Cardio 2 Flashcards
Typical angina of MI
crushing chest pain and feeling of impending doom!
midsternal pain which radiates to jaw, neck, shoulder and down left arm
stable vs unstable angina
stable - brought on with physical activity and relieved with rest, usually within 30 min
unstable - increasing chest pain at rest or with exercise
Prinzmetal’s angina
(aka variant angina)
spontaneous vasospasm of coronary arteries
typically lasts longer than 30 min
Levine’s sign
clenched fist held over the heart
ECG findings of ischemia
ST depression
Downsloping ST
What lab is done to rule out MI in patient with ischemia?
troponins
Quick acting, emergency treatment of ischemia
sublingual nitroglycerin
Side effects of vasodilator/nitrate medications
hypotension
headaches
N/V
Medications for angina
sublingual nitroglycerin long-acting nitrates BBs CCBs Aspirin
First line therapy for chronic angina
beta blockers
MOA of beta blockers to treat angina
lessen heart’s sympathetic response to epi and norepinephrine
MOA of calcium channel blockers to treat angina
decrease heart contractility
decrease peripheral vascular resistance
Surgical revascularization procedures for ischemia
Balloon angioplasty and stents
CABG = coronary artery bypass grafting
Possible cause of MI in young healthy individual
cocaine use
Atypical presentation of MI without chest pain most likely in what patients?
women and diabetics
Difference in clinical definition of angina vs MI
crushing chest pain in MI lasts longer than 30 min, whereas angina pain resolves within 30 min
Dressler Syndrome
post-MI syndrome; 1-2 weeks after MI patient experiences pericarditis, leukocytosis, pericardial effusion, pleural effusion
Changes in serial cardiac enzymes after MI (when do they elevate, peak, and normalize)?
Myoglobin: elevates in first 1-3 hrs, peaks at 6-7 hours, and normal by 24 hrs
Cardiac troponins I and K: elevate within 2-12 hrs, peak around 24 hrs, and normal by 2 weeks
CK-MB: elevate within 3-12 hrs, peaks around 24 hrs, and normal by 72 hrs
Progression of ECG findings with MI
peaked T waves -> ST segment elevation -> Q waves -> T wave inversion
ST elevation defined as > 0.1mv (one small box)
Using 12 lead how can you determine location of MI?
Inferior – II, III, aVF Posterior/septal – V1 and V2 Anterior – V3, V4 Anterolateral – V4, V5, V6 Lateral – I, aVL, V5, V6
Treatment of MI
“MONA”
Aspirin immediately Nitroglycerin Supplemental oxygen Morphine for pain Thromobytic
Contraindications of fibrinolytic therapy for STEMI (tPA)
Absolute: Ischemic stroke or head trauma within 3 months Intracranial neoplasm Active bleeding (excludes menses) Any prior intracranial hemorrhage Suspected aortic dissection
Relative: BP > 180/110 or h/o chronic severe HTN Past ischemic stroke +3 months Major surgery, prolonged CPR (>10 min), or internal bleeding within 3 wks Pregnant Active peptic ulcer Current use of anti-coags
Thrombolytic therapy (t-PA) for acute MI most effective within _____ hours, but can be used within _____ hours.
first 3 hrs
12 hrs
What is given to patient allergic to Aspirin?
Clopidogrel (Plavix)