Cardiac Flashcards
What are the 3 treatment principles for ACS?
- Nitrates (administer of GTN)
- Pain relief
- Anti platelet therapy
What is the dose of Aspirin?
300mg chewable tablet
Absence of ischemia on ECG does not exclude AMI, how is it diagnosed?
By repeated ECG’s, blood enzyme tests, patient history and angiogram.
What are the overall goals in the management of ACS?
Facilitate timely reperfusion, resolve pain and reduce cardiac workload
What is GTN?
It’s a potent venodilator, dilates peripheral blood vessels thereby reducing venous return to the heart
Signs of an inferior AMI on an ECG include:
ST elevation on leads II and III
Why is the use of GTN contra’d in suspected inferior or right ventricular infarcts?
As these patients may not be able to compensate for the drop in venous return.
What the contraindications for Aspirin?
H ypersensitivity A ctively bleeding peptic ulcers S suspected dissecting aortic aneurysm B leeding disorders E chest pain associated with psychostimulant use with BP greater than 160
What are the precautions when taking aspirin?
Asthma
ptS on anti coags
Peptic ulcer history
What can Aspirin sometimes cause?
Heartburn, prolonged bleeding, GI bleeds
What are the contraindications for GTN?
Hypersensitivity Use of Viagra or Levitra (24hrs) or cialis in 4/7. Heart rate over 150 Heart rate under 50 (exclude auto dysreflexia) Bp over 110 for tablet Bp over 90 for patch VT Inferior STEMI with BP
What is the dose for GTN?
Tablet- Bp >160mmhg
600mcg if previous admin
300mcg if NO previous admin
Repeat @5min initial dose or titrate
Patch if Bp >90mmhg
50mg (.4mg/hr)
In bradycardia, ideally what drug should the patient receive?
Atropine - MICA backup
What is the most likely definitive care for ongoing bradycardia?
Pacing- contact receiving hospital
What can absent P waves or
- SVT
- AF, atrial flutter
- Sinus Tach
- Atrial Tach
Signs and symptoms of SVT are:
- Tachycardia
- Persistent or severe chest pain
- SOB with crackles
When should immediate synchronised cardioversion be performed?
When Pt is unconscious or becoming unconscious
What can MICA administer to slow down Heart rate?
Adenosine (6mg then 12mg x 2)
What does adenosine do?
It slows down conduction through the AV node
When should the valsalva manoeuvre be performed?
When SVT is confirmed and BP is over 100mmhg.
How is an abdominal valsalva performed?
Position the patient supine.
Get pt to blow hard enough to move the plunger for 15 seconds if tolerated
How many times should the valsalva be performed?
Repeat twice 2 minutely
Max 3 attempts.
Pts with SVT showing signs of ectopic activity, what is administered?
O2 therapy.
What are components of VT?
QRS >0.12 > 30sec VT Rate >100 Mostly regular Av node dissociation, no p waves
What do MiCA administer to stabilise VT?
Amiodarone
What does Amiodarone do?
It’s an anti-arrhythmic agent, stabilises VT
Why can accelerated idioventricular rhythm be associated with?
- post arrest patients
- AMI
- Drug toxicity
- Post adrenaline admin
What are some features of the idioventricular rhythm?
Regular rate, 50-110bpm
3 or more ventricular complexes
QRS >0.12
Rates of AIVR distinguish it from other rhythms of similar morphology, what are the other rhythms?
Below 50bpm- Ventricular escape rhythm
Above 110bpm- VT
What are the cardiogenic caused of APO?
Left ventricular failure
Congestive cardiac failure
Liver/renal failure= fluid overload
What are the non cardiac causes of APO?
Smoke inhalation
Near drowning
Anaphylaxis
How are the non cardiac causes of APO treated?
No Nitrates, just O2 therapy
What is the treatment for cardiogenic APO?
- Nitrates if basal and midline crackles
- Nitrates and CPAP/assisted vents 100% if full field crackles
