PBL UNIT 3 part 2 Flashcards
Causes of anemia in the elderly?
- chronic disease (they cannot use their iron stores very well
- iron deficiency anemia (low iron stores)
- GI bleed is up there but no the most prevalent
Which troponin is the most specific to the cardiac muscles?
troponin I is only expressed in the cardiac muscle.
troponin T last for longer and it increases 2-3 hours after acute MI
troponin C is expressed in multiple locations
Highly sensitive troponin is also very specific and is available at many hospitals
Pre-cardiac cath guidelines (what to discontinue)
- stop metformin (24 hours), warfarin (2-3 days), stop direct oral anticoagulants (24-48 hours)
How to minimize the damage from contrast with cardiac catheterization?
- pre-hydrate and post hydrate
-use less media
-statin
-use anti-histamine
cardiac enzymes, what’s the first line? what else is useful and specific to the heart?
troponin I and T (rises as early as 4 hours after MI, and peaks 24-48 hours after onset)
CK-MB - detected at 4 hours, and peak at 24 hours post AMI
How do statins work?
Statins are a selective, competitive inhibitor of HMG-CoA reductase (enzyme that converts HMG-CoA to mevalonate in the cholesterol synthesis pathway)
Reduces hepatic cholesterol synthesis, so upregulation of hepatic LDL receptors occurs
This increases LDL/ VLDL uptake from circulation= good!
Liver also increases production of HDLs (unknown mechanism but being studied)
Overall: leads to a decrease in total cholesterol, triglyceride concentrations, and LDL, while increasing HDL
acute coronary syndrome intervention time line and steps:
Acute Coronary Syndrome Intervention: CAD -> STEMI, NSTEMI, unstable angina: emergency PCI “door to balloon time 90 min”
Indications for a coronary artery bypass graft:
-left main disease greater than 50%
-3 vessel CAD with greater than 70% with or without proximal LAD involvement
-2 vessel CAD - LAD plus 1 major artery
-1 or more significant stenosis is greater than 70% in a patient with significant angina symptoms despite max medical treatment
-one vessel greater than 70% in a survivor of sudden cardiac death with ischemia-related ventricular tachycardia
take graft from great saphenous vein
lipid panel levels:
Total Cholesterol < 200 mg/dL
200-239 is borderline and over 240 is high
Triglycerides (Fasting) < 150 mg/dL
Hypertriglyceridemia 150-499; Severe 500+
HDL-C > 60 mg/dL
Low: < 40 mg/dL
LDL-C < 100 mg/dL
Near optimal 100-129; Borderline high 130-159; High 160-189; 190+ very high
Ddx for chronic chest pain:
MI
pericarditis
acute aortic syndrome
pulmonary embolism
pulmonary hypertension
pneumonia or pleuritis
spontaneous pneumothroax
esophageal reflux
esophageal spasm
peptic ulcer
gallbladder disease
costochondritis
cervical risk disease
trauma or strain
herpes zoster
emotional and psychiatric conditions
difference between men and women in MI presentation
Men have first MI at younger age and experience chest pain, tightness , and pressure. Can experience burning/pricking pain sensations and sweating. More likely to be result of plaque rupture.
Women have their first MI at an older age and have nontypical symptoms like nausea, vomiting, dizziness, shortness of breath, abdominal discomfort, radiating pain (to arm, shoulder, neck, jaw, etc). Higher 1 year mortality.
STEMI EKG Findings:
New ST-segment elevation occurs at the J point in 2 contiguous leads, with a threshold greater than 0.1 mV in all leads except V2 and V3.
In leads V2 and V3, the threshold is greater than 0.2 mV for men older than 40, greater than 0.25 mV for men under 40, and greater than 0.15 mV for women.
STEMI acute pharmacological treatment:
Nitroglycerin 0.4 mg SL q5min; max dose 3 within 15 minute
a. Nitroglycerin 1-2 actuations SL q5min prn; max 3 actuations within 15 minutes
ALL PATIENTS with acute MI (with exception of course!
a. Beta blocker
b. High-intensity statin
c. Aspirin
d. P2Y12 inhibitor
e. The go to is dual antiplatelet therapy with aspirin and a potent P2Y12 inhibit such as prasugrel or ticagrelor.
i. Clopidogrel when the above two are contraindicated
f. ACE inhibitors have been shown to improve post MI outcomes with heart failure patients, LVEF < 40%, diabetes, CKD, or HTN
ALWAYS CHECK THE BIOMARKERS AS WELL
what aspirin do you give to someone with an STEMI or NSTEMI
chewable, non-coated aspirin 324mg
Types of pneumoconiosis
inorganic: asbestos (asbestosis), silica (mining, stone cutting, quarrying, sandblasting, etc.) coal dust, beryllium, other metals (aluminum, chromium, cobalt, nickel)
organic: cotton dust, grain dust, other agricultural dust: hypersensitivity pneumonitis,
