Acute coronary syndrome Flashcards
What is myocardial infarction
Cell death of myocytes
What are the three main spectrums of Acute coronary Syndromes
Unstable Angina, Non-ST-Elevation Myocardial Infarction, ST-Elevation Myocardial Infarction
Why does Nitroglycerin and rest not relieve a person’s symptoms in some ACS cases
There could be complete occlusion of an artery leading to a need of more intense therapy
T/F: When a patient enters an emergency department with clinical suspicion of ACS with ischemic symptoms and ECG should be within 10 minutes
True
What are the two types of ACSs that can be shown from an ECG
Non-ST-Elevation Myocardial Infarction, ST-Elevation Myocardial Infarction
T/F: Non-ST-Elevation Myocardial infarction is highly specific for a hear attack
False: ST-Elevation Myocardial Infarction is high specific for a heart attack. In Non-ST-Elevation Myocardial infarction ischemia is a concern
What is the cardiac enzyme that is sensitive to having a heart attack (confirms), how long does it take for the enzymes to show up, how long to peak
Troponin, 4 hours, 1 day
What is a spontaneous MI (type 1)
Spontaneous MI due to plaque rupture, thrombus formation, and low blood flow
What is a risk calculator used in patients with ACS, what does it asses
TIMI, Death or myocardial infarction within the next 14 days
On the TIMI score what events are one point each in the variable “HISTORY”
Greater than or equal to 2 events in the past 24 hours, Known cardiovascular disease, Aspirin use within 7 days
On the TIMI score what causes a point to be added in the variable “ECG”
Changes in ST
On the TIMI score what causes a point to be added in the variable “Troponin”
Elevated Troponin
On the TIMI score what causes a point to be added in the variable “Age”
Age greater than 65 years
On the TIMI score what causes a point to be added in the variable “Risk factors”
Having 3 or more risk factors
When all the points are compiled for the TIMI score what indicates low risk, intermediate risk, High risk
0-2, 3-4, 5-7
T/F: A clinical assessment that includes a physical exam gives evidence on whether a patient has heart failure
True
When getting labs what is needed for coagulation profile
INR, PTT
When getting labs what is needed for CBC
HgB, Hct, platelets
What Chem 7 labs are good for treating a patient
Electrolytes, BUN, Cr
What are the treatment goal for ACS
Restore blood flow to limit infarct size if having an MI, prevent/minimize complications, prevent reocculusion, relieve symptoms, resolve ECG changes
For patients who are having an acute coronary syndrome what are the treatment considerations (hint:thrombinss)
T: Thinopyridine (P2Y12 inhibitor) H: Heparin (parental anticoagulant) R: Renin-angiotensin-aldosterone system inhibitor O: Oxygen M: Morphine B: Beta-blocker I: intervention (PCI) N: Nitroglycerin S: Salicylate S: Statin
What is the acute supportive care that should be done regardless of whether the patient has a NSTEMI or STEMI
Aspirin: 162 mg - 325 mg IR, Nitroglycerin: 0.3 - 0.4 mg sublingual every 5 minutes as need but up to 3 doses
Oxygen: if O2 saturation is less than 90%
What drugs should all patients with ACS have, what is the preferred maintenance dose
Aspirin, 81 mg
T/F: Aspirin is contraindicated in patiens using ticagrelor
False: Patients treated with ticagrelor should not use aspirin doses greater than 100 mg daily
Why should aspirin tablets be crushed or chewed before eating them for ACS
The patient needs to bypass the enteric coating in order to get immediate release
T/F: There is no safety and efficacy data for the use of morphine and oxygen in ACS that has been established
True
What is the rationale behind using morphine, when should oxygen be administered in support
Decreases anxiety and calms the patient lowering BP, NTG is not working, IV acts as vasodilator/ When arterial oxygen saturation is less than 90%
When nitroglycerin is given IV what determines the titration, how often can this titration occur
Pain relief and BP, every 3-5 minutes
How does NTG cause headache
Vasodilation causes pain in the head
When should NTG be avoided
The patient has a right ventricular infarct, use of phosphodiesterase inhibitors
What phosphodiesterase inhibitors should be avoided with NTG use, how long
Sildenafil (Viagra) and Vardenafil (Levitra) within 24 hours, Tadalafil (Cialis) within 48 hours
When should oral beta-blockers be started if a patient is having a ACS event
Within the first 24 hours
When should IV beta-blockers be considered
A high blood pressure and high heart rate
When should beta blockers be avoided
Acute or Congestive heart failure, older than 70, Systolic BP less than 120 mmHg, Heart rate greater than 110 or less than 60, prolonged time since symptom onset
If a patient comes in with STEMI what should be done after the patient has had acute supportive care, how
Initiate reperfusion therapy: Primary PCI preferred, fibrinolysis if the door to balloon time is greater than 120 mins
What is the goal for reperfusion in a patient who has a STEMI, why
From door to drug 30 mins (thrombolytics), from door to balloon 90 mins (primary PCI)/ the more time wasted the more heart muscle tissue dies
What are two main characteristics a patient must have in order to be an adequate patient for fibronyltics
History of acute coronary syndrome presenting with symptoms within 12 hours of the symptom onset, EKG shows there is an ST elevation
T/F: Only consider fibronolytics if the patient has the two main indications and cannot recieve a PCI within one hour
False: Only consider fibronolytics if the patient has the two main characteristics and cannot recieve a PCI within two hours
