Acute Cardiac Diseases Flashcards
CK-MB
cardiac specific
but may not rise for up to 4 hours after onset
test for myocardial injury
normal <4-6%
troponin
cardiac and skeletal muscle
can be seen as early as within 1 hour of symptoms
<0.1
CRP
can speak to risk of heart disease and atherosclerosis
Helps identify acute MI, acute inflammation, may help identify risk of cardiac disease
low risk- <1
mod risk- 1-3
high risk >3
BNP
indicative of HF, unreliable alone
<100, over 100 can indicate HF
Lipids
high levels in blood correlate with high risk for CAD
HDL: Men >45, female3 >55
LDL <130, high risk >160
EPS is done for
cardiac arrhythmia’s
invasive diagnostic tests for cardiac
TEE (transesophageal Echo)
Cardiac Cath
EPS
class 1 of heart failure
symptoms on excretion, able to maintain ADL’s
class 2 of heart failure
symptoms with ADL’s, able to start day, can walk to around the store but are tired afterwards
class 3 HF
symptoms with normal daily activities such as preparing meals, feeding animals, must sit periodically, transition activities and living to 1 level of house cannot climb stairs
class 4 HF
symptoms with rest
walking from bed to bathroom can be to much, need chairs and periods of rest between
oxygen and assistive devices
often feel isolated and depressed
cardiomyopathy
big fat floppy heart
can produce HF
caused by CAD and HTN
common symptoms of heart failure
orthopnea
paroxysmal nocturnal dyspnea
fatigue
JVD
dependent edema (legs, lower body)
most useful diagnostic test for HF
Echo, then CXR and BNP (
remember that BNP can be elevated for inflammatory process)
treatment of HF
treat risk factors of HF
therapies to slow progression
ACE inhibitors, Beta Blockers, Diuretics
Hypertensive urgency
BP> 180/110m without evidence of acute organ damage
slowly lower BP
most common symptoms HA, nose bleeds, dyspnea
140 systolic is ideal
hypertensive crisis
BP >180/110 with evidence of acute organ damage
admit to ICU aggressive IV antihypertensives and Drip therapy
Aortic Rupture
balloon popping b/c its too big
50% die before reaching the hospital
AAA triad of symptoms- syncope, Acute onset of SEVERE abdominal pain
hypotension
surgical emergency, time is of the essence
fluid resuscitation with large bore IV’s, rapid blood transfusion, pain control, airway protection
aortic dissection
ripping away from artery wall
most common symptom is migrating pain (ripping, tearing, stabbing, burning)
IF hypotension is present on admission mortality is likely
treatment of aortic dissection
IV fluids for circulatory support
aggressive antihypertensive for reduced stress and pressure on vessel
pain control
emergency surgery
unstable angina is caused when
thrombi partially occludes arteries
EKG will show ischemic changes
T wave inversion and ST depression are 2 hallmark indicators of ischemia
MI occurs when
total occlusion of artery resulting in cell necrosis and release of cardiac markers
EKG may or may not have ST elevation (NSTEMI VS STEMI)
Rapid assessment of ACS
EKG
cardiac enzymes
common presenting signs CP lasting longer than 20 min but less than 12 hours
crushing, gripping, smothering pain
feelings of impending doom
atypical presentation is common especially in elderly
how is mortality decreased and myocardium preserved with STEMI
if reperfusion is started within 30 minutes of presentation, reperfusion therapy includes thrombolytic therapy, percutaneous coronary intervention, and CABG
