Day 4 - CV1 Normal, Ischemic Heart Disease

Question 1

ST elevations during brief periods of chest pain

Answer 1

Prinzmetal’s angina

Question 2

Sharp chest pain radiating to scapula or back

Answer 2

Aortic dissection

Question 3

Chest pain relieved by antacids

Answer 3

Esophageal spasm or GERD

Question 4

Acute tachycardia, dyspnea, and confusion

Answer 4

PE

Question 5

Next step if widened mediastinum on CXR

Answer 5

Chest CT (ddx: aortic dissection)

Question 6

Indications for drugs during angina: (1) ASA (2) Clopidrogel (3) GpIIb/IIa (4) Nitroglycerin (5) Beta-blockers (6) ACE inhibitors/ARBs (7) Statins (8) Heparin/Enoxaparin (9) Morphine (10) Thrombolytics

Answer 6

(1) ASA (except high risk of bleeding); (2) Clopidogrel (after PCA, during angina if known MI then load); (3) GpIIb/IIa inhibitors - Abciximab, Tifofiban, Eptifibatide (used in addition during angina, if NSTEMI, high TIMI likely MI); (4) Nitroglycerin (Nitro drip if MI, Sublingual or Nitropaste if not MI) (5) Beta Blockers - MI prevention, during MI, post-MI (Only Metoprolol or Carvedilol cardioprotective) (6) ACEi or ARBS - after MI (contraindication - pregnancy, cause renal problems in fetuses); Beta Blockers/ACEi/ARBs all decrease mortality post-MI; (7) Statin (8) Heparin/Enoxaparin (9) Morphine - decrease pain, decreasing HR/bp (10) Thrombolytics - MI, especially STEMI; if NSTEMI use GpIIbIIIa inhibitors