Adams Week 4 Flashcards
What is on the differential for Chest Pain?
anxiety, aortic stenosis, asthma, cardiomyopathy, esophagitis, gastroenteritis, hypertensive emergency, myocarditis, pericarditis, cardiac tamponade, aortic dissection, pulmonary emboli
What can Acute Coronary Syndrom break into?
non-cardiac ds, stable angina, unstable angina, definite ischemic event (stemi or nstemi)
What ages count for family history of coronary disease?
Father
If patient has stroke symptoms and EKG demonstrating MI what is possible dx?
aortic dissection dt ischemia cutting off the carotid
What are alternative presentations of chest pain in women, the young and the old?
no ‘pain’ just: SOB, sweaty, syncope, stroke, palpitation, indigestion, weakness
What are adjectives that people use to describe alternative presentation of chest pain?
heartburn, indigestion, sharp squeezing, burning, numbness
What heart sound has decreased left ventricular compliance (cannot occur in atrial fibrillation since it is caused by atria contraction driving blood into the ventricle and against an abnormal ventricular wall)
S4
What heart sound do you hear with left ventricular dysfunction?
S3
What do you note in CHF?
crackles, hepatojugular reflux, leg edema
What EKGs look the same initially?
unstable angina and NSTEMI
Can a q wave differentiate stemi or non-stemi?
No
How long do sx last in Angina?
less than 30 minutes
what has increasing duration, frequency, or intensity; new associated sx and occurs with increasingly less activity or at rest?
Unstable Angina
10% with unstable angina will have an MI within what time frame?
7 days
What is Angina grade 1? grade 4?
- ordinary physical activity does NOT cause Angina, but do have it with exertion prolonged
- inability to carry out any physical activity; angina at rest
What criteria defines an MI?
elevation of tropinin and at least 1: sx of ischemia, Q wave development, new ST/T wave change or new LBBB, intracoronary thrombus, loss of cardiac wall
What should you get if you have an inferior MI?
right side leads EKG looking for right ventricle infarct
STEMI
STE> 1mm in two contiguous leads but in leads V2-V3 at least 2 contiguous leads with >2 mm in men or >1.5 mm in women
New left bundle branch block
difficult to dx STE because LBBB have STE normally (may not be an MI)
EKG of Posterior MI
back of heart so infarct STE will appear as ST depressions
NSTEMI and EKGs
horizontal or downward sloping ST depression >.05 in contiguous leads AND/OR T wave inversion >.1 mV with prominent R wave R/S ratio >1 in 2 contiguous leads
Troponin: sensitivity vs specificity
higher sensistivity at the price of lower specificity, false + in anything that stresses the heart (AFib, Sepsis, CKD)
Can you have a normal troponin with unstable angina?
Yes
What to do with pt. with a heart score of 0-3?
Discharge
What to do with pt. with a heart score of 4-6?
X-ECG
What to do with pt. with a heart score of 7-10?
CAG
How to tx low risk ACS?
ASA, conservative observation with repeat troponin in 6-12 hours
How to tx moderate to high risk ACS?
nitroglycerin, heparin, repeat troponin in 6-12 hours
How to manage UA/NSTEMI?
PCI (percutaneous coronary intervention), medications
How to manage a STEMI (ST elevations or new LBBB)?
Fibrinolytics (only in STEMI), PCI with dilation and stinting, CABG, meds (heparin, aspirin, ticegralor)
When do you NOT give nitroglycerin? why?
right ventricular infarct (50% of inferior MI’s); reduces preload and caused BP to drop
What do you give in an MI if the patient is unable to take aspirin?
Clopidogel in pts less than 75
What is the MOA of clopidogel?
inhibits adenosine 5’-diphosphate (ADP)-dependent activation of the glycoprotein IIb/IIIa complex to stop platelet aggregation
When do you use a Glycoprotein IIb/IIIa inhibitor? name some
in conjunction with PCI, inhibits platelet aggregation (Abciximab, Eptifibatide, tirofiban)
What to give in the first 24 hours after MI?
ACE inhibitors and B Blockers
When to give an ACE inhbitior?
in pt with CHF or LV ejection fraction less than 40% and no hypotension
What to use if contraindications of B Blocker?
Ca channel blocker
What is Takotsubo cardiomyopathy?
stress cardiomyopathy dt surge of stress hormones; non-ischemic cardiomyopathy with sudden temporary weakening of the myocardium
What can cause the EKG to look like and anterior and posterior MI same time?
Myocarditis
What is usual USA cause of myocarditis?
Parovirus B19
What is the worldwide usual cause of Myocarditis?
Chagas ds from protozoan Trypanosoma cruzi
