More and More stuff

Question 1

3 coronary vessels that supply the blood to the heart?

Answer 1

• left main coronary artery
• Left descending artery
• Left circumflex artery
• Right main coronary artery - blood to SA and AV node

Question 2

Blockages of the LAD and LCx cause?

Answer 2

left ventricle to not pump as effectively and leads to CHF

Question 3

Blockages of the RCA can lead to?

Answer 3

RV infarct with right sided heart failure, or brady arrhythmias due to lack of blood flow to the SA node.

Question 4

What is ACS?

Answer 4

spectrum of unstable cardiac ischemia from unstable angina to acute myocardial infarction.

Question 5

How is ACS classified?

Answer 5

ST-segment elevation (STEMI) or “non- ST-segment elevation (NSTEMI) and the presence of elevated cardiac enzymes.

Question 6

represents a transmural or full thickness myocardial infarct)

Answer 6

STEMI

Question 7

represents partial muscle thickness infarct

Answer 7

NSTEMI

Question 8

There is one less commonly occurring type of infarct, which is caused from coronary vasospasm (also known as Prinzmetal Angina)

Answer 8

results from coronary vasospasm causing obstruction with either ST elevation or ST depression and positive cardiac enzymes

Question 9

What is the difference about coronary vasospasm?

Answer 9

when you perform a cardiac catheterization there is no blockages in the coronary vessels.

** Makes sense because the vasospasm is just a constriction of the coronary artery

Question 10

Symptoms/phsycail findings of acs?

Answer 10

(1) Substernal chest pain (#1 symptoms)
(2) Chest pain commonly described as pressure on chest (like an elephant is sitting on their chest)
(3) Chest pain can radiate to left shoulder, left arm, neck or jaw
(4) Occurs at rest, commonly in the morning
(5) Diaphoresis
(6) Nausea and vomiting
(7) Anxiety
(8) Intense feeling like they are going to die
(9) Weakness or dizziness
(10) 1/3 of patients will not have typical chest pain (older, female, diabetics, neuropathy patients) and have worse outcomes due to delay in treatment
(11) Dyspnea
(12) Patient may appear anxious, diaphoretic, clinching fist over their chest (called the Levine’s sign)
(13) Can hear a new heart murmur
(a) Can infarct the papillary muscle to the mitral valve cause acute Mitral Regurgitation (Systolic murmur)
(b) Can hear a S3 heart sound indicating large amounts of blood entering the LV quickly into a compliant ventricle indicating volume overload (i.e. CHF)

Question 11

Labs for ACS?

Answer 11

• Troponin I and T

* CK-MB

Question 12

What do elevated Troponin and CK-MB values indicate?

Answer 12

myocardial infarction

Question 13

Tx for ACS?

Answer 13

• MONA

* O2 4L NC <94%

Question 14

Dosing of aspirin for ACS?

Answer 14

160-325mg

Question 15

Dosing for nitro?

Answer 15

0.4 mg sublingual every 5 minutes as needed for chest pain, max dose 3 doses in 15 minutes

Question 16

Dosing for morphine?

Answer 16

1) 4-8 mg IV for chest pain unresponsive to Nitroglycerine

Question 17

Dosing for lovenox?

Answer 17

In the event of a STEMI: 30mg IV bolus followed by 1mg/kg SC q12 hours given 15 minutes after the IV bolus

Question 18

Metoprolol dosing?

Answer 18

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