IHD *** Flashcards
Criteria for STEMI
ST-elevation in 2 contiguous leads that is:
Men < 40: 2.5 mm ST-elevation in V2 or V3, 1 mm in any other lead
Men > 40: 2.0 mm ST-elevation in V2 or V3, 1 mm in any other lead
Women: >1.5 mm ST-elevation in V2 or V3, 1 mm in any other lead
Which ECG leads relate to which part of the heart?
Septal = V1 + V2
Anterior = V3 + V4
Lateral = v5 + v6
Anteroseptal = V1-V4
Anterolateral = V3-V6
Inferior = II, III, aVF
RF
Smoking
DM
Obesity
HTN
Lipids
CKD
Inactivity
Age
Fam history
Sx + signs
Substernal chest discomfort
Provoked by exertion or emotion
Relieved within 5 mins of rest of GTN spray
SOB, diaphoresis, pre-syncope
Atypical presentation: women, diabetes, elderly
Epigastric pain
Pleuritic CP
SOB
N/V/ belching
Signs: normal exam, hypotension, new S3 gallop, new JVP distension
Complications
Cardiac rupture
Arrhythmia
Shock
HTN
HF
Pericarditis
Aneurysm
DVT
Ix
ECG (ST elevation or depression, new LBBB, new Q wave)
Labs: trop, CK-MB if <6hrs, CBC, INR, lipids, a1c, LFTs, Cr, lytes
CXR
Stress test
Coronary CT angiography
Other causes of high trop
HF, malignancy, pericarditis, PE, renal failure, sepsis, stroke, SAH
Reducing risk
Smoking cessation
Diabetes control
Wt loss
Exercise
What clinical decision tools are there?
TIMI (thrombolysis in MI)
HEART score (predicts cardiac event)
Acute medical mangement
ABCs
- oxygen if sats <92%
ASA 300mg chewable
Nitroglycerin SL 0.4mg 1-2 sprays q5 mins
IV Morphine 3-5mg for pain
PCI within 120 mins:
Ticagrelor 180mg x1 then 90mg BID for 1 yr
Anticoagulant (UFH, enoxaparin) for 48 hrs/ until PCI performed
PCI unavailable, use fibrinolytics:
fibrinolytics - tpa (alteplase)
- clopidogrel PO
- transfer to PCI hospital
BB - start within 24hrs if no HF
ACEi - start within 24hrs if HTN, DM, CKD, STEMI or LVEF <40%
Indications for CABG/ PCI in STEMI vs NSTEMI
NSTEMI: in refractory angina, S+S HF, unstable, DM, TIMI >2
STEMI: if onset sx <2 hrs, fibrinolytics 30 mins
Longterm medications
GTN spray PRN
BB, CCB 2nd line
Statin (rosuvastatin 20-40mg)
ASA 81mg
ACEi if HF, HTN, DM, CKD, STEMI in anterior location
P2Y12 inhibitor (Ticagrelor) in NSTEMI for 1 yr, stent w/ ACS for 1 yr
What monitoring should happen in family office longterm?
Sx control
Med adherence
Impact on ADLs
Lifestyle modifications
Pneumococcal + flu vaccine
Screen for complications
A1c, BP, lipids
Criteria for NSTEMI
NSTEMI: + trop, ST depression, new Q wave
criteria for unstable angina
Unstable angina: myocardial damage, no ECG or BW changes