Acute Coronary Syndrome 2 Flashcards
Name 3 strategies to reduce myocardial oxygen demand?
bed rest and narcotics(does not improve outcomes)
B adrenergic blockers: beneficial effects on post MI (reduces oxygen need, anti arrhythmic properties and inhibit platelet activation
nitrates (potent veno and arterial vasodilators which reduce preload and after load)
Name 7 strategies to improve myocardial oxygen supply.
supplemental oxygen nitrates (improve local circulation) anti platelet therapy anticoagulant therapy early angiography and mechanical revascularization fibrinolytic therapy
Discuss different approaches to anti platelet therapy.
aspirin (can be attenuated by adrenaline)
clopidogrel, prasrugrel and ticagrelor (block ADP receptor on platelet
GP IIb/IIIa inhibitors (inhibit of activated glycoprotein IIb/IIIa receptors on platelets)
Name two drugs in anticoagulant therapy.
anti-thrombin III inhibition (heparin)
direct thrombin and factor Xa inhibition
When repercussion can be achieved within 90 min, emergency _____ is better than thrombolytics in terms of medium term survival, culprit artery potency and freedom of complications.
percutaneous coronary intervention (PCI)— result is regional MI systems employing rapid helicopter transport of MI patients
Name the two most commonly used thrombolytic agents.
streptokinase
tissue plasminogen activator (more effective)
greatest benefit if use in first 6hours of onset of chest pain
Discuss the major contraindication to thrombolytics.
any predispose to internal bleeding such as known intracranial pathology
recent stroke or head trauma
recent major surgery
Name 4 strategies that can be used to stabilize an unstable plaque.
HMG-CoA reductase inhibitors (statins)
anti-platelet therapy
angiotensin converting enzyme inhib
aggressive management of cardiovascular risk factors with lifestyle changes and medications
What is ventricular remodeling?
time-dependent, dynamic, and structural alteration in the ventricle resulting from coronary occlusion and myocardial necrosis (occurring in two phases)
Describes the process by which larger infarcts are often associated with progressive ventricular dilation.
early infarct expansion occurs over days post MI, over weeks, the entire heart enlarges and the infarct things further due to mechanical and neuro-hormonal factors
Name the serious complications that can occur post MI.
congestive heart failure
life-threatening ventricular arrhythmias
post-MI pericarditis
What are common causes of post MI cardiogenic shock?
severe left ventricular pump failure
acute formation of a ventricular septal defect
rupture of papillary muscle resulting in severe mitral regurgitation
pericardial tampande from ventricular free wall rupture
Discuss the 3 main elements of CHF in the setting got an acute myocardial infarction.
increased left ventricular end diastolic pressure, resulting from systolic and diastolic function
activation of sympathetic nervous system, increases arteriolar tone and ventricular after load
infarct related acute mitral regurgitation
Does arrhythmia within the first 48 hours following an MI carry prognostic significance? Are they common
not long-term prognostic, although ventricular arrhythmias in the subsequent days signify poor prognosis and increase risk of sudden death
telemetry is standard of care for first 48 hrs after MI
What can pericardiac chest pain and ECG changes mimic?
recurrent myocardial ischmia
