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Internal Med > Acute Coronary Syndrome > Flashcards

Acute Coronary Syndrome Flashcards

1
Q

Risk factors:

A
  1. Age: M>45, W>55

2. FHx: M60

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2
Q

DDx of chest pain:

A
  1. Cardio: angina, unstable angina, MI, coronary vasospasm, valvular dz, thoracic aortic aneurysm, pericarditis
  2. Pulm: PE, pneumothorax, cough
  3. GI: GERD, esophageal spasm, esophageal rupture, esphagitis, esophageal ulcer, peptic ulcer, hiatal hernia
  4. Musculoskeletal: costochondritis, herpes zoster, trauma, vomiting
  5. Other: cocaine, anxiety
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3
Q

Acute coronary syndrome history:

A

1: Pain: dull, aching, pressure, squeezing, heaviness

2. Diaphoresis, palpitations, pallor, impending doom

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4
Q

Acute coronary syndrome Physical exam:

A
  1. S4, or S3
  2. New systolic mitral murmur (papillary)
  3. Hypotension
  4. Pulmonary edema
  5. Oliguria
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5
Q

Acute coronary syndrome tests:

A
  1. Troponins

2. ECG

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6
Q

Pericarditis history:

A
  1. Pain - worse with lying down, coughing, deep inspiration

2. Pain - better when sitting, leaning forward

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7
Q

Pericarditis physical exam:

A

Pericardial rub

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8
Q

Pericarditis tests:

A

ECG

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9
Q

Aortic Dissection history

A

Pain - tearing, cutting, to mid-back or posterior chest

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10
Q

Aortic Dissection physical exam:

A
  1. Unequal BPs in arms

2. Loss of radial/carotid pulses

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11
Q

Aortic Dissection Tests:

A
  1. CXR - mediastinal widening
  2. angiography
  3. Transesophageal echo
  4. Helical CT/MRI
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12
Q

PE history:

A
  1. Pain - sharp, pleuritic
  2. Tachycardia, tachypnea, hypoxia
  3. Cough, hemoptysis, dyspnea
  4. Syncope - large thrombus
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13
Q

PE physical exam:

A

DVT - erythema, tenderness, unilateral edema, Homan’s sign, palpable cord

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14
Q

PE tests:

A
  1. CXR
  2. DDimer
  3. V/Q perfusion
  4. Helical CT
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15
Q

Pneumothorax history

A

Pain - sharp pleuritic

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16
Q

Pneumothorax tests:

A

CXR

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17
Q

Panic Attack history:

A
  1. younger age groups included

2. parasthesias, palpitations, fear of going crazy, depersonalization…

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18
Q

Cocaine abuse physical exam:

A

arrythmia

19
Q

Typical Angina definition:

A
  1. Substernal chest discomfort/pressure
  2. Provoked by exertion/stress
  3. Relieved by rest
20
Q

Atypical Angina definition:

A

Only 2/3 of:

  1. Substernal chest discomfort/pressure
  2. Provoked by exertion/stress
  3. Relieved by rest
21
Q

Unstable angina Etiology and Features and Duration:

A
  1. Etiology: partial occlusion.
  2. Features: New onset, progressive, at rest, in sleep, prolonged
  3. Duration: 20-30min
22
Q

EKG changes in unstable angina

A

ST depression

23
Q

NSTEMI Etiology, EKG changes , and durati onfor Type 1 and 2

A

Type 1: partial occlusion,
Type 2: demand ischemia

EKG for both: ST depression,
Positive troponins
Duration: 30min- hrs

24
Q

STEMI etiology, EKG changes, duration:

A

Etiology: Complete occlusion
Positive troponins
EKG: ST elevation AND Q wave.
Duration: 30min- hrs

25
Q

Prinzmental Variant definition, features, EKG changes, duration:

A

Coronary vasospasm, NOT acute coronary syndrome, typically not caused by atherosclerosis.

Occurs at rest
EKG: ST elevation
Duration: minutes

26
Q

EKG signs:

  1. T-wave inversions:
  2. T-wave peaking:
  3. ST depressions
  4. ST elevations
  5. Q waves:
A
  1. T-wave inversions: sensitive but not specific for ischemia/infarction
  2. T-wave peaking: early sign of ischemia/infarction
  3. ST depressions: ischemia
  4. ST elevations: injury
  5. Q waves: necrotic tissue, may not present until 24-36hrs after
27
Q

First marker for cardiac injury

A

CK/myoglobin

28
Q

Troponin - sens/spec, abnormal and normal timeframe:

A

> 95%/90 sens/spec
99% MI diagnosis
Abnorm 1-8hrs, peak at 24hrs
Normal 7-10 days after MI

29
Q

CK-MB - sens/spec, abnormal and normal timeframe:

A

Lower sens/spec
Good for recurrent MI
Abnormal 3-8hrs, peak at 24hrs,
Normal 2-3 days after MI

30
Q

DDx of high troponin:

A

ACS/ CAD, demand ischemia, nonischmic injury like myocarditis, toxins, trauma, CKD, PE, HF.

31
Q

CT angiography rules out

A

ACS, dissection, PE

32
Q

Stress test for

A

rule out ACS

33
Q

CXR for:

A

cardiomegaly, CHF, other chest pain cause

34
Q

Echo for:

A

wall motion abnormalities, valvular abnormalities

35
Q

Medical Treatment for ACS:

A
  1. Anti-coag: LMWH, Heparin
  2. Anti-platlet: ASA, clopidogrel (GDP inhibs)
  3. Anti-ischemia: Beta-Blocker, Nitroglycerine, Morphine, O2
  4. ACE-I/ARB - if MI to decrease cardiac remodeling
  5. GP IIB/IIIa inhib (abciximab, eptifibatide, tirofiban) - peri or post percutanous coronary intervention
  6. Statin - staring in hospital and continue outpatient
36
Q

Reperfusion Therapy - only for STEMI:

A

1st line: percutanous coronary intervention (PCI) - door to balloon 90min!
2nd line: tPA withing 30 min!

If need to transfer from OSH for : transfer should be

37
Q

MI complications:

A

0-24hrs: arrythmia, cardiogenic shock, HF, acute valve dysfunction
1-4days: pericarditis
3-14days: Rupture: free wall- tamponade, septum -VSD, papillary - murmur. Pseudoaneuryms - mural thrombus
2-10weeks: Dressler syndrome - immune mediated pericarditis,
True aneurysm

38
Q

TIMI Score is:

A

risk of unstable angina/NSTEMI: chance of death/MI/urgent revasc in 2weeks

39
Q

Factors in TIMI score:

A

AMERICA: Age>65 - 2pts, >25- 3pts, Markers - positive, EKG - ST changes or LBBB, Risk factors >=3, Ichemia, CAD - known, ASA use in last week.

Low risk - 0-2: meds, stress test, coronary angio if +stress test.
High risk 3+: meds, coronary angio

40
Q

Patients with sustained Vtach or Vfib need this treatment:

A

ICD = implantable cardioverter-defibrillator

41
Q

Discharge and followup tests:

A

Stress test and echo- assess EF for baseline

42
Q

EKG - U waves mean:

A

hypokalemia

43
Q

Hyperkalemia EKG findings progressively:

A

peaked T waves -> PR prolongation -> P wave flattening –> QT prolongation –> sine wave

44
Q

EKG findings for hypocalcemia and hypercalcemia:

A

Hypocalcemia: QT prolongation

Hypercalcemia: QT shortening

Internal Med (4 decks)

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