Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Cardiovascular Therapeutics > Acute Coronary Syndrome > Flashcards

Acute Coronary Syndrome Flashcards

1
Q

ACS Categorization

A

a) Unstable Angina
b) Myocardial Infarction
i) STEMI
ii) NSTEMI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the averge age of first ACS?

A

Late 60”s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

ACS occurs more in (males/females) ration

A

Male to female ratio 3:2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

ER Assesments of MI

A

1) Patient story
2) 12 ECG
3) Blood Tests –> Indicators of cell death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

A normal ECG is good evidence of….

A

Strong evidence to rule OUT ACS
Physicians will investigate other possible causes of sx’s (heartburn, gallbladder attack, etc)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

St Segment Depression Indicates

A

Strong evidence for coronary ischemia
However, ST depression is often associated with stable (fixed obstruction) angina. Further investigations will be needed to determine severity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

ST Elevation

A

A marker of complete coronary obstruction causing cardiac myocyte death
This finding suggests a serious MI requiring urgent revascularization in most cases
If blood flow is not restored quickly, the person is at high risk for major consequences such as heart failure, arrythmias, or even death.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

ST segment elavtion is refrred to as a

A

STEMI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Q-waves in normal ECG

A

Absent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Q waves in MI

A

Often will appear following (or during) a STEMI
Usually indicates extensive damage (transmural) to the heart wall
Often remains in the ECG for life (even after the acute event)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

a STEMI will be confirmed if….

A

if evidence of cell death is observed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the most sensitive and specific marker of MI?

A

Tropnins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Cardiac tropinins in MI

A

are the most sensitive and specific biomarkers in the context of ACS

Troponins ↑ in the blood within hrs of MI and remain elevated for several days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

The major classic presentation of STEMI is

A

ST elevation is a classic presentation of a major MI

Often leaves ECG evidence forever (Q-wave)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is left-bundle branch block?

A

Conduction in the left bundle of his is slow

Results in delayed depolarization of the left ventricle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

left Bundle Branch Block presnetation on ECG

A

QRS is delayed (>0.12sec)
Broad monomorphic R waves in I and V6 with no Q waves
Broad monomorphic S waves in V2, may have a small r wave

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

CRP is a test that indicates…

A

Inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

tests adminstered in the E.R. if STEMI suspected….

A

ECG
Cardiac troponins (3 – 6 hrs after symptom onset)
Natriuretic peptides (B-type or pro-B type –> Brain Naturietic Peptide elvated in MI)
CXR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Standard TX in ER

A

Oxygen (if O2 sats <90% or respiratory distress, etc)

ASA +/- ADP inhibitor

S/L NTG (IV NTG should be started if pain continues)
Ask about PDE5 inhibitor use!!!

Beta-blocker may be considered but onset slow and dangerous in acute setting if evidence of reduced CO, HF, or bradycardia

IV anticoagulation – recommended for all patients with suspected MI regardless of initial treatment strategy (e.g., UFH, enoxaparin, bivalirudin)

Old A** Never Beat Attacks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

A beta-blocker should only be used once a pt is…..

A

STABLE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

BB benfit has (increased/decreased) ove rthe years?

A

Decreased

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Why has the benfit of BB decreased over the years?

A

Post MI risk is generally lower today due to frequency of mechanical revascularization and medication use

In other words, people experiencing MIs are less likely to have damaged myocardium (or less myocardium is damaged)

Less damage likely means lower levels of epi/norepi. These SNS hormones can cause adverse outcomes. They also are the likely mechanism for BB protection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Betab-blockers are highly….

A

Beta-blockers are highly protective in people who have experienced damage to myocardial cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

If there is more damage, a BB is….

A

More damage = higher SNS = more likely to benefit from BB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

if there is less damage, a BB is …..

A

Less damage = lower SNS = less likely to benefit from BB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the first goal of a STEMI? Timing

A

Repurfusion

ALL patients presenting with STEMI with symptom onset within past 12 hours should receive reperfusion therapy (assuming eligibility criteria are met)

Primary PCI is the preferred method of reperfusion when done in a timely fashion

If PCI cannot be performed within 2hrs after first medical contact, fibrinolytic medications should be administered.
(tPA) –> Plasminogen to plasmin which breaks down fibrin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Why is repurfusion tx benficial?

A

Reperfusion as quickly as possible after a STEMI has great potential to restore blood, ↓ the risk for damaged myocardium, and ↓ the risk of death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Before a PCI, what drugs are given….

A

DAPT
Anticoagulant TX

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Why are pre-PCI antiplatelet tx used?

A

Antiplatelets are started PRIOR to PCI procedures

Helps protect against platelet activation that occurs during placement of stents

Stent placement can cause endothelial damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What drugs can be used in PRe-PCL antiplatlet tx? DOses? Which drug not used when?

A

ASA - 81-325 (325 if not taking 81 already)

Loading dose of P2Y12 inhibitor (either of the following)
Clopidogrel 600mg
Prasugrel 60mg
Ticagrelor 180mg

Prasugrel should NOT be used to patients with prior history of stroke or TIA**

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

When is Pre-PCI antiplatlet tx initiated?

A

Administered in ED as soon as possible after decision for PCI

32
Q

What anticoagulants can be used before PCI?

A

Options include:
LMWH –> enoxaparin
UFH
Bivalirudin

33
Q

Are IV anticoagulants always used before PCI?

A

YES

34
Q

Clopidogrel is adminstered as a….

A

Pro-drug –> requires liver activation –> May be a disadvantage for some

35
Q

Clopidogrel inhibits

A

ADP receptor

36
Q

Clopidogrel Inhibition Type

A

irreversible

37
Q

Prasurgrel MOA…

A

ADP receptor antagonits

38
Q

Prasurgrel is adminstered as… Comparison to clopidogrel?

A

Pro-drug –> Less intra-subject variability in conversion than Clopidogrel

39
Q

Prasurgrel Concerns for Usage

A

Concern regarding risk of serious bleeding in
Patients >75 yrs
Patients < 60kg

40
Q

Ticagrelor administration

A

Not a pro-drug

41
Q

Ticagrelor binding to ADP receptor

A

Reversible Inhibitor of ADP receptor (only one)

42
Q

STEMI Meds DAY 1

A

ABCDEK Mechanism + angina pain

ASA + Ticagrelor
Bispropol
ramipril

Statin
NTG

43
Q

In DAPT, what is preferred over Clopidogrel?

A

Ticagrelor and Prasurgrel

44
Q

DAPT is used for how long…

A

1 year and then re-evaluate

45
Q

At 1 year, on DAPT, need to….

A

Determine bleeding risk:

If not at high risk, Continue DAPT for 3 years
- ASA 81 mg OD, Ticagrelor 60 mg BID or Clopidogrel 75 mg OD

If high risk, SAPT –> ASA 81, or Clopidogrel 75 mg OD

(1975)

46
Q

DAPT for 1 year Combos

A

ASA 81 OD
Ticagrelor 90 BID
Prasurgrel 10 mg OD
Clopidogrel 75 mg OD

47
Q

Risk factors for bleeding…

A

Need for OAC, NSAIDs, or prednisone
Age > 75
Frailty
Anemia with Hb < 110
CrCl < 40ml/min
Body weight < 60kg
Bleeding hosp within previous year
Prior stroke/intracranial bleed

48
Q

If high bleeding risk, DAPT can be…

A

If bleeding risk is high, DAPT d/c can generally be considered
After 1 month for a BMS
After 3 months for a DES

49
Q

Indications for BB post MI

A

LVSD / Heart failure – absolute indication (not in acute phase)
Arrhythmia – absolute indication
STEMI – absolute indication
STEMI without residual dysfunction – 3 years and re-evaluate (AHA)
NSTEMI without residual dysfunction – “consider” BB

50
Q

ACE-i in M.I. What if ACE not tolerated?

A

Shown to ↓ mortality in patients with recent MI – used in virtually ALL people with MI (HOPE TRIAL)

  • Can use an ARB
51
Q

What ACEi to use in people with increased risk of ADR’s

A

Short acting ACEI (captopril or enalapril)

52
Q

if significant renal dysfunction, ACEi…..

A

If significant renal dysfunction, may wish to wait till kidney’s are stabilized (SCr improved)

53
Q

ACEi are considered in all high risk pt’s without HTN

A

TRUE

54
Q

Speciifc s/e of ACEi

A

Cough, Increased K+, Angioedema

55
Q

Drug Interactions of ACei

A

Anything that increases K+
Anything decreases renal perfusion

56
Q

C.I. of ACEi

A
  • Teratogenic
  • Bilateral renal artery stenosis
    History of angioedema
  • First line in renal dz –> But need to monitor
57
Q

What other class of drugs may be prescribed?

A

MRA –> Eplerenone

58
Q

Adding MRA to BB and ACEi in post MI benfit? This does not apply when…

A

Adding eplerenone to BB and ACEI in the post-MI setting to patients with EF<40% was associated with ↓ mortality

Does NOT apply IF significant renal dysfx (Cr > 170) or high K

59
Q

MRA is only given to people who present with….

A

heart failure after that heart attack

60
Q

what revascularization technique is preferred?

A

PCI

61
Q

CABG in STEMI when….

A

Urgent CABG indicated when coronary anatomy not amenable to PCI AND ischemia persists (or cardiogenic shock, severe HF, etc)

62
Q

CABG risks….

A

much higher risk for bleeding during the procedure.

63
Q

Before CABG, ____should be stopped and ____ should be used….

A

ADP inhibitors –> ASA should be used before surgery

64
Q

Elective CABG Meds Before Surgery

A

In NON-URGENT situations, ADP inhibitors should be d/c for at least 5 days before surgery!!!

65
Q

Uregent Situation - Primary CABG DAPT USe

A

If CABG is urgent, ADP inhibitors should be stopped at least 24hrs before surgery

66
Q

Post CABG Anti-platlet tx depends on….

A

Depends on situation

STEMI or NSTEMI  eligible for DAPT

Elective CABG  ASA only

67
Q

NSTEMI vs. Unstable ANgina DIagnosis

A

History of classic ischemic sx’s not relieved by rest
ST-DEPRESSION on ECG

If cell death can be proven in the context of ACS and ST depression, Jibby will be diagnosed with a NSTEMI (troponins positive – if positive, MI – if negative, unstable angina)

If NO cell death can be proven in the context of ACS and ST depression, Jibby will be diagnosed with unstable angina

68
Q

In order to be diagnosed with MI….

A

Cardiac cell death must be dtermined

69
Q

What is a primary PCI? What are the features favouring PCI?

A

Some patients will be sent for angiography (and possible PCI) very quickly (invasive strategy)

Features favouring invasive strategy
STEMI
Refractory angina
Hemodynamic/electrical instability
High risk features (Diabetes, previous MI, HF, etc)

70
Q

BB receommended for….

A

LVSD / Heart failure – absolute indication (not in acute phase)
Arrhythmia – absolute indication
STEMI – absolute indication
STEMI without residual dysfunction – 3 years and re-evaluate (AHA)
NSTEMI without residual dysfunction – “consider” BB

71
Q

Atrial Fib Define and Consequence

A

An arrhythmia of the atrium removing the atrial contraction altogether

Clots can form in the left atrium due to pooling of blood

These clots can embolize into the carotid artery and cause ischemia to the brain (i.e., stroke)

72
Q

Atrial FIb Tx

A

Anticoagulants (i.e., not antiplatelets) are effective for this condition

73
Q

ACS with Atrial FIb Tx

A

Makes the use of DAPT more likely to cause bleeding

However, antiplatelets are still necessary for treating ACS

74
Q

AFIB Elective PCI w/t High risk features for thrombotic CV events

A

Dual Therapy

OAC and C;lopidogrel 1-12 months

75
Q

AFIB ACS with PCI or Elective PCI with High risk Features fro Thrombotic CV events

A

Triple Tx –> OAC + ASA + clopidogrel –> 1day to 1 month

Dual Tx –> OAC + clopidogrel for up to 12 onths

76
Q

AFIB and ACS w/t PCI

A

Dual Tx

OAC and Clopidogrel

77
Q

Unstable Angina TX

A

Similar to Fixed Obstruction –> DAPT could be avoided

Cardiovascular Therapeutics (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions