ACS Rogers Part 1 and 2 Flashcards
which is not considered an acute coronary syndrome? SELECT ALL THAT APPLY
a. silent ischemia
b. unstable angina
c. NSTEMI
d. STEMI
e. SIHD
a. silent ischemia
e. SIHD (stable ischemic heart disease)
what would we see on an ECG for a STEMI?
persistent ST elevation
on an ECG for a STEMI, what causes the “electrical hole” from the P wave to the Q wave?
caused by scar tissue that cannot conduct electricity
what molecule is released from necrotic myocytes (injured heart cells) when the heart is under damage?
troponin
units for high sensitivity troponin
a. ng/mL
b. ng/L
b. ng/L
units for conventional troponin
a. ng/mL
b. ng/L
a. ng/mL
gold standard test for myocardial injury
troponin test
normal value for high sensitivity troponin is < ___ ng/L
< 14 ng/L
normal value for conventional troponin is < ___ ng/mL
< 0.05 ng/mL
true or false: unstable angina would have an elevated troponin level
false
true or false: an NSTEMI would lead to an elevated troponin level
true
main difference between stable and unstable angina
stable angina has chest pain during exertion and lasts a short time, unstable angina has chest pain that occurs at rest or with very little exertion (last longer)
true or false: a STEMI would lead to an elevated troponin level
true
A 68 year old female calls 9-1-1 twenty minutes after sudden onset of severe, substernal, radiating chest pain. Over the past several days she has been experiencing chest discomfort with exertion and dyspnea. Troponin is 3.2ng/mL and ECG shows no ST elevation or Q wave changes. Which of the following is correct?
a. Signs and symptoms are consistent with stable angina
b. Signs and symptoms are consistent with unstable angina
c. Signs and symptoms are consistent with NSTEMI
d. Signs and symptoms are consistent with STEMI
c. Signs and symptoms are consistent with NSTEMI
what is a TIMI risk score?
thrombolyis in myocardial infarction (TIMI) score: the risk of experiencing death, MI, or urgent need for revascularization within 14 days
what is it called when there is change in size, shape, and function of the left ventricle after an ACS?
ventricular remodeling
(this can lead to heart failure; preventing this is an important therapeutic goal)
get an ECG within _____ minutes of arrival at an emergency facility; if the initial ECG is not diagnostic but the pt remains symptomatic, we should perform serial ECGs every _____-_____ minutes for the first hour
10; 15-30
troponin levels should be obtained at presentation and ___-___ hours after symptom onset
3-6
What does MONA stand for? What are the roles of all the components?
morphine -> relieves chest pain
oxygen -> maintains O2 saturation > 90%
NTG -> inc blood flow to heart
aspirin -> thins blood and prevents clots
what is the dose for morphine in MONA?
4-8 mg IV, followed by 2-8 mg IV q5-15 mins
why do we avoid NSAIDs (except aspirin) during hospitalization for UA/NSTEMI/STEMI?
they lead to sodium and water retention = inc risk of MACE
what is the dose for NTG in MONA? (for sublingual and IV)
-sublingual NTG: 0.3-0.4 mg q5 min x 3 for ischemic pain
-IV NTG: start at 10 mcg/min and titrate by 5 mcg/min q5 min (MAX: 200 mcg/min)
can we use transdermal NTG when hospitalized for UA/NSTEMI/STEMI?
no, the onset of action is not rapid enough (15-60 min)
what is the dose range for aspirin in MONA?
162-325 mg chewable aspirin x 1 dose
(we normally just see 325 mg)
can we use enteric coated aspirin in MONA?
yes, it must be chewed in order to be absorbed quickly
if a pt is hospitalized for UA/NSTEMI/STEMI and already took a baby aspirin in the morning, would you still give a loading dose (325 mg)?
yes, give an additional 3 tablets to get 324 mg total for loading dose
3 reperfusion strategies
PCI; CABG; fibrinolytic therapy
a “heart cath” is also known as ?
coronary angiography
for STEMI, reperfusion therapy should be administered to all eligible STEMI pts whose symptoms began in the past _____ hours
12
door-to-needle time for reperfusion therapy for STEMI
within 30 min of hospital arrival
door-to-balloon time for reperfusion therapy for STEMI
within 90 min of hospital arrival
__________ therapy is recommended for STEMI pts at non-PCI-capable hospitals
fibrinolytic
if we are over _____ min away from a PCI-capable hospital, we can start fibrinolytic therapy at a non-PCI-capable hospital
120 min
tenecteplase dosing:
< 60 kg: ___ mg
60-69 kg: ___ mg
70-79 kg: ___ mg
80-89 kg: ___ mg
90+ kg: ___ mg
30 mg
35 mg
40 mg
45 mg
50 mg
reteplase dosing
10 units x 2 doses 30 min apart
A 63 YOM presents to your ED complaining of chest pain that began 1 hour ago. He is found to be having a STEMI. Your hospital is not able to perform a PCI. He does not have any contraindications to fibrinolytics and weighs 50 kg. Which of the following recommendations would you make? SELECT ALL THAT APPLY
a. give a fibrinolytic within 30 min
b. give a fibrinolytic within 90 min
c. transfer the pt to a PCI-capable hospital
d. no intervention at this time, as it is too late to give a fibrinolytic
a. give a fibrinolytic within 30 min
c. transfer the pt to a PCI-capable hospital
(a is best option if the closest PCI-capable hospital is 120 minutes away or more; c is best option if the hospital is less than 120 minutes away)
what drug class is not recommended for NSTEMI/UA?
fibrinolytics
