ACS Flashcards
Absolute contraindications for nitrate use
Hypotension
Use of sildenafil or PDE5 inhibitors within the previous 24-48 hours
Oral BB target heart rate
50-60 bpm
Antiplatelet in TIMI trial
Prasugrel
increased major bleeding compared to clopidogrel
Antiplatelet in PLATO trial
Ticagrelor
May be used in NSTE and UA patients whose symptoms are not relieved adequately by nitrates or BBs, or unable to tolerate these agents
CCBs
May be given for symptoms not relieved after 3 serial SL NTG tablets
Morphine
Coronary plaques prone to disruption
Rich lipid core and thin fibrous cap
Activated in the coagulation cascade converting prothrombin to thrombin which converts fibrinogen to fibrin
Factor VII
Factor X
MC presenting complaint of patients with STEMI
Pain (deep and visceral)
Painless STEMI is greater
Patients with DM, increases with age
PE manifestations of anterior MI
Usually sympathetic
PE manifestations of inferior MI
Usually Parasympathetic
Temporal stages of STEMI
Acute: first few hours-7days
Healing: 7-28 days
Healed: >29 days
Cardiac troponins remain elevated after STEMI
7-10 days after STEMI
Two serious complications of STEMI
VSD
Mitral Regurgitation
(by Doppler echo)
Prognosis relates to 2 general classes of complications of STEMI
Electrical complications
Mechanical compilations
Cause of most out-of-hospital deaths from STEMI
VFib
Classification of Myocardial Infarction Type I
Spontaneous MI
Classification of Myocardial Infarction Type II
MI 2 to an Ischemic Imbalance
Classification of Myocardial Infarction Type III
MI resulting in death when biomarker values are unavailable
Classification of Myocardial Infarction Type IVa
MI related to PCI
Classification of Myocardial Infarction Type IVb
MI related to stent thrombosis