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emed > Acute Coronary Syndromes > Flashcards

Acute Coronary Syndromes Flashcards

1
Q

What is rest angina?

A

Occurring at rest and prolonged, >20 min

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2
Q

What is increasing angina?

A

Previously diagnosed that has become more frequent, has a longer duration, or is lower in threshold, limiting ability to walk 1-2 block, or climb 1 flight of stairs

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3
Q

What are the 3 kinds of unstable angina?

A

New, rest, increasing (changing)

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4
Q

What is required before you give nitro?

A

EKG

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5
Q

What is angina chest pain due to?

A

Ischemia

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6
Q

What leads are inferior?

A

II, III, aVf

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7
Q

If the RCA is affected what can you not give?

A

Nitro

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8
Q

What determines coronary artery blood flow?

A

Duration of diastolic relaxation and peripheral vascular resistance

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9
Q

What are some things that classically precipitate angina?

A

Exercise, stress, and a cold environment

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10
Q

What is associated w/ non-classic ACS presentations?

A

DM, advanced age, female

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11
Q

What are the traditional risk factors for factors for CAD?

A
  1. HTN
  2. DM
  3. Tobacco
  4. Fam Hx
  5. Hypercholesteroemia
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12
Q

What are bradycardia rhythms more common with?

A

Inferior wall myocardial ischemia

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13
Q

What sound is present in 15-20% of AMI and may indicate a failing heart myocardium?

A

S3 (passive filling of an overly compliant LV creates the sound)

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14
Q

What does rales indicate?

A

LV dysfunction and L sided heart failure

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15
Q

JVD, hepatojugular reflex and peripheral edema suggest what on examination?

A

Right sided heart failure

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16
Q

What is the diagnosis of NSTEMI depend on in the setting of symptoms?

A

Abnormal evlevaton of cardiac biomarkers

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17
Q

What is the TIMI score? thrombosis in myocardial infarction

A

Stratifies the 14 day risk of mortality, w/ new or recurrent AMI or severe recurrent ischemia requiring urgent revasularization

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18
Q

What is the TIMI?

A
  1. Age 65 y/older
  2. 3 or more traditional risk factor
  3. Prior coronary stenosis 50%
  4. ST segment deviation
  5. 2 or more animal events in 24 hrs
  6. Aspirin use w/in 7d prior
  7. Elevated cardiac markers
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19
Q

What is the single best test to identify AMI?

A

ECG

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20
Q

How long do you have to obtain and interpret the initial 12 lead ECG tracing w/ patient presenting w/ symptoms of myocardial ischemia?

A

10 min

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21
Q

What is the general definition of a STEMI?

A

ST elevations of 1mm or more in at least 2 contiguous leads w/ reciprocal changes

22
Q

What are the two ECGs that you are required to have?

A

The first and then pain free

23
Q

Anteroseptal

A

V1, V2, maybe V3

24
Q

Anterior

A

V1, V2, V3, V4

25
Q

Anterolateral

A

V1-V6, I, and aVL

26
Q

Lateral

A

I and aVL

27
Q

Inferior

A

II, III, aVF

28
Q

True posterior

A

Initial R waves in V1 and V2>.04 s and R/S ratio?=1

29
Q

Inferolateral

A

II, III, aVF, V5, V6

30
Q

Right ventricular

A

II, III, aVF and ST in right sided V4

31
Q

How do you identify AMI in the setting of a LBBB?

A
  1. ST- elevation 1mm or greater and concordant (in the same direction as the main deflection) w/ the QRS complex
  2. ST segment depression of 1 mm or more in leads V1, V2, V3
  3. ST segment elevation of 5 mm or greater and discordant ( in the opposite direction) with the QRS
32
Q

Should unstable angina have positive cardiac markers?

A

No!

33
Q

What is the diagnostic criteria for acute myocardial infarction using serum markers?

A

Gradual rise and fall of cTn w/ a maximum value above the 99th percentile combined w/ any of the following

  1. Symptoms of ischemia
  2. Acute ECG changes
  3. Wall motion abnormality
  4. Loss of viable myocardium
34
Q

What are the absolute contraindications to STEMI fibrinolytic therapy?

A
  1. Prior intracranial hemorrhage
  2. structural cerebral vascular lesion,
  3. intracranial neoplasm,
  4. ischemic stroke w/in 3 months,
  5. active internal bleeding,
  6. suspected aortic dissection/ pericarditis
35
Q

What is the dysrthmia that he said that can occur as a result of ACS?

A

A fib

36
Q

What can occur in 1-5 days post infarction?

A

Ventricular free wall rupture

37
Q

What are the signs and symptoms of ventricular free wall rupture?

A

Tearing pain or sudden severe pain, w/ hypotension, tachycardia, and onset of confusion, increased neck veins, decreased heart sounds, pulses paradoxus

38
Q

What is associated w/ a new holosystolic murmur after MI and how do you see it?

A

Doppler echo,interventricular septum rupture

39
Q

2-4 days after transmural AMI, discomfort w/ deep respiration’s relieved by sitting fwd?

A

Pericarditis

40
Q

What is the treatment for pericarditis?

A

Aspirin/ colchicine

41
Q

2-10 weeks post AMI, chest pain, fever, pleuropericarditis?

A

Dressler’s treat w/ aspirin and colchicine

42
Q

How to treat someone coming back in shock, w/ RV infarction?

A

Give 1-2 L normal saline begin inotrope support w/ dobutamine

43
Q

What is the most sensitive sign for HF?

A

Dyspnea on exertion

44
Q

What is the most specific signs of HF?

A

PND,orthopnea, edema

45
Q

What is the exam w/ highest for HF?

A

S3

A abdominojugular reflex and JVD are the other two

46
Q

Risk factors for HF?

A
  1. HTN
  2. Diabetes
  3. Valvular heart disease
  4. Old
  5. Male
  6. Obese
47
Q

What is abnormal BnP?

A

> 500

48
Q

POC ultrasounds in HF show what?

A

B lines

49
Q

For normo-tensive HF how much diruetic how much do you give them?

A

Their daily dose, or double the daily dose

50
Q

Kid that dies while exercising?

A

HOCM

51
Q

Child w/ heart attack?

A

Sickle cell

52
Q

What causes primary cardiomyopathies?

A

Heart tissue only

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