Cardiovascular diseases Flashcards
Acute MI can be caused by?
Ischemia to coronary artery or blood clot that occludes artery
Symptoms of AMI?
Chest pain, radiation of left arm, jaw, back, neck, mimics heartburn, N & V, dyspnea, lightheadedness, diaphoresis, anxiousness, palpitation, LOC
Emergency treatment of AMI
Morphine 2-4mg IV q 15 mins, oxygen via nasal canula, aspirin 325mg PO, Nitroglycerin 0.4mg SL q 5 mins (3 doses)
Treatment for adjunct pulmonary embolism?
Lasix-Morphine-Nitro-Oxygen-Position/Positive pressure ventilation
Reperfusion therapy for AMI?
Thrombolytic drugs, balloon angioplasty, CABG
What leads would an inferior MI show up on and what artery affected?
II, III, aVF. RCA and PDA
What leads would an anterior MI show up on and what artery affected?
V1-V6. LAD
What leads would a lateral MI show up on and what artery affected?
I, aVL, V5, V6. Left circumflex artery
What leads would a posterior MI show up on and what artery affected?
V1-V4. RCA
Labs to run if suspect MI
Troponin occurs 2-6 hours and peaks 12-24 hours, CK-MB occurs 4-6 hours and peaks 12-24 hours, myoglobin occurs 1-3 hours and peaks 4-12 hours
When should thrombolytics be used and which ones?
Useful for STEMI when PCI is not available for >90 mins. Drugs to use tenecteplase, t-PA, r-PA
What are contraindications of thrombolytics?
Hx of hemorrhagic event in brain, intracranial neoplasm, active internal bleeding, suspected aortic dissection, hemorrhagic retinopathy, poorly controlled HTN, INR>2, pregnancy, recent trauma or major surgery, prolonged CPR
If someone has had an MI and they present with abrupt onset of hypotension with increased venous pressure and PEA what is the most likely cause?
Myocardial rupture
What are some contraindications of anticoagulation?
Recent stroke, pericarditis, ulcer disease
If someone has an PE following MI what should you treat with?
Heparin (80u/kg bolus, then 18u/kg/hr) or enoxeparin (1mg/kg q 12h SC). With massive PE consider t-PA and surgical consult
When would you not use a beta blocker?
Cocaine induced MI, increased risk of cardiogenic shock, heart block, asthma, reactive airway
Treatment for unstable, prinzmental agina?
Oxygen, serial EKG, enzymes and admit. Morphine, NTG, beta blocker, ASA, anticoagulants, GP IIB/IIIA inhibitors. PCI if patient doesnt respond to treatment
What is the treatment plan for CHF following MI?
Oxygen/venous access, Morphine, diuretics, nitroglycerin
What dosing would you use for nitroglycerin for CHF following MI? What do you want to look out for?
Give IV, start at 10 microgram/minute and tritrate. Beware of inerior MI or RV infarct.
When would you use nitroprusside? What dosing?
If CHF is directly related to hypertensive emergency. (2-20microgram/kg/min. Titrate for desired BP
What do you need to what out for with hypertension & hypertensive crisis?
Beware of aggressive treatment of asymptomatic patients with hypertension.
What drugs would you use in a hypertensive emergency and doses?
Nitroprusside ( 2-20microgram/kg/min), Labetalol ( 20mg IV over 2 minutes then double dose every 10 minutes as needed, maximum 300mg), Hydralazine (10-40mg IV every 15-30 minutes)
What medication can you use in a hypertensive emergency if the patient is pregnant?
Hydralazine (10-40mg IV every 15-30 minutes)
If a patient is planned to have a PCI following UA.NSTEMI, what should they be given?
Loading dose of P2Y12 inhibitor
