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PHRM 845 > ACS pt1 > Flashcards

ACS pt1 Flashcards

1
Q

What is ACS?

A

An imbalance between myocardial O2 supply and demand

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2
Q

What makes ACS problems worse?

A

If the clot(s) occur higher up the arteries of the heart

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3
Q

What differentiates ACS?

A

The plaque’s fibrous cap ruptures, causing a blood clot

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4
Q

What is type 1 ACS?

A

Spontaneous MI: atherosclerotic plaque rupture

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5
Q

What is type 2 ACS?

A
  • MI secondary to ischemic imbalance: O2 supply or demand mismatch to heart (ex. vasospasm, anemia, hypotension)
  • Rupture hasn’t necessarily happened
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6
Q

What is common epidemiology of ACS?

A
  • Median age is 68 yo
  • Males are more likely at a 3:2 ratio
  • For some, ACS (like heart attack) is first presentation of CAD
  • Approx 70% of pts who experience ACS has a NSTEMI
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7
Q

What are the region and radiation of ACS?

A
  • Retrosternal chest pain
  • May radiate to shoulder, down left arm, to back, or jaw
  • Most often at REST
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8
Q

What are the s/sx of ACS?

A
  • Nausea, vomiting
  • Diaphoresis
  • SOB
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9
Q

What patient population are atypical ACS sx more likely in?

A
  • Elderly
  • Females
  • Diabetics
  • Pts w impaired renal function
  • Dementia
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10
Q

What are these atypical (noncardiac) sx?

A
  • Epigastric pain
  • Indigestion
  • Stabbing or pleuritic pain
  • Increasing dyspnea in the absence of chest pain
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11
Q

What are high risk features of pts with chest pain?

A
  • Continuing chest pain
  • Severe dyspnea
  • Syncope/presyncope
  • Palpitations
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12
Q

What should be done w pts with chest pain and high risk features?

A

Transported by emergency medical services

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13
Q

What is the first thing done to all possible ACS pts who arrive at an emergency facility?

A

All pts w acute chest pain should have an ECG within 10 min of arrival

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14
Q

What does a normal P wave indicate?

A

The atriums contracting

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15
Q

What does a normal QRS wave indicate?

A

The ventricles contracting

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16
Q

What does a normal T wave indicate?

A

The ventricles relaxing

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17
Q

What is a common ECG finding with a STEMI?

A

ST elevation

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18
Q

What is a possible ECG finding with a STEMI other than a ST elevation?

A

Q wave change:
- Often not present in initial, develops over hours to days
- Electrical ‘hole’: scar tissue cannot conduct electricity
- May disappear after reperfusion once scarred tissue recovers
- Often remain permanently

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19
Q

What are possible ECG findings with a NSTEMI/UA?

A
  • Normal ECG
  • ST depression, transient ST elevation, or new T wave inversion are possible
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20
Q

What does not occur or unlikely to in a NSTEMI/UA ECG?

A
  • Q wave changes unlikely
  • No ST elevation
21
Q

When should troponin be measured?

A
  • Measured asap after presentation of acute chest pain and ACS once arrival to ED
22
Q

What releases troponin?

A

Necrotic myocytes (injured heart cells) into bloodstream

23
Q

What is the gold standard to determine myocardial injury?

A

Troponin

24
Q

Which troponin is PREFERRED?

A

High sensitivity troponin

25
Q

List the advantages of high sens troponin.

A
  • Greater sensitivity and negative predictive values
  • Shorter time from onset of chest pain to detectable conc
26
Q

What is the measurement unit of high sens troponin?

A

ng/L

27
Q

What is the other troponin that is not used as frequently?

A

Conventional troponin

28
Q

What is the measurement unit of conventional troponin?

A

ng/mL

29
Q

What is sensitivity?

A

Likelihood of detecting a disease when it exists (true positive rate)

30
Q

What is specificity?

A

Likelihood of not detecting a disease when it does not exist (true negative rate)

31
Q

What are normal values of troponin?

A
  • High sens: <14 ng/L
  • Conventional: <0.05 ng/mL
32
Q

How often should troponin tests be done?

A

3 levels over 12 hours

33
Q

Why must multiple troponin tests be done?

A

Initial may be negative

34
Q

What is another biomarker to check for myocardial injury?

A

Creatinine kinase myocardial band (CK MB)

35
Q

Why is CK MB test not done anymore?

A
  • Less sensitive than troponin
  • Substantially more tissue injury is required for its detection
36
Q

What are the characteristics of stable angina?

A
  • Chest pain occurs with exertion
  • Predictable
  • Relieved by rest
  • Lasts a short time (<5 min)
37
Q

What are the characteristics of unstable angina?

A
  • Chest pain may occur at rest, while sleeping, or w little physical exertion
  • More severe and lasts longer (may be >30 min)
38
Q

What are differences between UA and NSTEMI?

A

UA:
- Less ischemia
- Does not lead to detectable quantities of troponin
NSTEMI:
- Troponin is elevated

39
Q

What is a thrombolysis in myocardial infarcation (TIMI) risk score?

A

It is the risk of experiencing either death, MI, or urgent need for revascularization within 14 days

40
Q

What is a low risk TIMI score?

A

0-2 points

41
Q

What is a medium risk TIMI score?

A

3-4 points

42
Q

What is a high risk TIMI score?

A

5-7 points

43
Q

What % of pts have a low risk TIMI score?

A

5-8%

44
Q

What % of pts have a medium risk TIMI score?

A

13-20%

45
Q

What % of pts have a high risk TIMI score?

A

26-41%

46
Q

What is ventricular remodeling?

A

Changes in size, shape, and function of left ventricle after an ACS

47
Q

What factors are involved in ventricular remodeling?

A
  • Activation of renin-angiotensin-aldosterone system
  • Hemodynamic factors (increased preload and afterload)
48
Q

What does ventricular remodeling lead to?

A

Leads to heart failure:
- Increased morbidity and mortality

49
Q

What does MACE usually include?

A

Stroke, MI, CV death

PHRM 845 (48 decks)

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