Cardiology #7: ACS Flashcards
What is the MCC of Acute coronary syndrome (MI)?
Atherosclerosis
-Acute plaque rupture –> coronary artery thrombosis (occlusion)
What are symptoms of ACS?
-Chest pain: pain at rest, not relieved with rest or Nitroglycerin, lasting > 30 minutes and may radiate to jaw, left arm, back, shoulders OR change from typical pattern
-Sympathetic stimulation: tachycardia, anxiety, n/v
What are FOUR groups of people that can have a silent MI?
Diabetics, women, elderly, obese
Explain the following elevations on ECG with the locations of the MI. Also give the artery that is affected with each part.
Anterior Wall:
Lateral Wall:
Anterolateral Wall:
Inferior Wall:
Posterior Wall:
-Anterior: ST elevations V1-V4: LAD; ST elevations in V1 and V2: Proximal LAD
-Lateral: I, avL, V5, V6 = circumflex artery
-Anterolateral: I, avL, V4-V6: LAD or Circumflex
-Inferior: II, III, aVF: RCA
-Posterior: ST depressions V1-V2 = RCA, Circumflex
Regarding cardiac markers, which is the most sensitive and specific for an MI?
Which appears the FASTEST?
Troponin is the most sensitive and specific
Myoglobin appears the fastest
Cardiac Markers:
-CK/CKMB: Appears, Peaks, Returns to Normal
-Troponin: Appears, Peaks, Returns to Normal
-Myoglobin: Appears, Peaks, Returns to Normal
-CK: Appears 4-6 hours, Peaks 12-24 hours, Normal in 3-4 days
-Troponin: Appears 4-8 hours, Peaks 12-24 hours, Normal in 7-10 days
-Myoglobin: Appears 2-4 hours, Peaks 4-6 hours, Normal in 1 day
Regarding the management for ACS, these are the recommendations for testing and treatment times. Explain.
ECG
Door to Thrombolytics
Door to PCI
ECG within 10 minutes
Door to thrombolytics within 30 minutes
Door to PCI within 90 minutes
Explain the MONA regimen as treatment for ACS
Morphine
Oxygen
Nitrates
Aspirin (chewed)
Morphine if no relief with Nitrates such as isosorbide dinitrate
STEMI Treatment (think HAABRN)
Aspirin
ACEi
BB
Heparin
Nitroglyerin
Reperfusion!!!!
NSTEMI or Unstable Angina Treatment
-Same as STEMI, but no emergent reperfusion!
With cocaine induced MI, what is the treatment (remember, there’s one thing you should avoid!)
Heparin, Aspirin, Nitro
Avoid BB!!
If the chest pain began > 12 hours ago and they do NOT have current CP and are low risk, what is the conservative treatment that can be done for ACS?
-Aspirin +/- Clopidogrel x 9 months
-Statin
-BB
-ACEi
-Nitro
What are some complications of ACS
-Dressler Syndrome: Post MI Pericarditis + Fever + Pleural Effusion
-Heart Failure
-Ventricular Fibrillation
Explain how a clot is formed
Factor Xa converts prothrombin (II) –> thrombin (Factor IIa). Thrombin activates fibrinogen –> fibrin clot
What is the order in which a conduction is sent throughout the heart?
-SA node –> AV node –> Bundle of His –> Left bundle branch –> Right bundle branch –> Purkinje fibers
Explain the MOA of anticoagulant Unfractionated Heparin
Binds and potentiates antithrombin III’s ability to inactivate Factor Xa, inactivates thrombin (Factor IIa), inhibits fibrin formation
Explain the MOA of anticoagulant LMWH (Enoxaparin)
-More specific to Factor Xa than UFH
-Longer half life (12 hours) than UFH
-No need for PTT monitoring like UFH
-Thrombocytopenia side effect
Myocarditis, inflammation of the heart muscle, is MC in _______.
The MCC of myocarditis is ______, but other causes include Autoimmune (SLE, RA), or Medications (Clozapine, Isoniazid, and Phenytoin)
young adults
Viral (Enteroviruses - Coxsackievirus B)
Symptoms of Myocarditis include
-Viral prodrome followed by systolic dysfunction (dilated cardiomyopathy)
-HF symptoms (dyspnea, fatigue, S3 gallop)
-Megacolon, Pericarditis
What is seen on the following diagnostics for myocarditis?
-CXR:
-ECG:
-Echo:
CXR: Cardiomegaly
ECG: May show pericarditis (diffuse ST elevations and PR depressions)
Echo: Ventricular systolic dysfunction
However, what is the GOLD standard diagnostic for myocarditis?
Endomyocardial biopsy
What is the treatment for myocarditis?
Supportive
-However, if systolic HF, use ACEi, Diuretics, and BB
A Transient Ischemic Attack (TIA) is a transient episode of neuro deficits without acute infarction. What are the symptoms?
What is a TIA associated with a future….
-Deficits lasting < 24 hours
-Complete resolution in 1 hour
-Amaurosis fugax
-Carotid bruits
associated with increased future stroke risk
What diagnostics are done for a TIA?
CT scan initially
CT or MR angiography, Carotid doppler
Conventional angiography is definitive
Treatment for a TIA
Think both noncardiogenic and cardiogenic
-Supine position
-Only lower BP if > 220/120
-If a Noncardiogenic TIA:
–Antiplatelet: Aspirin, Clopidogrel
–Carotid endarterectomy if 50-99% stenosis of internal carotid
-If Cardiogenic due to A-fib
–Oral anticoagulation
