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ACS2 Flashcards

1
Q

Angioplasty superior ti thrombolytics bs

A
  • Better survival and mortality
  • Less bleeding
  • complications of MI decreased
  • Less arrhythmia,less CHF, fewer ruptures of septum, free wall( tamponade)and papillary muscles(valve rupture)
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2
Q

90min of arriving in ED with chest pain

A

PCI

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3
Q

“Door to balloon time”

A

Under 90 minutes

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4
Q

Complications of PCI

A
  • Rupture of coronary artery
  • Restenosis
  • Hematoma at entry site into artery
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5
Q

Most important in decreasing the risk of restenosis of CA after PCI?

A

Placement of drug-eluting stent( paclitaxel, sirolimus)

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6
Q

PCI=

A

Angioplasty

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7
Q

For DVT and PE ( VENOUS thrombosis) not Arteries

A

Warfarin

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8
Q

Restenosis within 6 months of PCI without stent

A

30-40%

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9
Q

Restenosis within 6 months of PCI with bare metal stent

A

15-30 %

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10
Q

Restenosis within 6 months of PCI with drug-eluting stent

A

10%

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11
Q

If contraidications to thrombolitics

A

Transfer to facility performing PCI

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12
Q

Abs. Contraindications to Thrombolitics

A
  • Major bleeding( bowel= melena, brain)
  • Recent surgery (within last 2 weeks)
  • Severe HTN> 180/110
  • Nonhemorrhagic stroke within last 6 months
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13
Q

NOT an absolute contraindication to the use of thrombolitics

A

Heme-positive brown stool

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14
Q

Best initial therapy, everyone

A

Aspirin

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15
Q

All MI undergoing angioplasty and stenting

A

Clopidigrel

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16
Q

Everyone, effect not dependent on time during admission

A

Beta blockers

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17
Q

Everyone, benefit best with ejection fraction< 40 %

A

ACEi/ARBs

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18
Q

Everyone, best with LDL > 100 mg/dl

A

Statins

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19
Q

No clear mortality benefit

A

Oxygen, nitrates

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20
Q

After thrombolitics/ PCI to prevent restenosis, initial Tx with NSTEMI and unstable angina

A

Heparin

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21
Q

If can’t use BB, cocaine-induced pain, Prinzmetal angina

A

Calcium-channel blockers

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22
Q

In the process if forming clot in CAD= ST depression= unstable angina, after aspirin

A

Low molecular-weight heparin

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23
Q

Abciximab, Tirofiban,Eptifibitide

A

Glycoprotein IIb/IIIa inhibitors

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24
Q
  • for pt who undergo angioplasty and stenting

* not beneficial in acute ST elevation infarctions

A

Glycoprotein IIb/IIIa inhibitors

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25
Q

New LBBB or ST elevation within 12 hours

A

Thrombolitics

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26
Q

Glpr IIb/ IIIa inhibitors

A

Inhibits platelet aggregation

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27
Q

Reduction in mortality with ST depression, particularly in pts whose troponin or CK-MB rise and then develop MI requiring PCI with stenting

A

Glycoprotein IIb/IIIa inhibitors

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28
Q

? Do you need Aspirin for
• Stable angina
• UA/ NSTEMI
• STEMI

A
  • +
  • +
  • +
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29
Q

?Do you need BB for
• stable angina
• UA/NSTEMI
• STEMI

A

+++

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30
Q

? Do you need nitrates for
• stable angina
• UA/NSTEMI
• Nitrates

A

+++

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31
Q

?Do you need Heparin for:
• Stable angina
• UA/NSTEMI
• STEMI

A
  • No
  • YES
  • Yes, only after thrombolytics
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32
Q

Do you need GP IIb/IIIa meds for
• Stable angina
• UA/NSTEMI
• STEMI

A
  • no
  • yes
  • no
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33
Q

? Do you use thrombolytics for:
• Stable angina
• UA/ NSTEMI
• STEMI

A
  • No
  • No
  • yes, but not as good as PCI
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34
Q

Do you use CCBs, Warfarin for
• SA
• UA/NSTEMI
•STEMI

A

No no no( no mortality benefit)

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35
Q

tPA ( thrombolytics) are beneficial only for

36
Q

Heparin is best for

37
Q

LMW heparin superior to

A

Unfractionated heparin for mortality benefit

38
Q

Unfract. Hep

A

Short half life ( last shorter period of time)

39
Q

In non-ST elevation ACS, when all meds have been given and pt is NOT better

A

Urgent angiography and possibly angioplasty( PCI) should be done

40
Q

” Not better” for NSTE ACS means

A
  • persistent pain
  • S3 gallop or CHF developing
  • worse EKG changes
  • rising troponin levels
41
Q

Tx for STEMI, Non-STEMI/UA

A

Aspirin/ Clopidogrel
BB, ACE
Statins, nitrates
Morphine

42
Q

STEMI tx

A
  • PCI ( if available< 90 min after pr arrives)

* Thrombolitics( if PCI not available. Use within 12 hours from start of chest pain)

43
Q

If PCI failed, ischemia refractory to ALL Tx

A

Perform Emergency CABG

44
Q

Why sinus bradycardia happen with MI( very common)

A

From ischemia of sinoatrial node ( SA)

45
Q

Why cannon “a” waves( 3rd degree= complete AV block) happen

A

From atrial systole against closed tricuspid valve

46
Q

Distinguishes 3rd degree block from sinus bradycardia before EKG

A

Cannon “a” waves

47
Q

Why tricuspid valve closed in 3rd degree block

A

Bs atria and ventricles contracting separately( out of coordination)

48
Q

Jugulovenous wave bouncing up into the neck

A

” Cannon”

49
Q

What to look for, if pt has cannon wave

A

RV infarction, 3rd degree block

50
Q

1st tx for bradycardias

51
Q

If atropine is not effective for bradycardia

A

Place pacemaker

52
Q

For all 3rd degree block tx

53
Q

RV infarction look for:

A

New inferior wall MI& clear lungs on auscultation

54
Q

Flip EKG leads from left side to right side of chest, Most specific finding:

A

ST elevation in right lead 4( RV4)

55
Q

Right coronary supplies:

A
  • RV
  • AV node
  • inferior wall of the heart
56
Q

RV infarction Tx

A

High-volume fluid

57
Q

Avoid in RV Tx

A

Nitroglycerin( markedly worsens filling)

58
Q

New inferior wall MI & clear lungs on auscultation

A

RVInfarction

59
Q

Tamponade due to free wall rupture

A

Several days after MI

60
Q
  • Sudden loss of pulse
  • Lungs clear
  • Pulseless electrical activity. Dx
61
Q

Tamponade test

62
Q

Tamponade Tx

A

Pericardiocentesis on way into operating room for repair

63
Q

Most common cause of death MI

A

Ventr tachycardia/fibrillation( no wsy to distinguish without EKG)

64
Q

Ventr tachycardia/fibrillation Tx

A

Cardiovert/defibrillate

65
Q

If ventr tachycard without pulse Tx

A

Defibrillate

66
Q

Reason why pts after MI monitored in ICU several days

67
Q

New onset murmur and pulmonary congestion after MI

A

Valve or septal rupture

68
Q

Best heard at apex with radiation to axilla

A

Mitral regurgitation

69
Q

Best heard at lower left sternal border

A

Ventricular septal rupture

70
Q

Look for a step-up in oxygen saturation as you go from the R atrium to the R ventr to ds

A

Septal rupture

71
Q

Most accurate test for tamponade, septal rupture

72
Q

42% oxygen saturation found on blood from RA and 85% in RV sample

A

Septal rupture

73
Q

Pump failure from anatomic problem that can be fixed in operating room

A

Intraaortic balloon pump( IABP)

74
Q
  • contracts&relaxes in sync with natural hearbeat

* gives a “push” forward to blood

75
Q

Never a permanent device( bridge to surgery)- valve or septal rupture, keep alive

A

Intraaortic balloon pump

76
Q

Most myoc. aneurysms don’t need specific therapy. If mural thrombi -> tx

A

Heparin followed by warfarin

77
Q

Preparation for discharge from hospital( detection of persistent ischemia)

A

Stress test prior to discharge. Determines if angiography needed( => revascularization with PCI or bypass surgery)

78
Q

MI Everyone should go home on

A 
Aspirin
Clopidogrel
BB
Statins
ACE inh
79
Q

Best for anterior wall infarctions bs of likelihood of developing syst dysfunction

A

ACE inhibitors

80
Q

Person intolerant for both aspirin and clopidogrel

A

Ticlopidine

81
Q

All MI or intolerant of aspirin or post- stenting

A

Clopidogrel

82
Q

Do not be fooled by the Q describing “ frequent PVCs and ectopy”. Do not treat

A

Prophylactic antiarrhythmics increase mortality

83
Q

Don’t combine nitrates with sildenafil bs

A

They’re both vasodilators

84
Q

ED postinfarction is most commonly from

85
Q

Most common medication causes ED

86
Q

Wait after MI for sexual activity

87
Q

If post MI stress test is normal,

A

Any form of exercise program can be started including sex

Cardiology (10 decks)

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