Chest pain Quiz - Ch18 Flashcards
what are the risk factors for CAD
- older age
- male gender
- fam Hx
- smoking
- HTN
- hypercholesterolemia
- DM
- long hx of cocaine use
what are signs of hemodynamic strain or acute heart failure
- pallor
- diaphoresis
- AMS
- elevated JVD
- peripheral edema
- rales on pulm exam
what is the ST segment based criteria for acute MI
what is the anatomic distribution of EKG changes
what is the characteristic presentation of unstable angina
chest pain assocaited with evidence of obstructive CAD and has one of the following:
1. began within the past 2 months
2. has increasing frequency, intensity, or duration of existing angina symptoms
3. existing angina begins to occur at rest
what are the 3 timeline goals for STEMI in the ER
- door to EKG in 10 min
- Door to thrombolytic in 30 min
- Door to PCI in 90 min
what is the treatment plan for a suspected ACS patient upon arrival to ER
- begin cardiac monitoring
- place IV line
- MONA (O2 only if <95%)
- clopidogrel
- unfrac heparin, LMWH, or fondaparinux
- BB within 24 hrs.
when are fibrinolytics indicated
if patients receive fibrinolytics they MUST be on anticoags for 48 hrs.
what are the 4 main fibrinolytics and their side notes
- tPa - fibrin specific. superior 90 min patency and reocclusion rates, no increase in bleeding risk
- reteplase (rPA) - non-fibrin specific. faster ti e to perfusion, given as a double bolus instead of continuous infusion.
- tenecteplase (TNK) - fibrin specific given as single weight based bolus
- streptokinase - non-fibrin specific. known to cause allergic rxns and hypotension.
what is the MC adverse effect of thrombolytics? how do you treat this?
- bleeding, particularly intracranial hemorrhage.
- if significant, DC thrombolytics, heparin and ASA
- crystalloid and RBC infusion may be necessary
- Cryoprecipitate and FFP may be used to reverse fibrinolysis.
