management of a Patient with Acute Coronary Syndrome

Question 1

What artery comes off the aorta and runs down the right lateral aspect of the heart and to the posterior side of the heart. It
supplies blood to the right ventricle, SA, and AV node

Answer 1

Right coronary artery

Question 2

What artery is small segment off the aorta and then branches into the Left Anterior Descending artery (LAD)

Answer 2

Left main coronary artery

Question 3

What artery supplies the anterior and septal part of the left ventricle and the Left Circumflex artery (LCx) which supplies the left lateral aspect of the left ventricle.

Answer 3

Left main coronary artery

Question 4

What artery supplies blood to the right ventricle, SA, and AV node.

Answer 4

Right coronary artery

Question 5

The coronary veins will all drain their deoxygenated blood into the ____

Answer 5

coronary sinus

Question 6

Oxygenated blood enters either the right or left coronary vessels from what?

Answer 6

the Aorta

Question 7

Coronary sinus then drains its blood into what?

Answer 7

right atrium

Question 8

Most tissues extract only about 25% of the
oxygen in arterial blood. However, the myocardium extracts about ____ of the oxygen resulting in a saturation of only about 30%.

Answer 8

65%

Question 9

The myocardium, unlike many other tissues, (CAN/CANNOT) compensate for a reduction in blood flow by extracting more oxygen from hemoglobin

Answer 9

CANNOT

Question 10

____is chest pain due to myocardial oxygen demand exceeding delivery (aka ischemia). It is commonly caused by atherosclerotic disease.

Answer 10

Angina

Question 11

Definition of what
Chest pain while resting. Initially this presents the exact same as NSTEMI until 4-8 hours after the symptoms begin when you will start to get elevated cardiac markers.

Answer 11

Unstable Angina

Question 12

what type of angina

Rare, caused by coronary vasospasm often without any CAD. DRUGS?

Answer 12

Prinzmetal’s Angina

Question 13

Myocardial ischemia is due what?

Answer 13

oxygen demand exceeding supply

Question 14

Because myocardial tissue extracts the maximum amount of oxygen (65%) from hemoglobin increased oxygen requirements must be met by what?
.

Answer 14

increased coronary blood flow

Question 15

Coronary blood flow occurs only during what phase?

Answer 15

ventricular diastole

Question 16

These will do what to myocardial oxygen requirements?
1) Increased HR
2) Increased afterload
3) Increased contractility
4) Increased amount of muscle (from left ventricular or right
ventricular hypertrophy)
5) Increased left ventricular end diastolic volume.
6) Increased Preload

Answer 16

increase……

Question 17

What can increase myocardial oxygen content?

What is the most important durring AMI

Answer 17

• Increased coronary blood flow either by coronary dilation or by increased diastolic blood pressure
• Decreasing HR (most important)
• Increasing hemoglobin if it is < 10 g/dL

Question 17

What can increase myocardial oxygen content?

What is the most important durring AMI

Answer 17

• Increased coronary blood flow either by coronary dilation or by increased diastolic blood pressure
• Decreasing HR (most important)
• Increasing hemoglobin if it is < 10 g/dL

Question 18

In young individuals with NSTEMI or STEMI without any risk factors, what would you suspect?

Answer 18

cocaine use

Question 19

cocaine use can cause what ?

Answer 19

intense vasoconstriction or coronary dissection leading to myocardial necrosis

Question 20

These symptoms may indicate what?

• Substernal chest pain
• Diaphoresis
• Nausea and vomiting
• Anxiety
• Intense feeling like they are going to die

Answer 20

Acute Coronary Syndrome

Question 21

Can hear a S3 heart sound indicates what?

Answer 21

large amounts of blood entering the LV quickly into a compliant ventricle indicating volume overload (CHF)

Question 22

Chest Radiograph is used to look for what?

Answer 22

Check for signs of CHF, but may lag behind other physical exam findings

Question 23

what is the #1 goal of treatment

Answer 23

prevent further cardiac tissue damage

Question 24

What is the treatment of acute coronary syndrome

Answer 24

Administer 4L NC oxygen if saturation < 94%,

ONAM protocol

Question 25

What the meds and doses in the ONAM protocol?

Answer 25

• O2 4L NC if sat <94%
• Nitroglycerine 0.4 mg sublingual q5min prn chest pain, max dose 3 doses in 15 min
• Aspirin 160-325 mg daily chewable
• Morphine 4-8 mg IV for chest pain unresponsive to Nitroglycerine

Question 26

Lovenox in the event of STEMI dosage

Answer 26

30 mg IV bolus followed by 1 mg/kg SC q12 hours given 15 minutes after the IV bolus

Question 27

Lovenox in the event of NSTEMI dosage

Answer 27

1 mg/kg SC q 12 hours with ASA

Question 28

You can tell in which area of the heart and which coronary vessel is blocked in an STEMI based on which what?

Answer 28

leads have the ST elevation.

Question 29

Metoprolol dosing for
STEMI
NSTEMI

Answer 29

• STEMI with tachycardia in absence of hypotension give 5mg IV q 5 minutes to a max dose of 15 mg
• In the event of a NSTEMI start with 50mg PO BID.

Question 30

NSTEMI vs STEMI EKG

Answer 30

NSTEMI may show ST segment depression, T wave inversion, or no changes at all.

STEMI will show a classic evolution of changes from ST segment elevation, T wave inversion, and finally Q wave development

Question 31

How would you treat a PT with a new left bundle block with symptoms of AMI?

Answer 31

Same as STEMI