Cardio Flashcards
ST segment depression and/or T wave inversions suggests
NSTEMI or Unstable Angina
If a pt with ACS is allergic to ASA, what do you give?
Clopidogrel
If a pt with ACS has the following RF: DVT, reinfarction, stroke, LV thrombus, reocclusion, what do you give?
Heparin
CI of nitroglycerin?
Sildenafil within 24 hrs
RV infarction
If possible, pt with a STEMI should get PCI within
<90 min from door to surgery
If you’re in a rural community >120min from PCI center, give
Antithrombolytics (TPA or other ~ase) within 30 min of arrival to ED
ST elevation in Leads I and aVL means infarct where?
Lateral wall
ST elevation in leads II, III, aVF means infarct where?
Inferior wall (could be right ventricle)
Pt presents with inferior wall infarction and bradycardia. The pt likely received what that led to the bradycardia?
Nitro
ST elevation in leads V1 and V2 =
Infarct in septum
ST elevations in V3 and V4 =
Infarct in anterior wall
ST elevations in V5 and V6 =
Lateral wall infarct
Who is more likely to have an atypical presentation of an MI?
Elderly, women, diabetics, hx of stroke or HF
Initial ECG changes with heart ischemia
T wave prolongation
Pt presents with chest pain, new onset murmur, positive cardio biomarkers, no ST changes would indicate what? May also hear a new S4 or paradoxical S2
NSTEMI
What 4 drugs have been shown to decrease mortality in patients with hx of an MI?
ACE-inhibitors, statins, ASA, BBs
After PCI and stent placement, what two drugs should be given to decrease coronary artery stent thrombosis?
ASA + Clopidogrel (ticagrelor, prasugrel)
After stent placement, what two drugs should be continued and for how long to decrease risk for coronary artery stent thrombosis?
ASA indefinitely
Clopidogrel for 1 year
Hydrochlorothiazide can cause elevation of what electrolyte?
Ca2+
MC atypical presentation of ACS in elderly pts?
Dyspnea
CI of fibrinolytic therapy
Absolute: Hx of intracranial bleed or neoplasm, stroke, facial trauma
Relative: diastolic BP >110, chronic HTN, pregnancy, and anticoagulant use
Risk stratification tool used for unstable angina and NSTEMI to determine treatment
TIMI = thrombolysis in myocardial infarction tool
Pt presents with chronic stable angina (treated), but is still symptomatic. What do you give?
Ranolazine
What is the most specific finding for myocardial ischemia in an exercise stress test?
2mm downsloping of the ST segment
Target HR in exercise stress test
85% of max HR
When should a high intensity statin be recommended?
When ASCVD risk is >20%
If LDL is >100 on a moderate intensity statin, what two drugs could be considered?
Ezetimibe or PCSK9-1 inhibitor
LDL >190 at age 40-75 y/o indicates you should start
a moderate intensity statin
EKG shows ST elevation in V1-V4. What artery is blocked?
LAD
EKG shows ST elevation in leads II, III, and aVF. What artery could be blocked?
Left circumflex or RCA
EKG shows ST elevation in leads I, aVL, V5, and V6. What artery could be blocked?
Left circumflex or LAD
Chronic stable angina first line treatments
BBs, ASA, Statin
Pt with chronic stable angina is still symptomatic on atenolol, ASA, and a stain. What could you try next?
CCBs like amlodipine, nifedipine, verapamil
Pt with chronic stable angina does not respond to BBs OR CCBs. What could you give next?
Ranolazine or Nitro
Pt presents with syncope and HR is the 40s. She is in sinus rhythm. First line treatment is?
Atropine
You see SVTs on the cardiac monitor. First line treatment is
Adenosine
What anti platelet drugs are recommended with a STEMI?
ASA, clopidogrel, ticagrelor, epitifibatide, prasugrel
When do troponin levels return to baseline post STEMI?
5-14 days
At what age should men with low CVD risk start lipid screenings?
35
Men with higher CVD risk or women with higher CVD risk should start lipid screenings when?
Men: 25 y/o
Women: 35 y/o
If pts are below the threshold to begin lipid lowering drugs, they should be screened
every 5 years
Children should have a lipid screening when?
Once before and after puberty
If a pt has LDL level of 140 and a 10 year ASCVD risk between 10-20%, you should
Initiate drug therapy (statin)
At what blood LDL level should a statin immediately be started?
> or = 190mg/dL
52 y/o pt presents with T2D. What therapy should you consider to protect their CVD risk?
Statins are recommended to pts with T2D btw ages 40-75y/o
LDL consistently above what level is considered an ASCVD risk factor?
160mg/dL
Chest pain early in the morning is a characteristic of
prinzmental/vasospastic angina
First line treatment for prinzmental angina
CCB or nitrates
What drugs are contraindicated in an NSTEMI?
Thrombolytics!!!! Altepase, reteplase
Pt presents with elevated cardiac enzymes but no ST elevation. What is the treatment regimen?
O2 if needed
Nitrates w/ L-sided HF and NO hypotension
BBs or ACEi
Antiplatelet (ASA, clopidogrel)
Anticoagulant (enoxaparin, bivalirudin, faundaparinux)
ST elevation in leads II, III, aVF. What drug is CI?
Nitrates
Earliest EKG finding in an acute STEMI
hyperacute T waves
What is commonly seen on EKG after a STEM
Q wave (smooth curve)
