Acute Coronary Syndrome + Shock

Question 1

Acute Coronary Syndrome (ACS) RF

Answer 1

Age, tobacco, hyperlip, DM, HTN, obesity, fam hx

Question 2

ACS Presentation

Answer 2

• CP or pressure
• Levine’s sign (clutching chest)
• Radiation to arm, neck, jaw
• Heartburn
• SOB
• Diaphoresis
• NV
• Syncope
• Fatigue

Question 3

ACS physical exam

Answer 3

• BP, HR and rhythm
• SPO2
• Distress? Anxious?
• JVD?
• Diaphoresis?
• Heart sounds
• Rales?

Question 4

ACS tests/labs to perform

Answer 4

• EKG
• Troponin
• CPK (muscle damage)
• CPK-MB (heart muscle damage)
• CXR (heart size, fluid in lungs)
• CBC
• CMP

Question 5

ACS tx

Answer 5

• MONA
• If nitro causes hypoTN, MI is on right heart
• Morphine: pt in pain has high HR, requires more O2 (want to decrease HR and O2 demand)

Question 6

Unstable angina

Answer 6

Plaque obstructing flow, but flow is still happening

Question 7

Unstable angina presentation

Answer 7

Sx at rest (vs stable angina, sx w/ exertion)

Question 8

Unstable angina test/lab results

Answer 8

• Biomarkers are NOT elevated

- Normal EKG

Question 9

Unstable angina tx

Answer 9

Observe for >12 hrs:

• If no pain or neg f/u studies –> d/c
• If + stress test –> ACS, admit
• If pain recurs or + f/u studies –> ACS, admit

Question 10

STEMI

Answer 10

Acute clogged pipe, full occlusion, no O2 to heart

Question 11

STEMI test/lab results

Answer 11

• EKG: diffuse ST elevations

- Elevated biomarkers

Question 12

STEMI tx

Answer 12

• REFER to cardiology for cath

- Cardiac rehab after d/c

Question 13

NSTEMI

Answer 13

Not fully occluded, but bloodflow is blocked enough to produce sx

Question 14

NSTEMI test/lab results

Answer 14

• EKG: no ST changes

- Elevated biomarkers

Question 15

NSTEMI tx

Answer 15

• Aspirin + Plavix + Statin + ACEI

- Cardiac rehab after d/c

Question 16

Cardiogenic shock

Answer 16

PUMP FAILURE
- HypoTN and hypoperfusion due to poor CO (10% of MI pts)

• Low CO
• High filling pressures (velocity thru vessels)
• High vasc resistance
• Low circulating O2

Question 17

Cardiogenic shock RF

Answer 17

Recent MI, recent viral illness, age, HTN, DM, valvular heart disease

Question 18

Cardiogenic shock sx/types and what do they mean?

Answer 18

• Warm + dry: no tx
• Warm + wet: diuresis
• Cold + dry: functional intolerance
• Cold + wet: in CS, inotrope or vasopressor and diuretic

Question 19

Cardiogenic shock labs to perform

Answer 19

EKG, echo, ABG, CBC, CMP, CE (troponin)

Question 20

Cardiogenic shock tx

Answer 20

• Pulm artery cath
• Intra-aortic balloon pump
• Impella device (temporary)
• Percutaneous ventricular assist devices
• ECMO
• Meds: inotropes, vasodilators, vasopressors