ACS: NSTEMI Flashcards
Type of MI
Atherosclerotic plaque rupture, ulceration, fissure, ore erosion with resulting intraluminal thrombus in >/=1 coronary arteries leading to decreased mocardial blood flow &/or distal embolization & subsequent myocardial necrosis
Type I
Type of MI
myocardial necrosis when condition other than coronary plaque instability causes imbalance b/t myocardial oxygen supply & demand (hypotension, HTN, tachy/bradyarrhythmias, anemia, hypoxemia, coronary artery spasm, spontaneous coronary artery dissection (SCAD), coronary embolism, & myocardial dyfxn)
Type 2
Type of MI
death when biomarkers not available & types 4 & 5 MI (r/t PCI & CABG)
Type 3
Differential Dx of ACS in setting of acute CP
Cardiac
Myopericarditis
Cardiomyopathies
Tachyarrhythmias
Acute HF
HTN emergency
Aortic valve stenosis
Takotsubo syndrome
coronary spasm
cardiac trauma
Differential Dx of ACS in setting of acute CP
Pulmonary
PE
Tension PTx
Bronchitis, Pneumonia
Pleuritis
Differential Dx of ACS in setting of acute CP
Vascular
Aortic dissection
Symptomatic aortic aneurysm
Stroke
Probability of Ischemia
Central
Pressure
Squeezing
Gripping
Heaviness
Tightness
Exertional/stress-related
Retrosternal
High
Probability of Ischemia
Left sided
Dull
Aching
Moderately High
Probability of Ischemia
Stabbing
Moderate
Probability of ischemia
Right-sided
Tearing
Ripping
Burning
Mild
Probability of Ischemia
Sharp
Fleeting
Shifting
Pleuritic
Positional
Low
Summary of Recommendations for Early Hospital Care
Administer Supplemental O2 only with what?
SpO2 < 90%
Respiratory distress
Other high-risk features for hypoxemia
Summary of Recommendations for Early Hospital Care
Administer sublingal NTG how often and how many doses for continuing ischemic pain and then assess the need for what?
5min x 3
IV NTG
Summary of Recommendations for Early Hospital Care
Administer IV NTG for?
persistent ischemia
HG
or HTN
Summary of Recommendations for Early Hospital Care
Nitrates are contraindicated with recent use of what?
A phosphodiesterase inhibitor
Summary of Recommendations for Early Hospital Care
IV morphine sulfate may be reasonable for what?
continued ischemic CP despite maximally tolerated anti-ischemic medications
Summary of Recommendations for Early Hospital Care
Initiate oral beta blockers w/n 24 hours in the absence of?
HF
low-output state
risk for cardiogenic shock
other contraindications to BB use
Summary of Recommendations for Early Hospital Care
Use of what is recommended for beta-blocker therapy w/ concomitant NSTE-ACS, Stabilized HF, and reduced systolic fxn?
sustained-release metoprolol succinate
carvedilol
bisoprolol