Acute Coronary Syndrome Flashcards
What is the difference between UA and AMI?
AMI has necrosis of cardiac muscle
In UA, is vessel completely occluded?
Nope
What causes a Type I MI?
ASCAD plaque rupture, clot formation, coronary thrombosis; SUPPLY problem
What causes a Type 2 MI?
Increased O2 demand or decrease O2 supply (coronary artery spasm, embolism, anemia, arrhythmias, hypertension, hypotension)
How long does it take for full necrosis to occur?
6 hours
What is ventricular remodeling?
Scarring in heart after MI–doesn’t function as well
What agent can reduce scarring post-MI?
ACE Inhibitor!
What are the symptoms of ACS?
Chest pain at rest for more than 20 minutes
Feels like angina
Also: N/V, diaphoresis, SOB, impending doom
How long do you have to do ECG after MI/
Within 10 minutes of presentation
In STEMI, ST is ____ and ___ wave appears
ST is elevated; Q wave appears
What are the cardiac enzymes that indicate MI?
Troponin T and Troponin I–elevation corresponds with size of MI
When should Cardiac Troponin be measured?
In ED and 3-6 hours after symptoms (and maybe later)
What are the TIMI Risk factors?
Age > 65 3 or more risk factors Known CAD >2 episodes of chest discomfort within 24 hours >0.5 mm ST-segment depression \+ biochemical marker
What does the TIMI score mean?
0-2: Low
3-4: Medium
5-7: High
What is the difference between Unstable angina, NSTEMI, and STEMI?
UA: maybe relieved by NTG; No ECG unusualy; negative cardiac markers
NSTEMI: Not usually relieved by NTG; no STE, rarely Q waves; POSITIVE cardiac markers
STEMI: Not usually relieved by NTG; STE; Q waves present; POSITIVE cardiac markers
How are all ACS’s treated initially?
MONA! Morphine Oxygen Nitrates Aspirin
Dosing for Morphine in ACS?
2-4 mg IV q5-30 minutes
When do you give oxygen?
if O2 sat <90%
When do you NOT use nitrates?
- SBP:
- ___ change from baseline
- HR between __ and __
- Use of ___ within 24-48 hours
- SBP <90
- 30 mmHg change from baseline
- HR between 50-100 bpm
- Use of PDEIs within 24-48 hours
How often to monitor BP and HR when using nitrates?
q2h
Dose of IV nitrates during ACS?
5-10 mcg/min titrated to 75-100 mcg/min (for symptom relief or limiting side effects)
Which class of meds should NOT be used for pain management during MI?
NSAIDs!!! (APAP, morphine sulfate, NTGs a-okay!)
What drug classes are used to treat STEMI w/PCI (after MONA therapy)?
- Antiplatelets (P2Y12 inhibitors or GPIIb/IIIa)
- Anticoagulants
Which antiplatelets are used for STEMI w/PCI?
Clopidogrel, Prasugrel, or ticagrelor
Prasugrel or ticagrelor preferred
When is prasugrel contraindicated??
History of TIA/stroke