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NSER 7210 - Theory > Module 3 - ACS, Cardiogenic Shock, Cardiac Arrest > Flashcards

Module 3 - ACS, Cardiogenic Shock, Cardiac Arrest Flashcards

1
Q

What area of the heart does the LAD serve?

A

Anterior surface of the LEFT ventricle (and septal and lateral)

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2
Q

What area of the heart does the LCX serve?

A

Lateral surface of the heart

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3
Q

What area of the heart does the RCA serve?

A

Right atrium and Right ventricle
And INFERIOR OF THE LEFT VENTRICLE!

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4
Q

What leads are supplied by the LAD?

A

I (or LCX)
aVL (or LCX)
V1 - V4

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5
Q

What leads are supplied by the LCX?

A

I
aVL
V5
V6

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6
Q

What leads are supplied by the RCA?

A

II
III
aVF

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7
Q

What leads show the lateral view of the heart?

A

I
aVL
V5
V6

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8
Q

What leads show the inferior view of the heart?

A

II
III
aVF

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9
Q

What leads show the septal view of the heart?

A

V1
V2

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10
Q

What leads show the anterior view of the heart?

A

V3
V4

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11
Q

What characteristics will you see for unstable angina?

A
  • ST depression / T wave inversion
  • (-) Troponin
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12
Q

What characteristics will you see for NSTEMI?

A
  • ST depression / T wave inversion
  • (+) Troponin
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13
Q

What characteristics will you see for STEMI?

A
  • ST elevation in two or more leads
  • (+) Troponin
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14
Q

What are the two reperfusion strategies for a coronary artery blockage?

A
  1. Thrombolytics
  2. Angioplasty
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15
Q

What is the gold standard for the treatment of an acute STEMI?

A

PCI
Percutaneous coronary intervention

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16
Q

What are the four goals of myocardial reperfusion therapy?

A
  1. Re-establish early patency of the coronary artery
  2. Save myocardial tissue
  3. Preserve L ventricular function
  4. Increase chance of survival from MI
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17
Q

What is the optimal door to balloon time?

A

< 90 minutes

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18
Q

What is the goal for door to needle time? (If PCI not available)

A

30 minutes

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19
Q

What medications are given for DAPT (dual antiplatelet therapy?

A
  • ASA
  • Clopidogrel or Ticagrelor
  • Heparin (anticoagulant)
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20
Q

What are the three key features associated with successful thrombolysis?

A
  • Relief of chest pain
  • Regression of ST segment elevation
  • Reperfusion arrhythmias
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21
Q

What is the major difference between unstable angina and NSTEMI?

A

NSTEMI has (+) troponin

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22
Q

What are some examples of antiplatelet medications?

A
  • ASA
  • Ticagerolor
  • Clopidogrel
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23
Q

Why are antiplatelet medications given to AMI patients?

A

Prevent blood clot formation by inhibiting platelet aggregation
- reduces risk of further clots

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24
Q

Why are anticoagulant medications given to AMI patients?

A

Prevent formation and growth of blood clots by inhibiting the activity of clotting factors
- prevents new clots from forming

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25
Q

What are two example of anticoagulant drugs given in AMI?

A

Heparin
Bivalirudin

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26
Q

Why are beta-blockers given to AMI patients?

A

Reduce HR
- decrease O2 demand
- decrease workload
- decrease further damage
Decrease BP
- decrease afterload, decrease workload, decrease O2 demand

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27
Q

What are some examples of beta-blockers given in AMI?

A

Carvedilol
Metoprolol
Bisoprolol

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28
Q

Why are nitrates given to AMI patients?

A

Vasodilation
- relax and widen blood vessels
- increase blood flow to coronary arteries
- decrease preload = decrease workload

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29
Q

What is an example of a nitrate given for AMI?

A

Nitroglycerin

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30
Q

Why are opioids given to AMI patients?

A

Pain management
- decrease workload on heart
- goal is 0/10 pain

31
Q

What are some examples of pain medications given for AMI?

A
  • Hydromorphone
  • Fentanyl
  • Morphine - cause vasodilation
  • Tylenol
32
Q

Why are statins given to AMI patients?

A

Stabilize plaque
- reducing the risk of plaque rupture and subsequent clot formation

33
Q

What are some examples of statins given for AMI?

A

Atorvastatin
Rosuvastatin

34
Q

Why are fibrinolytics (thrombolytics) given for patients with AMI?

A

Dissolve clots that are blocking coronary arteries

35
Q

What are two examples of fibinolytics given for AMI?

A

TNK (Tenecteplase)
TPA

36
Q

How do women present with ACS?

A
  • Unusual fatigue
  • SOB
  • Indigestion
  • Weakness
  • Dizziness
  • Palpitations
  • Anxiety
37
Q

What is the worst case scenario FOLLOWING an MI (other than cardiac arrest)?

A

Cardiogenic Shock

38
Q

What is the VIP rule for cardiogenic shock?

A

V = Ventilate (oxygen administration)
I = Infuse (fluid resuscitation)
P = Pump (vasoactive and inotropic agents)

39
Q

What are the three criteria for diagnosis of Cardiogenic Shock?

A
  1. SBP < 90 for 30 mins, vasopressors required
  2. Pulmonary congestion or elevated left ventricular filling pressures
  3. Impaired organ perfusion
    (ALOC, cold, clammy skin, oliguria, increased lactate)
40
Q

What are clinical signs of cardiogenic shock?

A
  • Cold, clammy skin (vasoconstriction and cyanosis)
  • Kidney (urine output < 0.5 mL/kg/hr)
  • Brain (ALOC, disorientation, confusion)
  • weak, rapid pulse
  • crackles on auscultation
  • restlessness & anxiety
  • delayed cap refill
  • worsening chest pain
41
Q

What is the vasoactive drug of choice in cardiogenic shock?

A

Norepinephrine

42
Q

What is the inotrope drug of choice for cardiogenic shock?

A

Dobutamine
- Increases contractility
- Decreases SVR (vasodilates)

43
Q

Why do you have to give Norepinephrine with Dobutamine in Cardiogenic Shock?

A

Norepinephrine balances out the vasodilation effects of Dobutamine

44
Q

What rhythms are defibrillated?

A

Pulseless VT
Vfib

45
Q

What is transthoractic impedence?

A

Resistance of the chest wall to the flow of current at the interface between the patient’s chest wall and the adhesive pads used for electrical therapy

46
Q

What is cardioversion?

A

Electrical therapy when a shock is delivered during ventricular depolarisation (QRS complex)

47
Q

What is the dose of adenosine in ACLS?

A

6mg IV push
If no response, given 12 mg

48
Q

What is adenosine used for in ACLS?

A
  • Stable tachycardias (narrow QRS)
  • Unstable tachycardias (narrow QRS), while making preparation for cardioversion
49
Q

What is the dose of amiodarone in ACLS?

A

300 mg IV push
Repeat dose of 150 mg IV push

50
Q

When is amiodarone used in ACLS?

A
  • pVT / VF that is unresponsive to CPR, defibrillation, and epi
51
Q

What is the first line drug for bradycardia (symptomatic)?

A

Atropine

52
Q

What is the total dose that can be given for atropine?

A

3 mg
(dose = 0.5 - 1 mg)

53
Q

What is the effect of Dopamine?

A

Increases HR and contractility

54
Q

When is Dopamine used?

A
  • Symptomatic Bradycardia (not responded to Atropine)
  • Hypotension after ROSC
55
Q

What are the H’s and T’s?
(5 of each)

A
  • Hypothermia
  • Hydrogen (Acidosis)
  • Hypoxia
  • Hypovolemia
  • Hypo/Hyper-kalemia
  • Tension pneumothorax
  • Tamponade, cardiac
  • Toxins
  • Thrombosis, cardiac
  • Thrombosis, pulmonary
56
Q

What happens if CO2 is < 10 mmHg during CPR

A

ROSC is unlikely

57
Q

How much time should CPR be delivered during a code?

A

At least 80% of the time

58
Q

What are risk factors for ACS?

A
  • HTN
  • Diabetes
  • Afib
  • Dyslipidemia
  • Smoking / ETOH
  • Previous MI
  • CAD
  • Family history
59
Q

What are some classic signs of MI?

A
  • Chest pain (crushing / pressure)
  • Radiating to L arm or jaw
  • Diaphoretic
  • SOB
  • Feeling of doom
  • Dizziness
  • Nausea
60
Q

What are interventions that need to be done in “C” for suspected MI?

A
  • IV
  • Cardiac monitor
  • ECG
  • Crash cart
  • Apply defib pads
61
Q

True or False:
ST depression = ischemia

A

True

62
Q

What does ST elevation on an ECG represent?

A

Infarct (death!)

63
Q

What are the drugs for standard ACS treatment?

A
  • ASA
  • Clopidogrel, Ticagrelor
  • Opioids
  • Nitroglycerin
  • Heparin
64
Q

What are the two treatment options for a STEMI?

A
  1. PCI - door to balloon 90 mins (120 mins for no cath lab)
  2. Fibrinolysis - door to needle 30 mins (if PCI not available)
65
Q

What are signs of RIGHT sided HF?

A
  • Lower limb edema
  • Sacral edema
  • Hepatomegaly
  • Increased JVD
  • Regurgitant murmur in the tricuspid area
66
Q

What are signs of LEFT sided HF?

A
  • lung crackles
  • respiratory wheeze
  • displaced cardiac index
  • L-sided heart murmurs
67
Q

What are signs that are shared by BOTH right and left HF?

A
  • Cool peripheries
  • Cyanosis
  • Orthopnea
  • Delayed Capillary refill
68
Q

What are the goals of treatment in Cardiogenic shock?

A
  1. Decrease preload
    - nitroglycerin, lasix, narcotics
  2. Decrease afterload
    - nitropursside (vasodilator on arteries), nitroglycerin
  3. Increase contractility
    - Dobutamine (increase contractility and decrease afterload)
69
Q

What area of the heart do Inferior MIs affect?

A

Right side of the Heart
- RCA
Interior of Left Ventricle!

70
Q

What is different about a RIGHT sided MI?

A

They are preload dependent

71
Q

What drugs do you have to be careful using with right sided MIs?

A

Nitro / Morphine
- affects preload

72
Q

What is the equivalent of a STEMI?

A

New LBBB

73
Q

What can obscure ST elevation on an ECG?

A

LBBB

NSER 7210 - Theory (6 decks)

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