Acute Coronary Syndrome Flashcards
What are the initial treatments for an individual with chest pain in the ED?
- STAT EKG
- Oxygen
3.ASA- 75-325 chewed or suppository - NTG- sublingual 0.4mg x3 doses or gtt (ensure not right sided because of decreased preload)
- Morphine 2-4mg Q5-15
6 labs- CBC, CMP, Cardiac enzymes, coags
Name the cardiac bio markers from most to least specific-
Triponin
CK-MB
Myoglobin
What are the elevation times for the cardiac enzymes
Myoglobin- 1-4hrs
CK-MB - 3-12hrs
Troponin - 3-12 hours, elevated for 7-10 days
What are some other causes for an elevated troponin?
Sepsis PE Rhabdo Renal failure Burns Aortic dissection
An elevation in leads V5, V6, AVL, and 1 are caused by what?
A lateral infarction. Usually the circumflex artery
An elevation in leads 2,3 and AVF are caused by what?
An inferior MI usually the RCA
An elevation in leads V2 and V3 is indicative of what?
A septal MI, often the LAD
An elevation in leads V2, V3, V4 is indicative of what?
An anterior MI, often the LAD
T inversions are indicative of what?
Ishemia
ST elevations are indicative of what?
Cardiac injury
Q waves are indicative of what?
Infarct
If a patient has a highly TIMI score (4-7). This is indicative that why intervention needs to be done
The patient would benefit from PCI
Start them on a IIb/IIIa inhibitor (Integrilin)
Integrilin should be given when?
Pre and post PCI patients
STEMI criteria includes:
- ST elevations in 2 continuous leads
- New LBBB
- ST depression in 2 or more precordial leads
- ST depression w/ ST elevation in AVR- may indicate LAD or LM occlusion
Treatments for patients after MI
Beta blocker ( decreased cardiac events) ACEI (helps with remodeling)
Plavix
ASA
Statin
Fibrinolytic therapy relative contraindications include:
Severe HTN >180/110 Current Anticoagulant use w/ INR > 2.5 Known bleeding No compressible vascular puncture Major sx or trauma (to include cpr) Pregnancy
What makes angina stable?
Follows a predictable pattern; like pain on exertion
What makes angina unstable?
Intermittent; occurs more, at rest, varies from its usual pattern
Prinzmetals angina is what?
Epicardial coronary vasospasms
Post-infarct angina is what?
Angina that occurs 24hours to 30 days after an Mi
What classifies a NSTEMI or Unstable angina?
T inversions
ST depressions
ST wave changes w/ out pain
What is the treatment of a NSTEMI?
Aspirin Nitroglycerin Plavix Beta blockers ACEI- if BP still elevated after BB and nitro Statin Echo IIb/IIIa of going to PCI
At what point would you send an NSTEMI patient to the catch lab?
Worsening or persistent symptoms or recurrent ischemia
Widespread EKG abnormalities
CHF
VTach
Prior CABG or PCI (within the last 6 months)
Depressed LV function
+cardiac markers
Hemodynamics instability
What should you expect post MI if patient has experienced acute deterioration and new mitral regurgitation with s/s of HF
Papillary muscle rupture
What are S/S of cardiogenic shock?
Hypotension Tachycardia Oliguria Pulmonary congestion Crackles Cool extremities
What is the treatment for cardio genic shock?
Ventilation IVF Sodium bicarbonate gtt for metabolic acidosis ASA IV heparin IIb/IIIa inhibitor PA catheter Inotropes Levophed
What are signs of right ventricular failure?
JVD Hypotension Lungs CTA Peripheral edema Hepatomegally
What is the treatment for right heart failure?
IVF Meds to decrease afterload: Milronone, dobutamine Oxygen Coronary reperfusion Transcutaneous pacing
Dressler’s syndrome is what?
Pericarditis post MI
What do you not give/do for right heart failure
No decreasing preload– No nitrates or diuretics
What are symptoms of pericarditis?
Progressively worsening chest pain especially when supine
Friction rub
Global ST elevations
What is the treatment for pericarditis?
ASA, colchicine and steroids
At discharge all ACS/MI patients should get what 5 things?
ASA
BB
Statin
ACEI (if LV dysfunction)
Smoking cessation
