CCRN ACS, STEMI, NSTEMI

Question 1

Unstable Angina Pectoris:
S/S?
What would labs show?

Answer 1

UA: crescendo angina, chest discomfort becomes more difficult to relieve and lasts longer.
Assessment: No elevation of cardiac biomarkers, no cell death. But pt has same symptoms of MI.

Question 2

How may Unstable Angina be relieved?
EKG would reveal what changes?

Answer 2

nitroglycerin
trop neg, ST depression, T wave inversion on EKG

Question 3

What is Prinzmetal’s angina? Tx (6)?

Answer 3

Coronary vasospasm seen with illicit drug use. Rare, occurs in AM.
Tx: asa 81, clopidogrel 75mg, angioplasty, drug-eluting stent placement, CABG, atherectomy

Question 4

NSTEMI S/S, EKG changes

Answer 4

Trop positive, ST depression or T wave inversion, unrelenting chest pain

Question 5

STEMI S/S, EKG change

Answer 5

Trop positive, ST elevation in 2+ contiguous leads, unrelenting chest pain
*may have pain w/o chest pain, esp true for women and DB

Question 6

NSTEMI Management (4)

Answer 6

1. Stat EKG
2. MONA,
3. A/C, Antiplatelets
4. Beta blockers

NO reperfusion needed

Question 7

Contraindications of beta blockers? (3)

Answer 7

1. Bradycardia
2. hypotension
3. use of phosphodiesterase inhibitor, i.e sildenafil (viagra)

Question 8

Goal management of STEMI?

Answer 8

REPERFUSION <12 hr since onset of symptoms.
Percutaneous coronary intervention, door to balloon <90 min. Or fibrinolytic drug therapy <30 min

Question 9

Eligibility criteria for STEMI reperfusion? (3)

Answer 9

1. ST elevation in 2+ leads of new onset of LBBB
2. chest pain< 12 hr
   Chest pain of 30 minl long not relieved with NTG

Question 10

STEMI Management: Evidence of reperfusion of coronary artery? (4)

Answer 10

1. Chest pain relief d/t blocked artery opening
2. ST deviation resolution d/t blood flow return
3. Elevated trop/CK-MB d/t myocardial stunning when vessels opens
4. Reperfusion arrhythmia d/t vessel opening

Question 11

Inferior Wall STEMI EKG presentation?

Answer 11

II, III, aVF
RCA, Circumflex

Question 12

Septal Wall STEMI EKG?

Answer 12

V1, V2, LAD

Question 13

Anterior wall STEMI EKG?

Answer 13

V1-V4, LAD

Question 14

Lateral Was STEMI EKG

Answer 14

I, aVL, V5, V6, Circumflex artery

Question 15

R Ventricular EKG?

Answer 15

V3R, V4R Right