IHD - ACS Flashcards
What are the diagnostic for STEMI
ST elevation
Biomarkers +
What are the diagnostic for NSTEMI
ST depression or T-wave inversion
Positive biomarkers
What are the Diagnostic for unstable Angina
ST depression or T wave inversion
Positive biomarkers
ACS clinical symptoms
Chest pain - that could radiate
Nausea
Sweating
Impending doom
Low grade fever
4th heart sounds
3rd heart sounds
What does BBB (bradial branch block )
1 or 2 mm raise in 2 or more leads (1-6 lead)
When do you take cardiac draws in the hospital
Every 6-8 for 3-4 draw bc some biomarkers are later in onset
What is the most important function of the heart ?
LV function and if you cant fix it you get a scar that can cause death if it ruptures
What does everyone get if they have STEMI or NSTEMI
Oxygenation 90% or greater
ECG leads monitoring
Glycemic control (<180 glucose)
Pain relief
Stool softeners
Chest discomfort last ≥10mins flow chart (pic)
STEM flow chart for treatment (pic)
Usually do fibrinolytic or primacy PCI
What pharmacological treatment for STEMI do we think of
Mona
What is MONA?
M- + or - morphine 1-5mg IV every 5-30mins (may or may not give due to chest pain relief being unknown wether it be nitro or morphine, usually 3 dose may or may not give M)
O - only give below 90%
N- Nitro .4mg every 5 mins for 3 dose (tachyphylaxis sign of nitrate intolerance, usually not in STEMI pts)
A - aspirin give 81mg QID ( #1 drug to use )
What anticoagulant is the drug of choice
Heparin
Heparin STEMI dosing for Fibrinolysis, Primary PCI or medical management
Fibirnolysis
Bolus - 60 unit/kg/IV max 4000
Main - 12 unit/kg/IV max 1000 units
PCI and medical management
Bolus - 60 unit/kg/IV max 5000
Main - 12 unit/kg/IV max 1000 units
Heparin dosing adjustment chart
STEMI when and which BB
when - significant HTN or ongoing ischemia without Contra
Which - Metoprolol tartate 5mg IV q 5 mins up 3 doses
When do we avoid BB in STEMI
Advance age 70+
Bradycardia < 60 bpm
Hypotensive pt SBP < 120
Prolonged PR interval >0.24 sec or 2nd/3rd degree Heart block
Active asthma or airway disease
Reperfusion flowchart for STEMI
Do we prefer PCI or thrombolytic in reperfusion
PCI because a much higher flow so much so that we withhold treatment with fibrinolytic for 30mins max
What are the indication for fibrinolytics for STEMI
- Within the first 12 hours
- ST elevation at least 1 mm in 2+ leads
- PCI can not be preformed in 120mins