Acute Coronary Syndrome Flashcards
1 Cause of death worldwide
Ischemic Heart Disease
RF (HD)
Age Male Fm Hx DM HTN HLD Smoking Obesity/Sedentary lifestyle
Chest discomfort (pressure, squeezing, tightness, heaviness) 2/2 ischemia
Exacerbated c exertion; Alleviated c rest
Atypical sxs c DM, Elderly, Female
Angina
Anginal pain at rest or upon waking
Young women
2/2 anxiety, stress, coronary VASOSPASM
ST elevation
Variant / Prinzmetal’s Angina
Tx Prinzmetal’s
CCB (Dihydropyridines) & Nitrates
Avoid caffeine, nicotine, ergots
NO BB
Atypical angina (DM, Elderly)
SOB, DOE, Dizzy, Fatigue, (Near) Syncope
Epigastric pain
Dec appetite
Asx - Silent
Predictable pattern to angina
Precipitated by: Exertion, Emotion, Eating
Lasts 5-15 min
Pain, no EKG chng, no elev enzymes
Stable (Demand) angina
Tx (Stable angina)
Rest
NTG
New onset angina; angina at rest
Changing pattern: freq, duration, intervention
“Pre-infarct”
Pain, no EKG chng, no elev enzymes
Unstable (Supply) angina
“Pre-infarction”
…longer periods of rest; more NTG req.
T-wave inversion
“Non-completed” MI
Pain, min EKG chng, elev enzymes
NSTEMI
ST elevation (depression in opp. leads)
Tombstones
Pain, maj EKG chng, elev enzymes
STEMI
Myocardial cell death
Usually coronary artery thrombus
More severe form of anginal pain
Q-wave
Myocardial Infarction
Tx (AMI)
MONA B ASA - right away (reduces mortality) Oxygen Morphine and Nitro (CP relief, but will dec BP) BB only after fluid off lungs
Anticoagulation (AMI)
ASA - always
Plavix - reduced mortality in STEMI
Heparin/Lovenox - red mortal in STEMI
Thrombolytics in STEMI (best if within 70 min)
…Cath lab/PCI most efective (within 90 min)
Post-MI Tx
BB (within 24 hrs); not with CHF, low EF ACEI - affects remodeling Statins ASA - 81 mg Plavix - 12 months if use DES
Avoid… in post-MI
NSAIDS Nifedipine (short-acting)
Surgery for:
Single vessel or mult discrete lesions =
Left main, diffuse dz, failure of balloon/stent =
= PTCA
=CABG
F/U (AMI)
Smoking cessation
Lipid eval
Diet & exercise
Mngt comorbid dz
ST segment:
depression =
elevation =
= subendocardial ischemia
= transmural ischemia
Which leads are: anteroseptal = anteroapical = lateral = inferior = posterior =
= V1-2 = V3-4 = V5-6, I, aVL = II, III, aVF = V1-2 (?)
Which leads affect the:
LAD =
RCA =
Circumflex =
= V1-4
= V1-2, II, III, aVF
= V5-6, I, aVL
ANS activation in AMI
SNS - diaphoresis, vasoconstriction
PSNS - Nausea (comm infer wall MI), weak
Sharp, pleuritic CP worse c inspiration Relieved leaning forward Friction RUB Odynophagia DIFFUSE ST elevation; PR depression EKG - electrical alternans (QRS size) Dyspnea, rales, tachypnea, fever, myalgias
Acute Pericarditis
Acute onset dyspnea
Pleuritic pain
RF: Virchow’s triad (stasis, endothelial damage, hypercoagulability)
Widened As gradient
PE
Intimal tear
Abrupt onset ripping/tearing (back, shoulder blades)
Unequal pulses
Cardiac tamponade c Beck’s triad (hypotension, JVD, muffled heart sounds)
Aortic dissection
Causes of Pericarditis (inflamm of sac)
Idiopathic Virus - Coxsackie... Bact - H. flu Fungal Neoplastic - Lung, breast , lymphoma Autoimmune - SLE, RA Meds - Procainamide, Hydralazine
Develop pericarditis 1-8 wks after AMI
Dressler’s Syndrome
Pulsus paradoxus (SBP drops > 10 with insp)
Dyspnea, cyanosis
JVD, hypotension, thready pulse, quiet / muffled pericardium (Beck’s triad)
Ewart’s sign - dullness and bronchial breathing
Pericardial tamponade
Tx (Pericarditis)
NSAIDS
