Acute Coronary Syndromes Flashcards
if a patient has chest pain what is the first 2 thing we need to do
determine if it is cardiac or non cardiac
and how emergent the situation is
how will herpes zoster appear
linear rash
what are some examples of cardiac chest pain
MI
stable angina
myocarditis
pericarditis
valve disease
what are some vascular reasons why might someone will have chest pain
aortic dissection
AAA
what are some pulmonary reasons why someone might have chest pain
pneumothorax
pneumonia
bronchitis
tumors
pulmonary emboli
what are some GI issues issues why someone have chest pain
ulcer disease
cholecystitis
acute pancreatitis
esophagitis
GERD
if someone has chest pain during exercise this might be what type of angina
stable angina
if someone has chest pain during rest this might be what type of angina
unstable angina
how to know if the patient is hemodynamically stable
vital signs
EKG
should the patient drive themself
no call 911
how might coronary ischemic pain present
pressure
substernal pain
radiates to shoulder/arm/jaw
how might an aortic dissection be described
tearning
may go to arms, abdomen, back, legs
pulmonary emboli present as
stabbing
radiates to neck and shoulders
could be assymp.
pneumothorax presents as
severe chest pain with sudden onset
sharp
penumonia presents as
burning or stabbing
cough
alot of the times if the pain radiates to the legs it is not cardiac except
aortic dissection
if there is severe abdominal pain
abdominal aortic anyrseum
if pain occurs when lying down it could be
GI related
risk factors for CAD
> 40
smoking
hypertension
DM
high cholesterol
family history
male
cocaine or alcohol
obesity
sedentary
high BMI
difference between modifiable and non
non we cannot do anything about
examples of nonmodifiable risk factors.
age
heredity
race
sex
modifiable risk factors
cigarette smoking
high cholesterol
hypertension
physical inactivity
obesity
diabetes mellitus
common associated symptoms with MI
N/V
syncope
what pain does NTG relieve
angina and esophagitis
pain suggestive of ischemia
uncomfy pressure and squeezing
imending doom
if someone has sharp or knife like pain that get worse with cough, do we think this is respiratory
no
what is the difference between. stable and unstable plaque
stable plaque is fixed
unstable has an opening that has platelet aggregation and then forms tighter clot
who might present weird with MI
women
diabetics
how might women present after MI
fatigue
how might diabetics present
not conventionalw
what do we do after intervention
reassessment
what is the most specific maker?
troponin
how do we draw Tropinin and Ck? why?
we draw serial, every 4-6 hours
it takes a long time to elevate and just because it isn’t elevated one time doesn’t mean that it is not cardiac related
questions to ask for onset
when did your symptoms start
what were you doing when it began
questions to ask for provocation/palliative/precipitating
did anything bring on the pain
does anything make it better or worse
questions to ask for quality
how would you describe it
questions for region/radiation/referal
where exactly is your discomfort
does the pain go anywhere
how do we as severity
numerical
questions to ask for timing
does it come and go or is it a constant pain
what might diabetics think that MI symptoms are caused by
diabetes/ or sugar control
stable anina
predicatable
typically exercised induced
relieved with nitro
unstable angina
change in previously established stable pattern of angina
more intense
variant/prinzemtal angina
midnight to 5am
same time every night
spasm
what type of sclerosis do we see
atherosclerosis
criteria for type 1 MI
identification of coronary thrombus by angio inducing intracornonary imaging
criteria for type 2 MI
imaging evidence of new loss of viable myocardium or new regional wall motion abnormality in a pattern consistent with an ischemic etiology
criteria for type 3 MI
cardiac death
- patients dead
will troponin and CK be elevated right away
normally not
what coronary artery supplies the nodes most of the time
RCA
what node does the RCA supply most of the time in most people
AV
ischemia wave
depressed T wave
injury wave
ST elevation
infarct wave
depressed Q and ST elevation
what might happen post MI
bundle branch block
which leads are responsible for inferior MI
II
III
aVF
which leads are responsible for anterior MI
V2
V3
V4
II
III
avF cause what type of MI
inferior
II III avf are associated with what coronary artery
RCA
V2, V3, V4 are associated with what MI
anteroir
what coronary artery is V2 V3, V4 associated with
Left
the more leads involved means
more severe
when might PCI be the treatment of choice
cariogenic shock
contraindications of fibro
when might we use fibrinolytic
if PCI is not used
contraincitiaons of fibrinolytic therapy
previous hemorrhagic stroke
intracranial bleeding
bleeding now
what is the goal for fibrinolytic therapy
30 min
drugs associated with anticoag
heparin
drugs associated with platelet inhibitors
asprin
glycoprotein IIB/IIIA inhibitors
what should be included in our immediate assessment
IV
O2
Monitor
ABC
how long to do our immediate assessment
<10min
immediate general treatment
MONA
MONA
- M
morphine
2-4mg q5-10
MONA
-O
oxygen 4L
MONA
- N
nitroglycerine
sublingual or IV
MONA
- A
aspirin 160-325 chew nd swallow
complications of PCI
closure of stent
groin hematoma
retroperitoneal hematoma
what should we monitor for reocculsion of stent
ST trend and pain
what should we monitor for retroperitoneal hematoma
persistent low back pain
patient education
avoid valsalva
smoking cessation
diet
meds
what might cause long QT
meds
what is a bundle branch block
- defintion
block of the entire ventricle of electrical impulse
what is our main cue with bundle branch block
QRS width
- longer than 0.12
