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Foundations II (Cholley) > CHD & ACS > Flashcards

CHD & ACS Flashcards

1
Q

Ddx for chest pain

A
  • Nonischemic

- Noncardiovascular: Pulmonary, GI, musculoskeletal

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2
Q

Classic ACS initial therapy “MONA”

A
  • Morphine
  • O2
  • Nitroglycerin
  • Aspirin
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3
Q

Define angina

A

Chest, jaw, shoulder, arm discomfort due to ischemia

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4
Q

Define typical angina

A

Substernal chest discomfort w/ quality & duration

  • Provoked by exertion or stress
  • Relieved w/ rest or nitroglycerin
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5
Q

Define atypical angina

A

Having only 2 of the typical characteristics

- May be pleuritic, reproduced by palpation or movement, constant & lasting days, fleeting pain lasting seconds

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6
Q

Stable angina

A
  • develops w/ predictable amount of exertion
  • similar to typical angina
  • short duration
  • resolves w/ rest or meds
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7
Q

MI

A

Rise/fall of cardiac biomarker values w/ at least 1 value above the 99th percentile & 1 of the following:

  1. sx of ischemia
  2. ST segment T wave changes or new LBBB
  3. pathological Q waves
  4. loss of myocardium or new RWMAs
  5. thrombus
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8
Q

Ischemia-guided strategy, when is invasive eval used?

A

Invasive eval, used if pt:

  • fails med therapy
  • has evidence of ischemia on stress test
  • has high risk
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9
Q

NSTE-ACS pathogenesis

A

Imbalance of myocardial O2 consumption & demand –> ischemia/infart

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10
Q

NSTE-ACS etiologies

A
  • Coronary artery obstruction
  • Vasospasm (Prinzmetal’s angina)
  • Coronary embolism
  • Dissection
  • Nonobstructive causes
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11
Q

Possible PE findings for ACS?

A
  • Levine’s sign (bringing hand to heart)
  • New S4
  • Paradoxal splitting of S2
  • Pericardial friction rub
  • CHF/shock
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12
Q

Initial ACS dx studies

A
  • ECG within 10 mins of arrival in ED
  • Obtain hx (1st step in risk stratification)
  • May repeat ECG 12-30 mins for 1st hr
  • Serum biomarkers
  • CBC, BMP, coagulation panel, cholesterol
  • B-type natriuretic peptide (BNP)
  • CXR
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13
Q

When should troponin be measured?

A

At presentation & 3-6 hrs after sx onset in all pts who present w/ sx consistent w/ ACS
- Should be repeated 6 hrs after sx onset in those w/ high suspicion for ACS even if troponin is negative (bc this does not mean that there is no ischemia!)

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14
Q

What is not useful for dx of ACS?

A

CK-MB & myoglobin

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15
Q

Causes of elevated troponin

A
  • Tachy/brady
  • Cardiogenic, hypovolemic, septic shock
  • HTN w/ or w/out LVH
  • HF
  • Pulmonary embolism or HTN
  • Sepsis
  • Renal failure
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16
Q

What can be used to dx reinfarction & assess reperfusion?

A

CK-MB

17
Q

What models can be used in the management of NSTE-ACS?

A
  •  TIMI Risk Score *
  •  GRACE Risk Model *
  •  PURSUIT Risk Score
  •  GUSTO Risk Score
  •  HEART Score for MACE *
  •  EDACS
18
Q

TIMI risk score values

A
  • Low risk = 0-2
  • Intermediate risk = 3-4
  • High risk = 5-7
19
Q

In the TIMI risk score model, what equals 1 point each?

A
  • Age ≥ 65
  •  ≥ 3 risk factors for CAD
    - Known CAD
    - ASA use in past 7 days
    - Severe angina (≥ 2 episodes within 24 hrs)
    - ST depression ≥ 0.5
    - Positive cardiac biomarkers
20
Q

Who should be admitted to hospital?

A
  • Recurrent sx
  • Ischemic changes
  • Elevated troponin
  • Intermediate to high risk
21
Q

NSTE-ACS standard med therapies

A
  • Supplemental O2
  • Anti-platelet
  • Statin
  • Nitroglycerin
  • Analgesics (NSAIDS contraindicated)
22
Q

What med is contraindicated?

A

NSAIDs

23
Q

Types of anti-platelet therapy

A
  • Aspirin (Non-enteric coated, chewable)

- P2Y12 Inhibitor (Clopidogrel, Prasugrel, Ticlopidine, Ticagrelor)

24
Q

Types of anticoagulation

A
  • Indirect thrombin inhibitors

- Direct thrombin inhibitors

25
Q

Beta blockers

A
  • Decreases myocardial contraction & O2 demand

- Metoprolol, carvedilol, bisoprolol

26
Q

Calcium channel blockers

A
  • Nondihydropyridine (verapamil, diltiazem)

- Initial therapy if ongoing angina

27
Q

Aldosterone antagonist

A
  • For pts post-MI in the absence renal dysfunction or hyperkalemia
28
Q

Features of unstable angina

A
  • Develops at rest or w/ minimal exertion
  • Change in typical pattern
  • More severe/ lasts longer
  • May not resolve w/ rest or meds
29
Q

What is unstable angina caused by?

A

Insufficient coronary blood flow, w/out evidence of myocardial necrosis

30
Q

NSTEMI & STEMI

A

Angina w/ elevated cardiac biomarkers

- Indicates MI, w/ or w/out ST deviation

31
Q

Coronary disease spectrum

A
  • Ischemia = stable & unstable angina
  • Infarction = STEMI & NSTEMI
  • ACS = unstable angina, STEMI, & NSTEMI
32
Q

Baseline risk factors for ACS

A
  • Male > female
  • Age
  • Family hx
  • Prio hx of CAD
  • Kidney disease
  • DM*
  • HLD*
  • HTN*
  • Tobacco*
33
Q

When is troponin elevated & how long does it persist?

A
  • As early as 2-4hrs, at tops 12hrs

- May persist 14 days or longer

34
Q

What should be administered to all pts w/ possible NSTE-ACS at presentation?

A

Non-enteric coated, chewable ASA

Foundations II (Cholley) (25 decks)

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