ACS/AMI I Flashcards
why do trops rise in NSTEMI?
distal embolization
exact definition of typical angina
- SSCP/discomfort
- worse w/ exertion or stress
- relieved by NTG or rest
exact definition of atypical angina
chest pain with 2/3 characteristics of typical angina
SSCP/discomfort, worse w/ exertion or stress, relieved by NTG or rest
name 4 anginal equivalents
dyspnea
Nausea
fatigue
faintness
Classification system for MI
1- plaque rupture 2- supply/demand (spasm, HTN, arrhythmia, embolus) 3- SCA (no objective evidence) 4a- s/p PCI 4b- IST 5- s/p CABG
are elderly (>75) more likely to have STEMI or NSTEMI?
NSTEMI
who has higher risk of In-Hospital mortality (elderly or young)
elderly
When choosing meds for elderly s/p ACS, what to watch out for?
calculate creatinine clearance
bleeding
what are the two inflection point (in years) for closing of a SVG vs artery?
5 and 10 years
which pt pop is at high risk for coronary artery dissection?
pregnant
what are the two local vasoconstrictors released from activated platelets?
serotonin
thromboxane A2
who gets oxygen is NSTEMI/UA?
when O2 sat<90%
what med to discontinue in NSTEMI/UA?
NSAIDs
TIMI risk score components
- > 65yo
- > 3 CAD risk factors
- prior obs CAD 50%
- ASA in last 7d
- > 2 anginal events in 1d
- ST deviation
- high trop/CK
TIMI score of what is low risk?
<3
GRACE score components
age resting HR SBP Cr CHF (Killip) cardiac arrest at admission ST deviation trop/CK
what does GRACE score predict?
probability of in-hospital and 6 month mortality and MI
in TIMI score, what are the markers of highest risk (regardless of other factors)? which is worse?
ST deviation
biomarkers- WORSE
3 factos contributing to myocardial oxygen demand
HR
Contractility
Wall tension (SBP, Vol)
Definition fo non-cardiac chest pain
Meets 1 or none of the angina criteria (SSCP/discomfort, worse w/ exertion or stress, relieved by NTG or rest)
definition of New onset angina
< 2 mo’s, atleast CCS Class III (marked limitation with nl activity like 1-2 blocks or Flight of stairs).
3 A’s of platelet activity
Adhesion, Activation, Aggregation
in a patient with suspected unstable angina, what serial test is important to do in ER?
EKG
how long after a pt has taken sildenafil or tadalafil do you wait until giving nitrates?
> 24h
when is it recommended to give clopidogrel in UA/NSTEMI?
when pt is intolerant of ASA
for pt’s with mild-mod CRI or DM and NSTEMI/UA, os conservative or early invasive strategy preferred?
invasive
which trial showed “an early invasive strategy (36h) in NSTEMI, and may be beneficial in high risk patients?”
TIMACS
