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ACNP 1 > Acute Coronary Syndrome > Flashcards

Acute Coronary Syndrome Flashcards

1
Q

What are the initial treatments for an individual with chest pain in the ED?

A
  1. STAT EKG
  2. Oxygen
    3.ASA- 75-325 chewed or suppository
  3. NTG- sublingual 0.4mg x3 doses or gtt (ensure not right sided because of decreased preload)
  4. Morphine 2-4mg Q5-15
    6 labs- CBC, CMP, Cardiac enzymes, coags
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2
Q

Name the cardiac bio markers from most to least specific-

A

Triponin
CK-MB
Myoglobin

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3
Q

What are the elevation times for the cardiac enzymes

A

Myoglobin- 1-4hrs

CK-MB - 3-12hrs

Troponin - 3-12 hours, elevated for 7-10 days

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4
Q

What are some other causes for an elevated troponin?

A 
Sepsis
PE
Rhabdo
Renal failure
Burns
Aortic dissection
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5
Q

An elevation in leads V5, V6, AVL, and 1 are caused by what?

A

A lateral infarction. Usually the circumflex artery

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6
Q

An elevation in leads 2,3 and AVF are caused by what?

A

An inferior MI usually the RCA

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7
Q

An elevation in leads V2 and V3 is indicative of what?

A

A septal MI, often the LAD

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8
Q

An elevation in leads V2, V3, V4 is indicative of what?

A

An anterior MI, often the LAD

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9
Q

T inversions are indicative of what?

A

Ishemia

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10
Q

ST elevations are indicative of what?

A

Cardiac injury

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11
Q

Q waves are indicative of what?

A

Infarct

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12
Q

If a patient has a highly TIMI score (4-7). This is indicative that why intervention needs to be done

A

The patient would benefit from PCI

Start them on a IIb/IIIa inhibitor (Integrilin)

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13
Q

Integrilin should be given when?

A

Pre and post PCI patients

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14
Q

STEMI criteria includes:

A
  1. ST elevations in 2 continuous leads
  2. New LBBB
  3. ST depression in 2 or more precordial leads
  4. ST depression w/ ST elevation in AVR- may indicate LAD or LM occlusion
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15
Q

Treatments for patients after MI

A 
Beta blocker ( decreased cardiac events)
ACEI (helps with remodeling)

Plavix
ASA
Statin

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16
Q

Fibrinolytic therapy relative contraindications include:

A 
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
17
Q

What makes angina stable?

A

Follows a predictable pattern; like pain on exertion

18
Q

What makes angina unstable?

A

Intermittent; occurs more, at rest, varies from its usual pattern

19
Q

Prinzmetals angina is what?

A

Epicardial coronary vasospasms

20
Q

Post-infarct angina is what?

A

Angina that occurs 24hours to 30 days after an Mi

21
Q

What classifies a NSTEMI or Unstable angina?

A

T inversions
ST depressions
ST wave changes w/ out pain

22
Q

What is the treatment of a NSTEMI?

A 
Aspirin
Nitroglycerin 
Plavix
Beta blockers
ACEI- if BP still elevated after BB and nitro
Statin
Echo 
IIb/IIIa of going to PCI
23
Q

At what point would you send an NSTEMI patient to the catch lab?

A

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

24
Q

What should you expect post MI if patient has experienced acute deterioration and new mitral regurgitation with s/s of HF

A

Papillary muscle rupture

25
Q

What are S/S of cardiogenic shock?

A 
Hypotension
Tachycardia
Oliguria 
Pulmonary congestion
Crackles
Cool extremities
26
Q

What is the treatment for cardio genic shock?

A 
Ventilation
IVF
Sodium bicarbonate gtt for metabolic acidosis
ASA
IV heparin
IIb/IIIa inhibitor
PA catheter
Inotropes 
Levophed
27
Q

What are signs of right ventricular failure?

A 
JVD
Hypotension
Lungs CTA
Peripheral edema
Hepatomegally
28
Q

What is the treatment for right heart failure?

A 
IVF
Meds to decrease afterload:
Milronone, dobutamine
Oxygen
Coronary reperfusion
Transcutaneous pacing
29
Q

Dressler’s syndrome is what?

A

Pericarditis post MI

30
Q

What do you not give/do for right heart failure

A

No decreasing preload– No nitrates or diuretics

31
Q

What are symptoms of pericarditis?

A

Progressively worsening chest pain especially when supine

Friction rub

Global ST elevations

32
Q

What is the treatment for pericarditis?

A

ASA, colchicine and steroids

33
Q

At discharge all ACS/MI patients should get what 5 things?

A

ASA

BB

Statin

ACEI (if LV dysfunction)

Smoking cessation

ACNP 1 (12 decks)

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