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ACS Flashcards

1
Q

ACS triggers

A

physical activity, emotional stress, SNS activation

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2
Q

endogenous anti thromotics

A

antithrombin III (enhanced w/ heparin), protein C and S (degrade Va and VIIIa), tissue factor inhib, tPA, prostacyclin (ups platelet cAMP and inhibits activation), NO

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3
Q

how much ischemia can cause infarct

A

20-30 min

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4
Q

how long to dissolve thrombus

A

12-24 hours

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5
Q

transmural infarct vs subendocardial

A

spans entire thickness of myocardium vs only innermost layers (more susceptible to ischemia)

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6
Q

factors determining amount of tissue death

A

mass perfused, magnitude/duration of ischemia, oxygen demand, collateral coronary flow, amount of reperfusion, inflammatory response

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7
Q

LAD occlusion

A

anterior LV, anterior 2/3 septum, apical LV

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8
Q

LCx occlusion

A

lateral LV, poserolateral LV

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9
Q

RCA occlusion

A

posterior LV, posterior 1/3 septum, posterior pap muscle, inferior

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10
Q

when does irreversible injury occur

A

in 20 mins

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11
Q

describe early changes during MI

A

shift to anaerobic, lactic acid accumulates, ATP drops, high Na causes cellular edema, abnormal electrolytes causes risk for arrhythmia (VT and V fib)

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12
Q

when does dark mottling of myocardium begin

A

4-12 hours

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13
Q

tan necrotic center forms?

A

1-3 days

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14
Q

when is injury maximally yellow tan, depressed red tan borders

A

3-14 days

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15
Q

when gray white scar forming

A

2-8 weeks

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16
Q

mature scar from MI?

A

more than 2 months

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17
Q

micro of MI less than 4 hours

A

no change, some wavy fibers

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18
Q

micro MI 4-12 hrs

A

early coag necrosis, edema, wavy fibers

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19
Q

micro MI 12-24 hrs

A

coag necrosis, pyknosis, contraction bands, early PMNs

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20
Q

micro MI 1-3 days

A

extensive coag necrosis, loss of nuclei, interstitial PMNs

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21
Q

micro MI 3-14 days

A

dying PMNs, disintegrating dead myocytes, macros and granulation tissue at border

22
Q

micro MI 2-8 weeks

A

loss of cells, more collagen

23
Q

micro MI over 2 months

A

dense collagenous scar

24
Q

contrast hypokinesis, akinesis, dyskinesis

A

in order: reduced contraction, no contraction, local region bulging outward

25
Q

diastolic dysfn from MI

A

impaired relaxation, less compliance and elevated filling pressue

26
Q

stunned myocardium

A

prolonged but reversible contractile dysfn

27
Q

ischemic preconditioning

A

brief ischemia renders tissue more resistant to future ischemia

28
Q

functional changes w/ MI

A

ventricular remodeling of infarcted and non-infarcted myocardium

29
Q

Sx of MI

A

angina; nausea vomiting weakness (PSNS, vagal); diaphoresis, cool skin (SNS), fever (inflammatory), SOB

30
Q

look for ___ in physical exam

A

breathing airway, circulation, systemic hypoperfusion, HF (S4, rales, IJV)

31
Q

importance of dynamic T wave inversions

A

w/ T wave inversions that resolve after nitro tx, more likely ischemia

32
Q

MI defined as rise in troponin and…

A

at least one: sx of acute ischemia, new ECG finding, imaging findings, ID of thrombus w/ angiography

33
Q

CK-MB and dx of MI

A

CK-MB more than normal and more than 2.5% of total CK

34
Q

meaning of initial negative biomarkers

A

doesnt rule out MI, can take time for elevation

w/ angina and ST elevations, dont wait for biomarkers to tx

35
Q

some other causes of Tn elevation

A

acute HF, PE, shock, dissection, myocarditis, trauma, ICD discharge

36
Q

MI dx w/ ECG

A

more than 1mm ST elevation in 2 contiguous leads or 2 mm in contiguous precordial leads or new LBBB (treated like STEMI, hard to tell apart)

37
Q

ST in II, III, aVF

A

inferior, RCA (some LCx if left dominant)

38
Q

ST in V2-V4

A

anterior, LAD

39
Q

ST in V1-V4

A

anteroseptal, LAD

40
Q

ST in I, aVL, V5V6

A

lateral, LCx

41
Q

LBBB

A

anterior, LAD

42
Q

ST in V4R

43
Q

ST depressions in V1 and V2

A

posterior, RCA (LCx if left dominant)

44
Q

electrically silent MI

45
Q

pathologic Q waves

A

more than 1 mm wide, 25% amplitude of QRS, 2 or more contiguous lead

46
Q

variant angina/prinzmetal

A

coronary artery spasm, transient ST elevations

47
Q

risk factor and dx/ tx for variant angina

A

risk w/ smoking, dx w/ cardiac cath, tx w/ nitrates, CCBs

48
Q

UA vs NSTEMI

A

UA has negative Tn, no infarction

49
Q

ECG of UA/NSTEMI

A

ST depression or T wave inversion, no pathologic Qs chronically

50
Q

TIMI criteria

A

over 65, known CAD, 3 or more CAD risk factors, ASA use w/i 7days, 2 or more angina episodes w/i 24 hours, ST changes above .5 mm, elevated Tn or CK-MB

51
Q

other ACS causes

A

Supply: hypotension from shock, anemia, dissection/embolus

demand: rapid tachy, acute HTN, severe aortic stenosis

Cardio (34 decks)

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