ACS Flashcards
Type 2 MI is caused by what?
Seen in what conditions?
MI 2/2 ischemia caused by increased oxygen demand or decreased supply
Coronary artery spasm, embolism, severe anemia, arrhythmia, HoTN
What is type 3 MI?
SCD w/new STE or LBBB
What is type 4 MI?
Type 5?
MI associated w/instrumentation like PCI
MI associated w/CABG
When does coronary arterial vessel stenosis cause ischemic symptoms?
What about during exercise?
When CAD exceeds 95% obstruction to flow
60% vessel stenosis
What is the MC angina equivalent symptom presentation?
Dyspnea
Where does reciprocal STD occur in inferior MI?
Anterior MI?
aVL
II, III, aVF
Where should T waves always be upright?
Inverted?
Left-sided leads: I, II, V3-V6
aVR, V1 (usually)
STE in leads I and aVL indicate lesion where?
1st diagonal branch of LAD
What favors RV infarction in an inferior STEMI?
STE in V1 with STE in lead III > II
Inferior STEMI has what reciprocal changes?
STD in I, aVL
Why is it important to diagnose RV infarction with right-sided EKG?
They have larger infants w/higher mortality rates and complications
Name the 5 ACS mechs of pathophysiology
- Endothelial damage through: plaque disruption, irregular luminal lesions/shear injury
- Platelet aggregation
- Thrombus formation —> occlusion
- Coronary artery vasospasm
- Reperfusion injury via ROS, Ca, neutrophils
How can excessive oxygen therapy increase rate of ADVERSE outcomes in ACS?
Increases coronary vasoconstriction and oxidative stress
AVOID trial —> O2 increased myocardial injury, dysrhythmias increased
How do nitrates effect myocardium?
How?
Decrease preload (and some afterload)
Inc venous capacitance and induces venous pooling
Why is IV BB use in the ED discouraged?
What is the benefit?
Inc risk of adverse events including: higher rate of cardiogenic shock, inc rate of development of HF, persistent HoTN and bradycardia
Minimal reduction of re-infarction and VFib
Ticagrelor (Brillinta) MOA and dosing?
Peak serum [ ] reached when?
Major SE?
What clinical trial states “good value for the money” when used with ASA?
P2Y12 receptor inhibitor that does NOT require hepatic activation, 180mg loading dose
2.5 hours
Nonprocedure-related bleeding, inc ICH
PLATO study
What is the standard loading dose of Clopidogrel for STEMI?
300mg but can do 600mg
What is the ACC/AHA class I recommendation regarding clopidogrel/ticagrelor?
What if CABG is preformed w/in 5 days of clopidogrel use?
Withhold for at least 24 hours before urgent on-pump CABG
Inc rate of op and postop hemorrhage, need for transfusion, postop mortality
What is Cangrelor (kenreal)?
IV P2Y12 receptor inhibitor w/IMMEDIATE action and half life of 4-6 minutes
What about prasugrel (Effient) 60mg compared to ticagrelor 180mg?
Adverse SE of prasugrel?
ISAR-REACT5 trial in Germany 2019 showed prasugrel was superior to ticagrelor
Pts > 75 y/o,weighing more than 60kg, previous TIA have higher bleeding risk
LMWH (Enoxaparin) dosing is what?
If GFR < 30?
Bid at 1 mg/kg
QD
Dose of tPA for STEMI?
100mg bolus
What time frame is considered a contraindication to fibrinolytic therapy?
How was this proved?
> 12 hours after symptom onset
LATE trial found 26% decrease in 35 day mortality in pts treated w/tPA from 6-12 hours sx onset with NO decrease in mortality after 12 hours
What BP is an absolute contraindication to tPA for STEMI?
What are 2 additional contraindications?
> 200/120 in the ED
Previous ICH
CPR for > 10 minutes
What does the term ACS include?
Unstable Angina
AMI (NSTEMI and STEMI)
SCD - sudden cardiac death
Type 1 MI is spontaneous MI related to ischemia from what?
Plaque erosion rupture
Thrombus formation that is eroding, fissuring, dissecting
Vasospasm
