11. Chest Pain/Angina/Discomfort DSAs

Question 1

Someone is presenting with NonSTEMI ACS, meds specifically for this case includes aspirin, P2Y12 inhibitors, Glycoprotein IIb/III3 inhibitors, and what therapy?

Answer 1

Anticogulation therapy

Question 2

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?

Answer 2

IV Heparin

Question 3

Next in high risk patients with NSTEMI (recurrent angina, inc. troponin, ST depression, HF, high risk stress test) one would do an angiography and?

Answer 3

Percutaneous Coronary Intervention to break up clot

Question 4

NOTE: if the patient is not high risk of NSTEMI then the person would most likely undergo what procedure?

Answer 4

Stress Test

Question 5

Why is distinction between ACS with and without ST segment elevation so essential?

Answer 5

For reperfusion with fibrinolytics!

Question 6

In what situation (N or STEMI) can fibrinolytic therapy be harmful, unlike in the other situation where reperfusion saves lives?

Answer 6

DO NOT REPERFUSE WITH NONSTEMI INFARCATIONs

Question 7

V1-V4 are supplied by what blood supply?

Answer 7

V1-V2 (septal) V3-4 (anterior)= Left anterior descending artery

Question 8

II, III, and avF make up the inferior wall supplied by?

Answer 8

Right coronary artery

Question 9

I, V5,V6 make up the lateral wall and are suppled by?

Answer 9

Circumflex A

Question 10

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?

Answer 10

PCI first, and if not availble then Thrombolytics

Question 11

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?

Answer 11

Give thrombolytic therapy and then start transfer to primary PCI

Question 12

Thrombolytic therapy is recommended for acute stemi ONLY. absolute contraindications include… previous stroke, head trauma, intracranial neoplasm or suspectic aortic?

Answer 12

dissection

Question 13

What are the three main things to give when someone comes in with acute STEMI?

Answer 13

Aspirin
P2Y12 inhibitors (clopigrel/ticagrelor)
Reperfusion therapy

Question 14

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?

Answer 14

Pacing (pacemaker)

Question 15

What is the most common thing to occur within the first 24 hours of a MI?

Answer 15

Ventricular Arrhythmias (SHOCK EM if hemodynamically unstable— amiodarone if stable)

Question 16

What can occur 3-7 days post MI with a new systolic murmur, pulmonary edema, mitral regurg?

Answer 16

papillary muscle rupture (sometimes a VSD too)

Question 17

What occurs 2-7 days post MI usually associated with immediate death and located on the anterior wall?

Answer 17

Myocardial rupture

Question 18

Cardiogenic shock is when systolic BP <90 with signs of diminished perfusion including cold extremities, decreased urine output and?

Answer 18

confusion

Question 19

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?

Answer 19

need to maintain BP even though increasing HR/blood flow will increase damage

Question 20

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?

Answer 20

Hypovolemic Shock (tx with repletion of fluids)

Question 21

What type of shock includes cardiac tamponade, tension pneumothorax and massive pulmonary embolism, needing the underlying cause to be treated?

Answer 21

Obstructive shock

Question 22

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?

Answer 22

65mmhg

Question 23

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 ?

Answer 23

fluid resuscitation

Question 24

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)?

Answer 24

Cardiogenic shock

Question 25

The following hemodynamic measurements coincide with what type of shock?
CO and CI increased initially but then reduced, LOW SVR, CVP, PCWP

Answer 25

Septic shock

Question 26

What is the main difference in hemodynamic measurements between cardiogenic and septic shock?

Answer 26

Cardiogenic will have elevated SVR, CVP and PCWP while septic shock will have DECREASED SVR CVP and PCWP