4 ACS Flashcards
Spectrum of Conditions
1) ___ of atherosclerotic plaque
2) ___ adherence, activation, aggregation = activation of ___ cascade
3) ___ formation
4) ischemia
1) rupture
2) platelet, clotting
3) clot
Classification
1) Spontaneous MI - atherosclerotic plaque ___
2) MI secondary to ischemic imbalance - oxygen supply or demand ___ to heart. (Examples: vasospasm, anemia, hypotension)
rupture
mismatch
Classic Signs and Symptoms
___ chest pain
- may radiate to shoulder, down the left arm, to the back or jaw
- most often at ___
N/V
diaphoresis ( ___ )
SOB
dizziness
retrosternal, rest, sweating
atypical symptoms
more likely to occur in the elderly, females, diabetics, renally impared, dementia patients
Examples:
- ___ pain
- indigestion
- ___ or pleuritic pain
- increasing ___ in the absence of chest pain
- epigastric
- stabbing
- dyspnea
Diagnosing ACS
1) All patients with acute chest pain should have an ___ within ___ min of arrival at an emergency facility
ECG, 10
ECG - STEMI
- persistent ST ___
- ___ wave changes; not present on initial ECG but develops over hours to days
- electrical “hole” - ___ ___ cannot conduct electricity
elevation
Q
scar tissue
ECG - NSTEMI and UA
- may have normal ECG
- ST ___ , transient ST ___ , or new ___ wave inversion are possible
- ___ wave changes unlikely
- no ST ___
- depression, elevation, T
- Q
- elevation
Diagnosing ACS
2) all patients presenting to the ED with acute chest pain and suspected ACS should have ___ measured ASAP
troponin
Myocardial Injury Biomarkers
released from ___ myocytes into bloodstream
___ is the gold standard
high sensitivity is ___
- measured in ___
- < ___
- greater sensitivity and negative predicitive values
- ___ time from onset of chest pain to a detectable concentration
conventional
- measured in ___
- < ___
need to check trend: ___ levels over 12 hours
necrotic
troponin
preferred
ng/L
14
shorter
ng/mL
0.05
3
T or F: troponin is only elevated by myocardial necrosis
FALSE
Myocardial Injury Biomarkers
___ ( CK MB)
- no longer used (no benefit)
- less ___ than troponin, more tissue injury is required for its detection
creatinine kinase myocardial band
- sensitive
stable angina vs unstable angina
Stable
- chest pain happens with ___ and stops with rest
- predictable
- lasts a ___ time
Unstable
- chest pain can occur during ___
- unpredictable
- may be > ___ min
exertion
short
rest
30
Unstable Angina vs NSTEMI
- closely related conditions; depends on the degree of ___
UA
- less ischemia
- does not lead to detectable quantities of ___
NSTEMI
- troponin is ____
ischemia
- toponin
- elevated
NSTEMI vs STEMI
NSTEMI
- chest pain
- troponin is elevated
- no ___ elevation on ECG (may have depression or ___ wave inversion)
STEMI
- chest pain
- troponin is elevated
- persistent ___ elevation on ECG
- ST, T
- ST
Practice Question
3
TIMI - Thrombolysis in Myocardial Infarction Risk Score
risk of ___ , ___ , or urgent need for ___ within 14 days
death, MI, revascularization
