ACS Flashcards
Give thrombolitics (time)
30 min since coming to the hospital door
Angioplasty time
90 min since coming to the door
Physical finding during ACS
S4 gallop
> 10 mmHg decrease in BP on inhalation
Pulsus paradoxus=> tamponade
Increase in jugular venous pressure on inhalation
Kussmaul sign=> constrictive pericarditis
Triphasic scratchy sound
Pericardial friction rub => pericarditis
Tbc, fibrosis pericarditis
Constrictive
Premature ventricular complexes PVCs
Should NOT be treated, even with acute infarction
Substernal chest pain for last HOUR
1st next step ASPIRIN
Next step after aspirin( 1 hour of chest pain)
Angioplasty ( if can do now)
If should TRANSFER for angioplasty
Give thrombolitics
Not critically dependent upon time Tx
BBs, statins
Time to being abn on EKG
Immediately at pain onset
Duration of EKG abnormality
ST elev progresses to Q waves over days to a week
Myoglobin time to being abn
1-4 hours
Myoglobin / duration of abn
1-2 days
CK-MB / time to being abn
4-6 hours
CK-MB/ duration of abn
1 -2 days
Troponin / T to being abn
4-6 hours
Tropinin / duration of abn
10- 14 days
Reinfarction marker
CK-MB
Renal insufficiency gives FP tests
Troponin ( renally excreted)
After initial management pt should be in ICU
Continuous rhythm monitoring is essential
Monitoring and rapid cardioversion
Improves survival
Most common cause of death 1st several days after MI
Ventr arrhythmia( v tachycardia, v fibrillation)
Reperfusion arrhythmia( accelerated ventr rhythm)
Do not treat( look like slow version of )
