ACS Flashcards
ACS risk factors
M>45 W>55
FH MI primary M
What might clue in a physician that a panic attack was occuring and not ACS?
other symptoms suck as paresthesias, palpitations, fear of going crazy, derealization, depersonalization
and may be younger group (same with cocaine etiology)
How is MSK pain distinguished from ACS-
pain is sharp or dull and reproducible with chest wall palpation
Typical angina criteria
1- substernal chest pressure/discomfort
2- provoked with exertion/stress
3. relieved with rest/nitros
2/3= atypical and 1/3= non cardiac chest pain
what chest pains are typically not considered ACS>
prinzmetal- occurs at rest
typical angina
what ACS does not respond to nitros
NSTEMI and STEMI
What are the EKG signs of of ACS?
- New LBBB
- T wave inversion
- T wave peaking- early sign
3.ST depressions= ischemia
3ST elevation= injury then some T wave depression
4 q wave= necrotic tissue 24-36 hours later
How long until troponins and CK MB peak?
24 hours
What medical therapy do we begin in the case of ACS
LMWH/Heparin Aspirin clopidogrel B-blocker Nitro Morphine O2 ACEI/ARB Statin
MONA ABC and heparain
If non PCI facility?
absolute contraindications of tPA?
transfer to PCI hospital if door to balloon can be
When does pseudoaneurym occur?
same time as rupture because it is essentially the same thing. 3-14 days
True aneurysm occurs after 2-10 weeks.
Factors of the TIMI score
AMERICA age >65 Markers EKG- ST deviation >.5 Risk factors >3 Ischemia- severe angina CAD Aspirin use in last 7 days
TIMI algorithm
Risk stratify for unstable angina or NSTEMI
>3–> coronary angiography +initial therapy
0-2–> initial therapy and predischarge stress test of abnormal or EF
difference between unstable angina and NSTEMI?
unstable does not have troponins
EKG change hyperkalemia
peaked T–> PR segment increase –> P flattening–> QRS prolongation –>shortened QT
