7: ACS, Angina Flashcards
modifiable RFs for CAD
- HTN
- HLD
- DM
- obesity
- cigarettes
- physical inactivity / unhealthy diet
- stress
non-modifiable RFs for CAD
- male
- older than 45
- FHx premature CAD
- African american, hispanic, southeast asian
four non-traditional RFs for CAD
- CKD
- proteinuria
- metabolic syndrome
- inflammatory states
what % of MI’s are painless or atypical symptoms
20%
populations more likely to have atypical or silent MI
women, elderly, diabetics
how do vasodilators vs inotropes/cronotropes work in a cardiac stress test?
vasodilators: coronary A’s are already max dilated at rest, so they receive less flow when whole body is dilated
inotropes: increases myocardial O2 demand
explain stress MPI
- administer IV radioisotope
2. use a special camera system to detect gamma photons
what to observe for during a dobutamine stress ECHO
regional wall abnormalities: hypokinesis, akinesis, or dyskinesis
what % is considered significant stenosis?
70%
if a patient has a past/known ___ on ECG, you cannot diagnose a STEMI
LBBB
there are multiple types of acute MI, but what are Type I and II?
Type I: infarct due to coronary atherothrombosis
Type II: infarct due to supply-demand mismatch
three CABG indications
- 3 vessel disease >70% stenosis
- left main disease
- LV dysfunction
three drugs that improve mortality in MI
- ASA
- B Bs
- ACEi’s
when to use thrombolytics like tPA?
STEMI only
MOA for aspirin, P2Y12 inhibitors, and GPIIb/IIIA inhibitors
- ASA: blocks COX1 and 2
- P2Y12 inhibs: blocks platelet recruitment/activation
- GPIIb/IIIA inhibs: block platelet aggregation
how does tPA work?
activates plasminogen -> plasmin -> breaks up clots
STEMI diagnosed at a PCI capable vs incapable hospital
- PCI capable: administer drugs -> PCI in <90mins
2. not PCI capable: thrombolytics in <30mins -> transfer to PCI hospital in <120mins
what does a TIMI score predict?
risk of 14 day death, recurrent MI, or urgent revascularization
what artery is blocked in MI’s: inferior, septal, anterior, posterior, lateral
- inferior: RCA
- septal: LAD
- anterior: LAD
- Lateral: LCx
- posterior: PDA
what leads show MI in: inferior, septal, anterior, posterior, lateral
- inferior: 2, 3, aVF
- septal: V1-V2
- anterior: V2-V4
- posterior: V1-V3
- lateral: V5-V6 OR I, aVL
why is ECG a little different for a posterior MI?
tall R waves and ST depression bc theres no leads directly for the posterior heart
DDx of acute MI
- aortic dissection
- PE
- pericarditis, pleuritis
- PNA, pneumothorax
- GERD, PUD, esophageal spasms/rupture
- costochondritis
