in under 90 mins. If primary place has no PCI/ cath lab, then transfer to PCI place within 120 minutes. If cant make transfer in 120 minutes, then what?
Give thrombolytic therapy and then start transfer to primary PCI
Thrombolytic therapy is recommended for acute stemi ONLY. absolute contraindications include… previous stroke, head trauma, intracranial neoplasm or suspectic aortic?
dissection
What are the three main things to give when someone comes in with acute STEMI?
Aspirin
P2Y12 inhibitors (clopigrel/ticagrelor)
Reperfusion therapy
Compelte AV block is most common in inferior MI which may be transient. Prognosis is worse when AV block with anterior MI, usually resulting in permanent?
Pacing (pacemaker)
What is the most common thing to occur within the first 24 hours of a MI?
Ventricular Arrhythmias (SHOCK EM if hemodynamically unstable— amiodarone if stable)
What can occur 3-7 days post MI with a new systolic murmur, pulmonary edema, mitral regurg?
papillary muscle rupture (sometimes a VSD too)
What occurs 2-7 days post MI usually associated with immediate death and located on the anterior wall?
Myocardial rupture
Cardiogenic shock is when systolic BP <90 with signs of diminished perfusion including cold extremities, decreased urine output and?
confusion
Cardiogenic shock does not respond to fluid resuscitation. Give them IV diuretics for less sick cohort and inotropic support with dopamine, dobutamine, or NE- why?
need to maintain BP even though increasing HR/blood flow will increase damage
Dx of shock includes, hypotension, tachycardia, oliguria, altered mental status and have different classifications. What type is due to decrease volume secondary to loss of blood or fluids?
Hypovolemic Shock (tx with repletion of fluids)
What type of shock includes cardiac tamponade, tension pneumothorax and massive pulmonary embolism, needing the underlying cause to be treated?
Obstructive shock
Distributive shock is aka septic shock. Sepsis is life threatening organ dysfunction caused by dysregulated host response to infection. Septic shock is sepsis with hypotension unresponsive to fluid, serum lactate level >2 and a need for vasopressors to keep mean arterial pressure above?
65mmhg
MCC of septic shock is gram pos or gram neg organism. Tx includes prompt dx and fluids, mechanical ventilation, cardiac monitoring and IV access and ?
fluid resuscitation
The following hemodynamic measurements coincide with what type of shock?
Reduce CO, Cardiac Index, ELEVATED SVR, CVP, PCWP (systemic vascular resistance, central venous pressure, pulmonary capillary wedge pressure)?
Cardiogenic shock
The following hemodynamic measurements coincide with what type of shock?
CO and CI increased initially but then reduced, LOW SVR, CVP, PCWP
Septic shock
What is the main difference in hemodynamic measurements between cardiogenic and septic shock?
Cardiogenic will have elevated SVR, CVP and PCWP while septic shock will have DECREASED SVR CVP and PCWP
