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Nayla Foundations > CHD/ACS > Flashcards

CHD/ACS Flashcards

1
Q

What is classic ACS initial therapy

A 
MONA---
Morphine
Oxygen
Nitro (vasodilation)
Aspirin
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2
Q

What are atypical symptoms of ACS that women can present with

A

Fatigue, GI, pulmonary

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3
Q

What is angina (general)

A

clinical syndrome w/ chest, jaw, shoulder, or arm discomfort attributable to coronary ischemia (supply too little for demand)

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4
Q

What are the subtypes of angina

A
  • Typical: substernal, provoked by EXERTION/stress, relieved by REST
  • Atypical: may be PLEURITIC, reproduced by palpation/MOVEMENT, lasts days or seconds
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5
Q

What is stable vs unstable angina

A
  • Stable: develops w/ EXERTION, resolves with REST. short duration
  • Unstable: develops AT REST/minimal exertion. lasts longer. D/t insufficient blood flow w/o myocardial necrosis
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6
Q

What is NSTEMI/STEMI

A

angina w/ elevated cardiac biomarkers indicating MI

-Actual muscle is dying

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7
Q

What is NSTE-ACS

A

imbalance of myocardial oxygen consumption and demand causing ischemia/infarct

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8
Q

How do you characterize an MI

A

High or low Troponin w/ at least 1 of following:

  • Sx of ischemia
  • New ST-T wave changes/LBBB
  • Pathologic Q waves
  • Loss of myocardium/new RWMA
  • Intracoronary thrombus
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9
Q

What patients would you use an ischemia guided strategy in, and what is the strategy

A

Low risk score (TIMI 0-2)
Extensive comorbidities
-Start on meds and plan for stress test

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10
Q

What patients would you use an early invasive strategy in, and what is it

A

New ST depression, elevated trop, recurrent angina, CHF

-Send to cath lab

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11
Q

What are some causes of NSTE-ACS

A 
Atherosclerosis
Vasospasm 
Coronary embolism
Dissection
Non-obstructive (HTN, anemia, hyperthyroid)
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12
Q

What are some possible findings in CHD PE

A 
Levine's sign
New S4
Paradoxical splitting of S2
New murmur
Pericardial friction rub
CHF/shock
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13
Q

What are the 3 P’s that tell you its LESS likely to be a STEMI/NSTEMI

A

Palpable
Positional
Pleuritic

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14
Q

What are some CAD risk factors

A 
DM
HTN
HLD
Tobacco
sex age FHx 
ESRD
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15
Q

What categorizes ST depression and T wave changes

A

new ST depression 5mm (0.5mV) in 2+ leads

T wave inversion 1mm in 2+ leads

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16
Q

What is the ACS early branch system

A

Patient comes in with ACS
EKG
Biomarkers
Risk stratify to determine approach

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17
Q

How long does it take for Troponin to elevate

A

2-4 hours, persists 14 days

18
Q

What are causes of elevated troponin

A 
Tacky/brady arrhythmia
Shock
HTN 
HF
Severe PE
Sepsis
Renal failure
19
Q

When is CKD helpful

A

when diagnosing reinfarction and assessing perfusion

20
Q

What are the TIMI risks

A
  • Age 65+
  • 3+ CAD RF (HTN, DM, HLD, FHx, smoking)
  • CAD
  • Elevated cardiac biomarker
  • ASA w/in 7 days
  • ST elevation
  • Severe angina
21
Q

What are admission criteria for ACS

A

Recurrent symptoms
Ischemic changes on ECG
Elevated troponin
TIMI 3+

22
Q

What are standard medical therapies for NSTE-ACS

A 
Oxygen
Anti-Platelet (ASA&P2Y12 inhibitor/)
Statins (high intensity)
Nitro 
Analgesics (NO NSAIDS)
23
Q

What is a P2Y12 inhibitor

A

an anti platelet given WITH ASA
Clopidogrel (Plavix)
*If possible hold clopidogrel 5 days prior to surgery

24
Q

What are GP IIa/IIb inhibitors

A

Anti-platelet used WITH ASA and heparin during AMI

25
Q

What anti-HTN med takes precedence when treating NSTE-ACS

A

BB- given within first 24 hours (but NOT in CHF, HB, or asthma)
If BB contraindicated, use CCB
Add CCB to BB if with persistent angina

26
Q

What are other NSTE-ACS therapies to initiate

A

ACE (if LVEF <40%
ARB
Ald. Antagonist (on ACE and BB with EF <40%)

27
Q

What are stress test options

A

Exercise ECG
Echo (exercise or Dobutamine)
Myocardial perfusion imaging (exercise or adenosine)
–For those with abnormal baseline ECG

28
Q

What are the most specific and sensitive stress tests for detecting CAD

A

Sensitive: Vasodilator nuclear MPI
Specific: Dobutamine Echo

29
Q

What post-hospital care should be given to patients

A 
\+/- cardiac rehab (if rule in and have MI)
TLC
Aspirin
ACE/ARB
BB
30
Q

What are likely causes of ACS with ST elevation

A

AMI
STEMI
Cocaine (young w/o RF)
Vasospasm

31
Q

Who might you see a painless MI in

A

women
elderly
DM
alcoholic

32
Q

What categorizes ST elevation

A

> 1mm in 2+ leads
2mm in V2V3 for men
1.5mm in V2V3 for women

33
Q

What are key goal times for a STEMI

A 
12 lead ECG w/in 10 min
Reperfusion w/in 24 hours
FMC to device w/in 90 min
Transfer to PCI w/in 120 min
Fibrinolytic therapy w/in 120 min
34
Q

What is the best vessel to graft the LAD

A

Internal thoracic artery

35
Q

What is class I criteria for needing a CABG

A

Significant left main stenosis
>70% stenosis of LAD and LCA
three vessel CAD

36
Q

What is PCI therapy

A

Unfractionated Heparin w/wo GP IIb/IIIa inhibitor

*Initiate ASAP

37
Q

What are major contraindications for Fibrinolytics in STEMI

A

Prior ICH
malignant neoplasm
Ischemic stroke
aortic dissection

38
Q

What is fibrinolytic therapy

A

Streptokinase
Urokinase
tPA

39
Q

What are complications of infarctions

A

arrhythmias/conduction abnormality
HF shock
mechanical defect
Inflammatory (pericarditis)

40
Q

What will you see with a papillary muscle rupture

A

Systolic Apical murmur and pulmonary edema

41
Q

What will you see with an IVS rupture

A

holosystolic murmur at LSB

Nayla Foundations (18 decks)

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