Acute Coronary Syndromes

Question 1

if a patient has chest pain what is the first 2 thing we need to do

Answer 1

determine if it is cardiac or non cardiac
and how emergent the situation is

Question 2

how will herpes zoster appear

Answer 2

linear rash

Question 3

what are some examples of cardiac chest pain

Answer 3

MI
stable angina
myocarditis
pericarditis
valve disease

Question 4

what are some vascular reasons why might someone will have chest pain

Answer 4

aortic dissection
AAA

Question 5

what are some pulmonary reasons why someone might have chest pain

Answer 5

pneumothorax
pneumonia
bronchitis
tumors
pulmonary emboli

Question 6

what are some GI issues issues why someone have chest pain

Answer 6

ulcer disease
cholecystitis
acute pancreatitis
esophagitis
GERD

Question 7

if someone has chest pain during exercise this might be what type of angina

Answer 7

stable angina

Question 8

if someone has chest pain during rest this might be what type of angina

Answer 8

unstable angina

Question 9

how to know if the patient is hemodynamically stable

Answer 9

vital signs
EKG

Question 10

should the patient drive themself

Answer 10

no call 911

Question 11

how might coronary ischemic pain present

Answer 11

pressure
substernal pain
radiates to shoulder/arm/jaw

Question 12

how might an aortic dissection be described

Answer 12

tearning
may go to arms, abdomen, back, legs

Question 13

pulmonary emboli present as

Answer 13

stabbing
radiates to neck and shoulders
could be assymp.

Question 14

pneumothorax presents as

Answer 14

severe chest pain with sudden onset
sharp

Question 15

penumonia presents as

Answer 15

burning or stabbing
cough

Question 16

alot of the times if the pain radiates to the legs it is not cardiac except

Answer 16

aortic dissection

Question 17

if there is severe abdominal pain

Answer 17

abdominal aortic anyrseum

Question 18

if pain occurs when lying down it could be

Answer 18

GI related

Question 19

risk factors for CAD

Answer 19

> 40
smoking
hypertension
DM
high cholesterol
family history
male
cocaine or alcohol
obesity
sedentary
high BMI

Question 20

difference between modifiable and non

Answer 20

non we cannot do anything about

Question 21

examples of nonmodifiable risk factors.

Answer 21

age
heredity
race
sex

Question 22

modifiable risk factors

Answer 22

cigarette smoking
high cholesterol
hypertension
physical inactivity
obesity
diabetes mellitus

Question 23

common associated symptoms with MI

Answer 23

N/V
syncope

Question 24

what pain does NTG relieve

Answer 24

angina and esophagitis

Question 25

pain suggestive of ischemia

Answer 25

uncomfy pressure and squeezing imending doom

Question 26

if someone has sharp or knife like pain that get worse with cough, do we think this is respiratory

Answer 26

no

Question 27

what is the difference between. stable and unstable plaque

Answer 27

stable plaque is fixed unstable has an opening that has platelet aggregation and then forms tighter clot

Question 28

who might present weird with MI

Answer 28

women diabetics

Question 29

how might women present after MI

Answer 29

fatigue

Question 30

how might diabetics present

Answer 30

not conventionalw

Question 31

what do we do after intervention

Answer 31

reassessment

Question 32

what is the most specific maker?

Answer 32

troponin

Question 33

how do we draw Tropinin and Ck? why?

Answer 33

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

Question 34

questions to ask for onset

Answer 34

when did your symptoms start what were you doing when it began

Question 35

questions to ask for provocation/palliative/precipitating

Answer 35

did anything bring on the pain does anything make it better or worse

Question 36

questions to ask for quality

Answer 36

how would you describe it

Question 37

questions for region/radiation/referal

Answer 37

where exactly is your discomfort does the pain go anywhere

Question 38

how do we as severity

Answer 38

numerical

Question 39

questions to ask for timing

Answer 39

does it come and go or is it a constant pain

Question 40

what might diabetics think that MI symptoms are caused by

Answer 40

diabetes/ or sugar control

Question 41

stable anina

Answer 41

predicatable typically exercised induced relieved with nitro

Question 42

unstable angina

Answer 42

change in previously established stable pattern of angina more intense

Question 43

variant/prinzemtal angina

Answer 43

midnight to 5am same time every night spasm

Question 44

what type of sclerosis do we see

Answer 44

atherosclerosis

Question 45

criteria for type 1 MI

Answer 45

identification of coronary thrombus by angio inducing intracornonary imaging

Question 46

criteria for type 2 MI

Answer 46

imaging evidence of new loss of viable myocardium or new regional wall motion abnormality in a pattern consistent with an ischemic etiology

Question 47

criteria for type 3 MI

Answer 47

cardiac death - patients dead

Question 48

will troponin and CK be elevated right away

Answer 48

normally not

Question 49

what coronary artery supplies the nodes most of the time

Answer 49

RCA

Question 50

what node does the RCA supply most of the time in most people

Answer 50

AV

Question 51

ischemia wave

Answer 51

depressed T wave

Question 52

injury wave

Answer 52

ST elevation

Question 53

infarct wave

Answer 53

depressed Q and ST elevation

Question 54

what might happen post MI

Answer 54

bundle branch block

Question 55

which leads are responsible for inferior MI

Answer 55

II III aVF

Question 56

which leads are responsible for anterior MI

Answer 56

V2 V3 V4

Question 57

II III avF cause what type of MI

Answer 57

inferior

Question 58

II III avf are associated with what coronary artery

Answer 58

RCA

Question 59

V2, V3, V4 are associated with what MI

Answer 59

anteroir

Question 60

what coronary artery is V2 V3, V4 associated with

Answer 60

Left

Question 61

the more leads involved means

Answer 61

more severe

Question 62

when might PCI be the treatment of choice

Answer 62

cariogenic shock contraindications of fibro

Question 63

when might we use fibrinolytic

Answer 63

if PCI is not used

Question 64

contraincitiaons of fibrinolytic therapy

Answer 64

previous hemorrhagic stroke intracranial bleeding bleeding now

Question 65

what is the goal for fibrinolytic therapy

Answer 65

30 min

Question 66

drugs associated with anticoag

Answer 66

heparin

Question 67

drugs associated with platelet inhibitors

Answer 67

asprin glycoprotein IIB/IIIA inhibitors

Question 68

what should be included in our immediate assessment

Answer 68

IV O2 Monitor ABC

Question 69

how long to do our immediate assessment

Answer 69

<10min

Question 70

immediate general treatment

Answer 70

MONA

Question 71

MONA - M

Answer 71

morphine 2-4mg q5-10

Question 72

MONA -O

Answer 72

oxygen 4L

Question 73

MONA - N

Answer 73

nitroglycerine sublingual or IV

Question 74

MONA - A

Answer 74

aspirin 160-325 chew nd swallow

Question 75

complications of PCI

Answer 75

closure of stent groin hematoma retroperitoneal hematoma

Question 76

what should we monitor for reocculsion of stent

Answer 76

ST trend and pain

Question 77

what should we monitor for retroperitoneal hematoma

Answer 77

persistent low back pain

Question 78

patient education

Answer 78

avoid valsalva smoking cessation diet meds

Question 79

what might cause long QT

Answer 79

meds

Question 80

what is a bundle branch block - defintion

Answer 80

block of the entire ventricle of electrical impulse

Question 81

what is our main cue with bundle branch block

Answer 81

QRS width - longer than 0.12