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Gen Med: Emergency Med > ACS > Flashcards

ACS Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Define acute coronary syndrome

A
  1. Any constellation of symptoms that are compatible with acute myocardial ischemia
  2. Spectrum that includes unstable angina, NSTEMI, and STEMI
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2
Q

How does the body respond to damage to the endothelium?

A
  1. Platelets
  2. Vasoconstriction
  3. Cascade
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3
Q

How is ACS diagnosed?

A
  1. History
  2. Clinical presentation
  3. 12 lead EKG
  4. Cardiac injury panel
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4
Q

What does an inverted T wave correlate to?

A

Ischemia

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5
Q

Where can you look for the baseline of an EKG?

A

T-P segment

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6
Q

What EKG findings indicate ischemia?

A

T wave inversion, transient ST elevation or depression

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7
Q

How many Unstable angina pts continue on to nstemi/stemi?

A

The diagnosis of Unstable angina confers a 10-20% risk of MI in the untreated pt

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8
Q

What is included in the TIMI score?

A
  1. Age > 65
  2. Three CAD risk factors
    A. Smoking, wt, hyperlipidemia
  3. ST segment deviation
  4. ASA use in past 7 days
  5. Positive cardiac enzymes
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9
Q

Who are high risk pts?

A
  1. resting angina
  2. Resting angina
  3. Asst. ekg changes
  4. Continued sxs despite initiation of medical therapy
  5. TIMI score of >6
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10
Q

How is ACS treated?

A
  1. ASA
  2. Clopidogrel (plavix): ADP inhibitor
  3. Heparin
  4. Beta blocker, calcium channel blockers: Blood pressure control
  5. Nitro/morphine: pain control
  6. Oxygen
  7. GP IIb/IIIa antagonists: abciximab
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11
Q

What is the dominant coronary artery?

A

Right coronary artery bc it supplies the SA Node

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12
Q

What are the goals of therapy?

A
  1. Prevention of a thrombus
  2. Restoration of coronary flow
  3. reduction of myocardial oxygen demand
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13
Q

What are the indications for CABG?

A
  1. significant left main diz

2. three vessel dz and abnormal LV function (EF

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14
Q

How can ACS be prevented?

A 
1. Risk factor modification
A. Smoking cessation
B. HTN control
C. Hyperlipidemia control
D. Wt reduction
E. DM control
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15
Q

How should hypovolemia be treated in the context of MI?

A

FLUIDS - NOT Pressors!!!

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16
Q

What is the pathophys of ACS?

A
  1. Thrombus formation is the underlying mechanism.
  2. UA/NSTEMI most often represent acute atherosclerotic plaque rupture with exposure of thrombogenic subendothelial matrix. But may also be due to progressive mechanical obstruction from underlying atherosclerotic disease.
  3. Causes other than plaque rupture may be due to Vasospasm (Prinzmetal Angina) and Cardiac inflammation or infection.
17
Q

What ekg changes may be seen with classic angina (noninfarction subendocardial ischemia)?

A

Transient ST depressoins

18
Q

What ekg changes may be seen with noninfarction transmural ischemia?

A
  1. Transient ST elevations

2. Paradoxical T wave normalization, sometimes followed by T wave inversions

19
Q

What ekg changes may be seen with NSTEMI?

A
  1. ST depression
  2. T wave inversion
  3. No q waves
20
Q

What ekg changes may be seen with STEMI?

A
  1. New q waves preceded by hyperacute T waves/ST wave elevations and followed by T wave inversions
21
Q

What is the timeline for troponin elevations?

A
  1. Troponin T or I levels increase 3-12 hours after the onset of MI
  2. peak at 24-48 hours
  3. return to baseline over 5-14 days
22
Q

What is the timeline for myoglobin?

A
  1. Myoglobin is not a cardiac marker but is released more rapidly from Infarcted Myocardium than CK-MB or Troponins.
  2. It may be detected as early as 2 hours after the onset of MI.
  3. Limited use because of brief duration of its elevation (
23
Q

Who are low risk ACS pts?

A
  1. Observation in Chest pain observation unit.
  2. If remains pain free, No ECG changes, Negative cardiac markers at 6-12 hours, a stress test can be performed.
  3. If stress test is negative manage as outpatient
24
Q

What is the management for intermediate risk pts?

A
  1. Should be admitted to hospital. If symptoms free admit to Telemetry.
  2. If remain symptomatic, should be admitted to ICU.
25
Q

What is early conservative therapy for ACS? Who is it for?

A
  1. Medical Therapy at Maximally Tolerated Doses.
  2. The Coronary Angiography is reserved for patients with recurrent Ischemia despite Medical Therapy, Strongly Positive Stress Test.
  3. Is for low risk patients and selective Intermediate risk patients
26
Q

Who is the early invasive therapy for?

A
  1. High Risk Patients.
  2. Recurrent Ischemia despite on Medical Therapy.
  3. Evidence of Congestive Heart Failure.
  4. LV Dysfunction.
  5. Sustained Ventricular Tachyarrhythmia’s.
  6. Prior Coronary Revascularization (PCI within 6 months or CABG).
27
Q

What is anti-pltlt therapy?

A
  1. Aspirin. All patients should receive Aspirin unless contraindicated.
  2. Clopidogrel.
  3. Glycoprotein (GP) IIb/IIIa Antagonists
28
Q

What is anti coagulant therapy?

A
  1. Treatment with Heparin has shown to reduce the death or MI by 60 %.
  2. Enoxaprin or Intravenous UFH.
29
Q

What is anti-ischemic therapy?

A
  1. Nitroglycerin.
  2. B-Adrenergic Blockers.
  3. Calcium Channel Antagonists.
  4. ACE Inhibitors.
  5. Thrombolytic Therapy (Not Indicated for UA or NSTEMI).

Gen Med: Emergency Med (13 decks)

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