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CPR Exam 1 > Angina and ACS > Flashcards

Angina and ACS Flashcards

1
Q

Stable Angina

A

CP for >2m precipitated by exertion or emotional distress that is not getting worse

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2
Q

3 types of ACS

A
  1. Unstable Angina
  2. NSTEMI
  3. STEMI
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3
Q

Difference between unstable angina and NSTEMI

A

NSTEMI= elevated cardiac enzymes

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4
Q

Modifiable risk factors for development of CAD

A

HHCD

  • Hyperlipidemia
  • HTN
  • Cigarrette smoking
  • Diabetes (bedus)
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5
Q

What are CKD, proteinuria, and chronic inflammatory states risk factors for?

A

CAD

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6
Q

Explain the steps of plaque formation (5 steps)

A
  1. Endothelial injury
  2. LDL and Macrophage deposition
  3. Foam cell formation
  4. smooth muscle recruitment into tunica intima
  5. deposition of ECM

Fibrous Cap with a Necrotic Center

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7
Q

3 outcomes of atherslerotic plaque deposition

A
  1. Aneurysm and Rupture
  2. Occlusion via Thrombus
  3. Stenosis
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8
Q

Clinical presentation of ACS

A 
CP that radiates to neck, jaw, arms (angina pectoris) 
Dyspnea
NV
Diaphoresis
Fatigue
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9
Q

What groups of people should you suspect atypical presentations of ACS in?

A

Elderly
Women
Wilford Brimley (Diabetics)

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10
Q

Diamond Forrester Criteria of CP

A
  1. Substernal CP
  2. Provoked by exertion/emotion
  3. Relieved by Nitro
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11
Q

Using the Diamond Forrester Criteria, define typical, atypical, and Non-Angina CP

A

Typical- all 3 components
Atypical- 2/3
Non-Anginal- <1

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12
Q

What would you see on ECG in stable angina, unstable angina, NSTEMI, and STEMI?

A 
Stable= NORMAL
Unstable/NSTEMI= ST depression/Inverted T wave
STEMI= ST elevation with hyper acute T wave
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13
Q

Different stressors of a cardiac stress test

A
  1. Exercise

2. Pharmacology- Vasodilators or Dobutamine

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14
Q

3 testing modalities of a stress test

A
  1. Stress ECG
  2. ECHO
  3. Myocardial Perfusion Imaging (MPI)
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15
Q

If a person has abnormalities on ECG during a stress test, what is the next step of treatment?

A

Coronary Angiography

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16
Q

STEMI ECG criteria

A

ST elevation >2mm in continuous leads or new LBBB

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17
Q

NSTEMI ECG criteria

A
  1. New ST depression >0.5mm in two contiguous leads
  2. T wave inversions
  3. prominent R waves (R/S ratio >1)
18
Q

What usually precipitates a STEMI vs a NSTEMI?

A

STEMI- occlusion of blood flow in a coronary vessel

NSTEMI- partial occlusion or complete occlusion with collateral flow

19
Q

When do Troponins typically peak?

20
Q

Treatment of Stable Angina

A

Lifestyle mods
Aspirin
Statin
Anti-Anginal drugs: B-blockers, CCB

21
Q

Describe External Enhanced Counterpulsations (EECP) Therapy

A

Option to treat stable Angina. Compresses LE’s during diastole

22
Q

CABG Indications

A
  1. 3 vessels @ >70% stenosis
  2. Left main artery disease
  3. LV dysfxn
23
Q

Describe MONA treatment for ACS

A

Morphine
Oxygen
Nitrates
Aspirin

Antiplatelet therapy

24
Q

Dual Antiplatelet Therapy (DAPT)

A

Aspirin and P2Y12 Inhibitor

25
Q

Drugs shown to improve mortality rates in MI patients

A
  1. ASA
  2. B-blockers
  3. ACE Inhbitors
26
Q

Why does Aspirin help decrease platelet aggregation?

A

COX1 and COX2 Inhibition leads to decreased Thromboxane A2.

27
Q

Management of a STEMI

A

Percutaneous Coronary Intervention (PCI=Cath Lab) capable hospital: <90m

Non-PCI: If PCI is <120m away, transfer or Thrombolytics <30m then transfer

28
Q

Inferior MI’s are usually due to what artery occlusion?

A

LCx or RCA

29
Q

Lateral MI artery occlusion

A

LCx or branch of LAD

30
Q

Anterior MI artery occlusion

31
Q

Dressler Syndrome

A

Post MI autoimmune reaction that causes pericarditis

32
Q

Ddx of Acute MI should include what other 2 things?

A
  1. PE

2. Aortic Dissection

33
Q

Stanford Classification of Aortic Dissections

A

Type A: Involves the ascending aorta

Type B: No ascending Aorta

34
Q

Which stanford classification type of Aortic Dissections is the most common?

35
Q

What risk factors are associated with a young person having an aortic dissection?

A

CT disorders
Nose candy
Trauma

36
Q

3 ways an aortic dissection can occur

A
  1. Tear in the intima that creates a false lumen
  2. Intramural hematoma caused by rupture of vasa vasorum
  3. Athersclerotic plaque ulcerating through intima and causing a hematoma
37
Q

Classic presentation of an aortic dissection

A

Tearing pain that radiates to the back
Remember also on the Ddx is: MI, PE

Other findings: Tamponade, Horner Syndrome, Mesenteric Ischemia, Hemothorax, MI, Aortic Regurge (diastolic murmur)

38
Q

Most commonly used imaging method to diagnosis aortic dissection

A

CT Angiography

39
Q

Anti-impulse therapy for Aortic Dissection

A

IV-Beta blockers +/- Vasodilators to get BP <120 and HR<60

40
Q

Which Stanford classification of Aortic Dissection has a higher mortality rate?

A

Type A- surgical management needed

CPR Exam 1 (19 decks)

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