CV 18 Flashcards
What is ACS
syndrome (set of signs and symptoms) indicative of inadequate coronary perfusion and ischemia
ACS is pro what??
pro thrombotic and pro inflammatory
pathophysiology of ACS
disruption of atherlosclorotic plaque in the coronary arteries causing platelet activation and formation of coronary thrombus
what are the consequences of an ACS
death - SDC
fatal arrhythmias (VF/VT)
anoxic brain damage
heart failure
valvular dysfunction
clinical presentation of ACS
chest pain, pressure, tightness, sweating (diaphoresis), SOB
how do women, elderly, and DM pts present
pain in arm, SOB, indigestion, N/V, weakness/fatigue
what are initial routine measures?
MONA
when is morphine used
if nitroglycerin is ineffective!
what does morphine do
symptomatic relief, decreases pain anxiety and pulmonary edema
ASA efficacy and toxicity
mortality reduction, bleeding, thrombocytopenia
nitroglycerin
reduction in pain,, hypotension, headache
avoid in SBP <90mmHG, and in recent 1-2 days use of phosphodiesterase 5 inhibitors
morphine
reduction in chest pain, avoid in suspected RV infarction, hypotension, rash,
risk strat
unstable angina (no ecg changes) = low risk
NSTEMI (moderate risk)
STEMI (high risk)
what does troponin indicate
myocardial cell death, higher number leads to HF and puts you at risk for arrythmias
three ways of revascularization
PCI, CABG, medical therapy
PCI steps
put stent in, balloon is inflated balloon is deflated, catheter is removed
two types of stents
BMS - bare metal stent
DES - drug eluting stent
- stent coated with antiproliferative drugs
what is a CABG
BV is harvested from pt during CABG surgery, and surgically grafted to bypass coronary occlusions
If pt has a STEMI, and they are transported to a PCI capable hospital, what do we do
PCI, door to balloon time less than 1.5 hours
If pt has a STEMI, and they are transported to a non PCI capable hospital, what do we do
fibrinolytic therapy, door to needle time less than 30 mins. transfer to a PCI capable hospital in less than 2 hours.
what are the indications for fibrinolytic therapy for STEMI
chest pain of less than 12 hours and ST elevation of >1mm on 2 contiguous leads on ECG except V2-3
Fibrinolytic CI
any prior intracranial hemmorage, severe hypertension, anything related to intracranial stuff
ADR/Monitoring parameters for fibrinolytic therapy
hemorrhage, ICH
4 fibrinolytic therapies
streptokinase, tpa, rpa, tnk (will be ending in ase)
name the 7 therapies BADAMS C.
Beta blocker
Anticoagulation
DAPT
ARB/ACEI
MRA
Statin lowering therapy
Colchicine
What are the DAPT options
ASA + Clop
ASA + TIca
ASA + Prasu
when is Prasugrel CI
pts with prior stroke/TIA, not recommended in ages >75 or <60kh
when is Ticagrelor CI
Strong inhibiters/inducers of p450 CYP3A4
how long is DAPT continud
12 moths after PCI DES, CABG, and Medical therapy
1 month if PCI BMS
UFH route
IV
LMWH (enoxa) and Factor 10a inhibitor (fonda) route
SC
how long does anticoagulatino therapy last
until patient receives revascularization or 2-8 dyas if the patient only receives medical therapy.
dont continue anticoagulation on discharge
Prasugrel major SE
bleeding, ICH
Ticagrelor SE
dyspnea, bradycardia
heparin major SE
bleeidng, thrombocytopenia, HIT,
