Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CMC > acute_coronary_syndrome_cmc_20161029221613 > Flashcards

acute_coronary_syndrome_cmc_20161029221613 Flashcards

1
Q

A 53 year old male awakens in the morning with crushing chest pain that occasionally radiates into the neck and jaw. He has had these same symptoms before, but only in the morning. It doesn’t bother him while working out or walking. This man mostly likely is suffering fromA. Unstable AnginaB. STEMIC. Prinzmetal’s AnginaD. None of the above

A

C. Prinzmetal’s AnginaThis angina is the result of coronary artery spasms and is not brought on by exercise. It is most common among males 51-57.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are three additional names for Prinzmetal’s Angina?

A

Variant, Atypical, or Vasospastic.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Define Unstable Angina

A

Discomfort that occurs when oxygen demand exceeds oxygen supply.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the most important modifiable risk factor associated with Prinzmetal Angina?

A

Smoking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Identify 3 symptoms of Prinzmetal’s Angina

A

Chest Pain: Under sternum, Squeezing, constricting, tightness, pressure or crushing. May radiate. Most often occurs at rest. Lasts 5-30 minutes. Relieved by NTG.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the Gold standard for diagnosis of Prinzmetal’s Angina?

A

Coronary Angiography with injection of a provocative agent such as Ergonovine, methylergonovine, or acetylcholine.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What medication is used to treat Prinzmetal’s Angina?

A

Calcium channel blockers.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the top 4 modifiable risk factors associated with Unstable Angina?

A

Smoking, HTN, Obesity, and Hyperlipidemia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Name 4 unmodifiable risk factors of unstable angina

A

Sex > in males until around age 65. Age: 55-60Family HistoryRace: African American, esp. females.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What diagnostics are used to identify Unstable Angina?

A

12-lead ECG showing T wave inversion and ST-Depression. Also collect ABG’s, H&H, and EnzymesPerform Echo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How quickly should an echo be performed during Unstable Angina?

A

Within 60 minutes. If EF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the recommended treatment for Unstable Angina?

A

-Oxygen-Aspirin-Nitrates-Beta Blockers-Calcium Chanel Blockers (Post Stent)-Heparin-GBA inhibitors.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Name 3 contraindications to the administration of Aspirin in the setting of ACS.

A

-Hypersensitivity-Active GI bleed-Reactive airway disease (caution)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Name 3 causes of MI

A

Atherosclerosis, Coronary artery spasm, coronary embolism, coronary artery dissection.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Name 4 diagnostics used to diagnose MI

A

12-lead ECG, Enzymes, Echo, Clinical Symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

ST elevation in leads two three and AVF signal what kind of MI

A

Inferior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

ST elevation in leads V2 through V6 indicate what type of MI?

A

Anterior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

ST elevation in leads 1 AVL, V5-6 indicate what kind of MI?

A

Lateral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How long should bed rest last for a patient with a stable MI?

A

24 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

List the primary pharmacologic treatment for MI

A

Oxygen, aspirin, nitrates, morphine, fibrinolytic therapy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Name one contraindication for the use of morphine in acute MI.

A

Systolic blood pressure less than 90

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Name absolute contraindications for Fibrinolytic therapy

A

Previous intracerebral hemorrhage, structural cerebral vascular lesion, malignant intracranial neoplasm, ischemic stroke within three months, suspected aortic dissection, severe closed head injury of facial trauma within three months.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the relationship between an MI and carcinogenic shock?

A

Acute MI causes damage to heart muscle. Damaged heart muscle = impaired pumping.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What respiratory symptom is commonly associated with an Anterior MI?

A

Pulmonary edema related to impared LV function.

25
Q

A right inferior MI is most likely to cause: a: Bradycardia b: Pulmonary edema c: Hypotension d: Tachyarhythmias e: all of the above f: a and c g: b and c

A

f: Bradycardia and Hypotension

26
Q

Name four possible contraindications for cardiac cath.

A

Allergy to seafood, Reaction to contrast, Current use of sildenafil or other phosphodiesterase inhibitor, or pregnancy.

27
Q

Name two possible risks associated with Cardiac Cath

A

Hypotension, contrast reaction, Stroke (Cholesterol emboli), and Trauma r/t hematoma or coronary dissection.

28
Q

Name the indications for PCI vs Fibrinolytic therapy.

A

Onset of ACS>3 hours, Fibrinolytic contraindicated, High risk for Heart Failure, STEMI diagnosis is not absolute.

29
Q

Name the leads used to monitor the RCA during PCI

A

Leads II, III, and aVF

30
Q

Name the leads used to monitor the LAD during and after PCI

A

Leads V1-4

31
Q

Name the leads used to monitor the Left Cx during and after PCI

A

I, aVL, V5, or V6

32
Q

How long is there increased risk for reocclusion post PCI?

A

up to 6 months.

33
Q

What are relative contraindications for CABG?

A

Lack of adequate conduit, Coronary artery distal to stenosis <1-1.5, Severe aortic sclerosis, severe LV dysfunction, coexisting pulm, renal, carotid, and PVD Increase risk.

34
Q

What is the most common Dysrhythmia post CABG? How common is it and when is it’s peak prevalence?

A

Atrial dysryhthmias occuring in 20-40% of patients and with peak prevalence at 3-5 days post-op.

35
Q

What acute cardiac process is responsible for 75% of instances of SCD?

A

Previous MI esp. within the first 6 months. Also CAD 80%

36
Q

Name four major risk factors for CAD

A

Smoking, Family Hx Cardiovascular disease, High cholesterol, and Cariomegaly

37
Q

What are the risk factors for SCD?

A

EF <40%, prior episode of MI, family hx SCD, family hx long Qt syndrome or WPW, VT or VF after ACS, Congenital heart defects, Syncope, HF 6-9x more likely to have V arrhythmia, Drug use.

38
Q

What is the recommended screening for SCD

A

If family history or increased risk, Exercise stress test Men >40 Women >50. every 2 years.

39
Q

What medication shows a 10% reduction in risk for SCD in at risk patients?

A

ACE

40
Q

What medication shows a 50% reduction in risk for SCD in at risk patients?

A

Beta Blocker

41
Q

What medication is recommended to reduce risk of SCD in patients with Prinzmetal’s angina Coronary spasms?

A

Calcium Channel Blocker

42
Q

What interventions are used to prevent SCD

A

ICD, Angioplasty, CABG, Ablation

43
Q

A 53 post CABG patient has an epicardial Pacemaker set to AAI. What does this mean?

A

The pacemaker will Pace the Atrium, it Will Sense the Atrium, and it will inhibit pacing if an underlying beat is present.

44
Q

A 74 year old patient with CHF has a DDI setting on their implanted Pacemaker. What does this mean.

A

The pacemaker will pace both atrium and Ventricles. It will sense both chambers and it will Inhibit pacing for intrinsic beats.

45
Q

What percentage of Cardiac arrest occur outside of hospital and what percentage survive?

A

64% occur out of hospital with a 2-9% survival rate. Of these, 1/3 sustain irreversible cognitive dysfunction.

46
Q

What were the current survival rate of in hospital arrest?

A

18%

47
Q

What is the induction phase of therapeutic hypothermia?

A

The goal is to achieve target body temp as quickly as possible.

48
Q

What means are used to achieve induction of hypothermia therapy?

A

Ie packs, ice lavage, rapid cold infusion, IV cath that circulates cold fluid in a closed loop.

49
Q

What consideration should be made during induction TH?

A

Sedation and neuromuscular blockade to prevent shivering.

50
Q

During induction of Hypothermia, What is expected to occur in regard to fluid balance.

A

Cold diuresis resulting in the loss of several liters of fluid in 1-2 hours.

51
Q

What is the Goal of the Maintenance Phase of TH?

A

The goal is to maintain a core body temp between 32-34 Degrees C.

52
Q

What is the goal of the Rewarming phase of HT?

A

Close control of the rewarming process.

53
Q

What is the goal rate of rewarming in TH?

A

o.15 - 0.5C per hour is recommended.

54
Q

Why is close control of the rewarming process so crucial?

A

Rewarming a patient too quickly may cause excessive shivering leading to deadly electrolyte shifts.

55
Q

Name some considerations for monitoring during the rewarming phase of TH.

A

Close observation of electrolytes as they shift out of cells into serum. Close monitoring of fluid volume r/t vasodilation. Close monitoring of blood sugar (risk for hypoglycemia).

56
Q

Do no perform TH on:

A

DNR/DNI, Underlying coagulopathy or bleeding disorder, Head injury, Core body temp of 30C prior to therapy, CPR/Unresponsive ≥60 min.

57
Q

What is goal time for Induction phase of TH?

A

Goal = 6 hours.

58
Q

What is recommended for Cannulation induction?

A

LR or NS 30mL/kg with pressure beg via large bore cannula.

59
Q

What and How often should labs be drawn during the maintenance phase of TH?

A

BMP CBC Trop/CK/K-MB ABG’s every 6 hours.

CMC (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions