acute cards pt 1

Question 1

Prinzmetal’s angina

Answer 1

coronary artery vasospasm (not precipitated by atherosclerosis)

treatment w calcium channel blocker

Question 2

type 1 MI diagnosis

Answer 2

rise/fall of troponin >99th % URL plus one of the following:

• symptoms of acute myocardial ischemia
• EKG changes indicative of new ischemia (new ST/T wave changes or new LBBB)
• new pathologic Q waves
• imaging evidence of new loss of viable myocardium or new regional wall motion abnormality
  -ID of coronary thrombus on angiogram

Question 3

populations that commonly have atypical presentations of MI

Answer 3

women
diabetics
heart failure diagnosis
ESRD
geriatrics

Question 3

troponin

Answer 3

preferred cardiac biomarker for acute MI

troponin I rises faster than troponin T & is specific to cardiac necrosis

should be obtained in all patients with CP concerning for MI

trend q6 to peak

Question 4

ACS mgmt

Answer 4

emergency - morphine .1 mg/kg IV (2-4 mg); oxygen, Nitro 0.4 SL; aspirin 162-325 mg PO

B blocker PO within 24 hr of admit

antithrombotic therapy - aspirin, heparin gtt/enoxaparin, clopidogrel

consider nitro gtt

PCI within 90 mins!!!!!

fibrinolytic therapy within 3 hr of symptom onset (if no PCI availability)

Question 5

CI to fibrinolytic therapy

Answer 5

previous hemorrhagic CVA, other CVA or event within last ear, active internal bleeding, suspected aortic dissection

Question 6

Post STEMI meds

Answer 6

beta blocker - everyone unless cardiogenic shock, decreased output states, hypotension, or severe asthma

statin - everyone

ACE/ARB - if anterior infarct or LV dysfunction, caution in renal disease

SL nitro before activity

dual anti platelet therapy

Question 7

dual anti platelet therapy

Answer 7

post STEMI 12 months for high risk & low bleeding risk, <12 mos for high bleeding risk/low ischemic risk

aspirin (81-325 mg PO QD) - reduce morbidity/mortality - indifinite tx

AND

clopidogrel (plavix) OR prasugrel (effient)

-loading dose & maintenance therapy

Question 8

Dressler syndrome

Answer 8

fever, malaise, fatigue, arthralgias, CP occurring ~2 weeks following PCI or cardiac event

secondary pericarditis w/wo effusion

Question 9

causes of acute HF

Answer 9

acute valvular (mitral or aortic regurgitation)
MI
myocarditis
arrhythmia
drugs (cocaine, CCB, BB OD)
sepsis

Question 10

RHF vs LHF
??????

Answer 10

left - s/s of pulm edema (crackles, resp distress, A fib, S3, murmur, pulm congestion on CXR

right - FVE (increased CVP, JVD, edema, ascites, S3/S4, hepato/splenomegaly)

Question 11

cardinal exam findings of HF

Answer 11

parasternal lift
displaced PMI
diminished S1
S3/S4

Question 12

CI to LVAD

Answer 12

RV ventricle failure ( cannot support LV flow)