Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Clinical 2.0 > Acute Coronary Syndrome > Flashcards

Acute Coronary Syndrome Flashcards

(92 cards)

Start Studying
1
Q

describe the difference between plaques between non stemi and stemi

A

nonstemi still some blood flow mostly made of platelets

stemi theres complete occlusion and lots of fibrin

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

troponin or st elevation in the following?

  1. unstable angina
  2. nstemi
  3. stemi
A
  1. none
  2. troponin
  3. troponin and st elevation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what are the 3 types of acute coronary syndrome

A

unstable angina
non-st-segment elevation MI
ST-segment elevation MI

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

what causes stemi

A

complete occlusion of a coronary artery by clot - rupture of atherosclerotic plaque

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

what is the diagnosis of acs based on

A

signs and symptoms
ECGs
cardiac biomarkers - CK-MB, TnT

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

what are some classic symptoms

A

radiating chest apin
SOB
NV
diaphoresis

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

who is more liekly to have silent type without chest pain and other classical symptoms

A

elderly, diabetic, women

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

signs

A

syncope
arrythmia
elevated or low BP
diffuse rales, wheezing, resp distress

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

what does jugular venous distention indicate

A

right atrial hypertension usually from RV infraction or elevated LV filling pressure

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

what enzymes are released into circulation when cardiac cells are damaged

A

creatinine kinase

troponins

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

describe the timing of ck-mb enzyme

A

detectable in serum within 3-6 hr post MI
peaks in 12-24 hr
stays elevated for 2-3 days
*can be elevated in other conditions

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

which is the perferred biomarker for assessment of myocardial damage

A

troponins because of high sensitivity

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

describe timing of troponins

A

appears in serum within 4-12 hr after MI onset
peaks 12-48 hours
stays elevated for 7-10 days

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

when should biomarker essays be done

A

stat on presentation then repeated every 4-6 hours for the first 12-24 hrs then periodically

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

what biomarker results are needed for diagnosis

A

at least 2 elevated ck-mb or 1 tnt exceeding the upper reference range

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

when should a 12 lead ecg be done

A

within 10 min on presentation

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

what does an ecg tell you

A

distinguishes from stemi and nstemi
informs location of myocardial damage
affects decision pathway and management

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

ecg diagnostic criteria for st elevation

A

st segment elevation in >2 contiguous leads exceeding .2mV in leads v1, v2, v3 or .1mV or greater in other leads or new left bundle branch block

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

what acg abnormalities might be observed for nstemi

A

st depression

t wave inversion

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

initial management of acs in emergency

A

oxygen 4L/min by nasal prong
asa 162-325
nitroglycerin SL or IV
morphine 2-5mg IV q5-30min prn if pain not relieved by nitro

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

what does mona stand for

A 
initial management 
morphine
oxygen 
nitrates 
asa
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

why is it important to treat the pain right away

A

pain raises sympathetic activation so increase the myocardial demand

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

time is what in stemi

A

muscle

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

priority to reestablish blood flow to occulded artery as wuickly as possible what are the two types of perfusion strategies in stemi

A

primary percutaneous coronary intervention

fibrinolytics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
what does the choice of reperfusion strategy depend on
location availablity of pci capable facilities | onset of symptoms
26
reperfusion goals of therapy
decrease mortality and complications reduce or contain infarct size salvage functioning myocardium and prevent remodelling reestablish patency of the infarct related artery
27
whats the recommended method of reperusion
primary pci when it can be preformed in a timely fashion
28
ideal door to balloon time for primary pci and for stemi in non pci capable hospital
under 90 min | if transferred should be considered if <120min can be acheived
29
when fibrinolyic therapy is chose when should it be administered
within 30min of hospital arrival
30
when should reperfusion therapy occur within
12 hours
31
if the fibrinolytic is administered at a non pci capable hospital what happens after
urgent transfer for pci in patients with failed reperfusion or reocclusion OR transfer for angiography and revascularization within 3-24hr for other patients as part of an invasive strategy
32
describe primary pci process
catheter placed through femoral artery to the aorta and coronary arteries contrast dye injected xrays taken to determine location of occlusion balloon catheter with or without stent goes to site and inflates to open the coronary stents left inplace to keep vessel open repeat xrays
33
define timi grade flow
adopted scoring system from 0-3 referring to level of cornary blood flow assessed during PCI 3 = complete perfusion
34
whats a drug eluting stent
antiproliferative drugs coating released slowly over time to prevent restenosis
35
patients who recieved a des will require what
dual antiplatelet therapy for a min of 1 year
36
why is fibrinolytics not administered to nstemi and ua patients
clot is not fibrin made mostly of platelets
37
fibrinolytic agents
tenecteplase reteplase alteplase streptokinase - non fibrin specific
38
tenecteplase fibrinolytic of choice whats the dose
5 second single bolus
39
absolute contraindications to fibrinolytics due to bleeding risk
prior ICH known structural cerebral vascular lesion malignant intracranial neoplasm ischemic stroke within 3 mon except acute witin 4.5hr suspected aortic dissection active bleeding sig head trauma within 3 mon intracranial/spinal surgery within 3 mon severe uncontrolled hypertension
40
what should patients be given before undergoing primary pci
asa 162-325 loading dose of a p2y12 receptor inhibitor as early as possible usually low molecular weight heparin
41
dose before primary pci and examples of p2y12 receptor inhibitor
clopidogrel 600 prasugrel 60 ticagrelor 180
42
what should patients be on after primary pci
asa 81-162 daily for life plus a p2y12 receptor inhibtor at maintenance dose for min 1 year
43
maintenance dose of p2y12 receptor inhibitors
clopidogrel 75 prasugrel 10 ticagrelor 90 bid
44
what should be given for stemi patients recieving fibrinolytics
asa 162-325 on presentation then for life clopidogrel 300 loading dose then continue 75mg daily for 14 days LMWH/UFH initiated at time of fibrinolytics and continued for 48hr-8days
45
enoxaparin in stemi in patients < 75
give 30mg iv bolus before tnk continue 1mg/kg sc q12h after tnk max 140mg
46
enoxaparin in stemi in patients over 75
dont give enoxaparin iv bolus .75mg/kg sc q12h after tnk max 100mg
47
who should not use prasugrel
patients with history of stroke or TIA due to higher rates of major bleeding
48
patients who undergo pci should receive dual antiplatelet therapy for
1 year
49
what is the maintenence dose of asa
81 same amount of antiplatelet action but less risk of bleeding
50
stemi patients treated with fibrinolytics should be on dapt for how long
not warranted just asa daily undefinately but most go on to have a pci
51
triple therapy of dapt and warfarin indicated in who
stemi patients with low ejection fraction of has concurrent heart failure
52
what should you monitor for efficacy after reperfusion
signs and symptoms of ongoign chest pain no new ecg changes serial monitoring of biomarkers stent thrombosis complications: arrhythmias, HF, pericarditis
53
what should you monitor for safety after reperfusion
major and minor bleeding complications | signs of bleeding: bloody stool, melena, hematuria, bruising, oozing from puncture sites
54
what are some stemi complications
heart failure cardiogenic shock arrhythmias pericarditis
55
why might heart failure occur after stemi and what is the therapy
LV myocardium may become ischemic, stunned, or injured after mi echocardiography to assess lv ejection fraction diuretics, vasodilators, and inotropic may be needed
56
what is cardiogenic shock after stemi and what is the result
decreased cardiac output and evidence of tissue hypoxia in precence of adequate intravascular volume often due to extensive lv infraction high rate of mortality
57
why do arrhythmias happen post mi
due to ischemia and severe HF
58
who is an impantable cardioverter defibrillator indicated in
before discharge in patients who develop sustained VF more than 48 hours after stemi
59
treatment of pericarditis after stemi
asa 650 qid or nsaids | resolves in 3-4 days
60
goals of adjunct therapy after stemi
reduce the risk of short term and long term complications with stemi slow progression of chd and minimize the future cardiovascular events and other morbidities improve mortality and restore quality of life
61
how do beta blockers help post stemi
increase myocardial salvage in the infarct area prevent extension of infraction by reducing oxygen demand decrease mortality and nonfatal mi
62
when should beta blockers be initiated after mi
within 24 hours after onset of mi
63
start beta blockers at a low dose post mi and titrate to maintain a resting hr of what
55-60bpm
64
contraindications to beta blockers
``` hypotension bradycardia acute heart failure cardiogenic shock asthma 2nd or 3rd degree av block ```
65
dosing of metoprolol post mi
start 25mg bid | titrate to max 100bid
66
dosing of atenolol
12.5-25 daily up to 100 daily
67
dosing of carvediol
3.125 bid | titrate to 25 bid
68
how do acei help post mi
min ventricular remodelling reduce oxygen demand and myocardial wall stress by reducing afterload and preload reduce cv mortality
69
who is the benefit of acei the greatest
anterior infraction HF diabetes CKD
70
when should acei be intiated after mi
24 hour of mi once bp has been stabilized
71
who should you use acei with caution in
renal impairment | hyperkalemia
72
acei monitoring
scr electrolytes watch for hyperkalemia
73
ramipril dosing
1.25-2.5 daily | target 10mg
74
enalapril dosing
2.5 bid | target 10-20bid
75
lisinopril dosing
2.5-5 daily | target 40 daily
76
captopril dosing
6.25 tid | target 25-50 tid
77
candesartan dosing
4mg daily | target 32
78
telmisartan dosing
40mg daily | target 80
79
valsartan dosing
20mg bid | target 160 bid
80
what should you monitor for statins
lipid panel LFT CK symptoms of myopathy
81
dosing for atorvastatin, fluvastatin lovastatin simvastatin
20-80 mg daily
82
dosing for pravastatin
20-40 daily
83
rosuvastatin dosing
5-40mg daily
84
what does evolocumab do
monoclonal antibody that inhibits PCSK9 - lowers LDL
85
should you use evolocumab
not much risk reduction and very costly
86
who should aldosterone antagonists be considered in
patients with sig LV dysfunction
87
who should you caution the use of aldosterone antagonists in
crcl<30 and potassium >5
88
monitoring for aldosterone antagonist
check potassium baseline and wihtin 1 week of initiation
89
spironolactone dosing
12.5 daily | titrate to 25mg
90
eplerenone dosing
25mg daily | titrate to 50
91
non pharm therapies
``` cardiac rehab program weight maagement physical exercise ICD assessment for patients with ongoing lv dysfunction psychosocial issues ```
92
risk factor modification
``` smoking cessation hypertension dyslipidemia obesity sedentary stress ```

Clinical 2.0 (24 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions