ACS and Heart Failure Flashcards
What is the classic presentation for ACS?
Typical CP, epigastric feeling of fullness and gas, dyspnea, N/V, diaphoresis, fatigue, AMS
What are the 3 classic components of angina?
Substernal CP or discomfort, provoked by exertion or emotional stress, relieved by rest and/or nitroglycerin
What is typical angina?
has all 3 components of the diamond forrester criteria of CP
What is atypical angina?
has 2 of the 3 components of the diamond forrester criteria of CP
What is non-angina CP?
has <1 of the components of the diamond forrester criteria of CP
What is unstable angina?
new onset angina, angina with exertion, angina at rest, or angina accelerating in frequency or severity; may or may not have ST depression and/or T wave inversions with normal cardiac enzymes
What is NSTEMI?
Defined by ST segment depression and/or T wave inversions with abnormal cardiac enzymes
What are the auscultatory cardiac findings of ACS?
Paradoxical splitting of S2 (LBBB), new mitral regurgitation murmur (holosystolic), papillary dysfunction/rupture, pericardial friction rub, distant S1 and S2, diminished pulses, delayed cap refill
What is the classic presentation for HF?
DOE, fatigue, edema, orthopnea, JVD, rales, paroxysmal nocturnal dyspnea, dyspnea at rest, RUQ discomfort due to hepatic congestion (RHF)
What PE findings significantly increase the likelihood of HF?
JVD, S3 heart sound and displaced apical impulse
What will HFrEF show on an echo?
reduced LVEF, atrial and ventricular chamber dilation or hypertrophy, valvular dysfunction, pericardial pathology and elevated ventricular filling pressures
What does TEE rule out?
intracardiac thrombi or infectious source of HF
What does a stress echo/nuclear stress testing/cardiac CT rule out?
Ischemia as a precipitating cause for HF
What does an cardiac MRI determine the etiology of?
cardiomyopathy by IDing the presence of inflammation, fibrosis, and infiltrative pathology
Cardiopulmonary exercise testing is an important component in the determination of what?
candidacy for mechanical circulatory support and cardiac transplantation
What is the management for ACS?
Aspirin, relief of ischemic pain, assessment of hemodynamic state, initiation of repercussion therapy with percutaneous coronary intervention or fibrinolysis, anti-thrombotic therapy to prevent rethrombosis, beta blocker to prevent recurrent ischemia and ventricular arrhythmias, ACEi, statin, dual anti platelet therapy
How is ACS diagnosed?
ECG, cardiac biomarkers, invasive coronary angiography
What is the treatment for a STEMI?
Initiate medical therapy with aspirin, beta blocker, nitrates, heparin and then either perform PCI or transfer to PCI capable facility (after performing thrombolytic theory)
What does a TIMI score predict?
risk of 14 day death, recurrent MI or urgent revasculariziton
What are the MCC of acute HF exacerbations?
myocardial ischemia or infarct and noncompliance
What can be useful as a diagnostic marker for HF?
BNP
What does tx for HF include?
oxygenation, correction of the underlying cause, relief of sx by preload and after load reduction, and possibly inotropic support
What are the goals of HF tx?
improve sx, duration of life and prevention of hospitalization
What is the tx for acute decompensated HF?
Monitor oxygen saturation, vital signs and cardiac rhythm; non-invasive ventilation unless respiratory failure; initiate diuretic therapy to relieve congestion/fluid overload; nitroprusside for after load reduction and IV dobutamine or milrinone for HRrEF
What is the management for HFrEF?
Tx of underlying cause of HF, pharmacological therapy, conduction abnormalities (cardiac resynchronization therapy), monitor renal function and electrolytes
What is the management for HFpEF?
Diuretics are the mainstay in the absence of HTN, ID and tx comorbidities
What is the tx for cor pulmonale?
Maintain oxygen delivery to tissues, optimize volume status (diuretics, fluids and Na restriction), arrhythmia management, inotropes for low CO, activity restriction while symptomatic, palliative care
What pt education should be provided to HF pts?
take meds as prescribed, follow action plan of sx, call doctor if you gain weight suddenly, cut down on salt, lose weight if you are overweight, stop smoking, avoid alcohol, be active
