Review Flashcards
Hyperkalemia –
Hypokalemia –
Hyperkalemia – peaked T waves; wide QRS and flattened p waves
Hypokalemia –tall U waves and flat T
how do we name the expected compensation?
named for the expected compensation (respiratory/metabolic) and the pH (acidic/alkalotic
If delta delta is higher or lower, then we have what?
a 3rd acid base disorder present
Acute coronary syndrome is an umbrella term for
Unstable Angina, NSTEMI and STEMI
If cardiac enzymes are elevated, you are dealing with ________
NSTEMI or STEMI
If cardiac enzymes are elevated, you are dealing with either NSTEMI or STEMI. What can tell the difference between the 2?
EKG
Unstable Angina indicates _______ without _____
ischemia w/o myocardial damage
Pt presents with chest pain what do you do?
What is the inital steps in management of NSTEMI?
- O2 is low saturation
- Pain relief with opiate analgesia and nitro; ONLY IF PAIN
- ASA
- EKG
- Cardiac enzymes and CMP (to check renal function)
There’s no ST elevation or depression on EKG, what is the DDX?
- NSTEMI: sudden decrease in myocardial BF d/t acute plaque rupture leading to partially occluding thrombosis
- Unstable angina: ischemia that does not necrosis.
What do you give a patient with NSTEMI or Unstable angina?
- ASA; given to 100% of pts with CP
- P2Y12-inhibitors (-grel)
- Bblockers, ACE inhibitors, statins
Cardiac enzymes come back positive, what is the diagnosis?
NSTEMI
How do you fix the STEMI (DO NOT USE IN NSTEMI)?
Coronary angiography/PCI are THE first choice for treatment if can be given in 90 minutes. If no cath lab and if can transfer to a hospital within 120 minutes, do IT.
If this can’t be done, thrombolytic (fibronitic) therapy should be started and the patient should be sent to somewhere for PCI
This is harmful if ACS without ST segment elevation
Class 1 Antiplatelet drugs (have to do them over and over again for a year) given for NSTEMI-STEMI
- ASA
- P2Y12- inhibitors
3- Glycoprotein 2a/3b-inhibitors (abciximan, tirofiban, eptifibitide) is used long-term, IF THE PT IS AT HIGH RISK FOR NSTEMI
What is a class 3 drug that you should NOT use for NSTE-ACS?
Thrombolytics
When do you give PCI (percutaneous intervention) to a patient with NSTE-ACS?
High-risk patient, then send to cath lab
High risk = ST Depression and high troponin
How do you treat a low-risk and high-risk patient differently with NSTEMI-ACS?
Low risk (NL troponin and - ST depression): stress test
High risk (high troponin and + ST depression): PCI and cath lab
How can we tell if patient with ACS is experiencing unstable angina?
NL levels of troponin
_______ is dangerous in NSTE-ACS.
______ is the MOST important thing in STEMI?
thrombolytic/fibrinolytic therapy
reperfusion therapy
How do you treat the patient long term?
- Glycoprotein IIB/IIIA inhibitors are used for high risk NSTEMI
- Patients should be on long term anticoagulation therapy when they leave the hospital – Heparin and LMW heparin
- Beta blockers, statins and ACE inhibitors are used to treat comorbities
what is the progression of changes in cardiac enzymes in pt with STEMI?
Initial cardiac enzymes may be NL.
Become + 4-6 hours later
Troponin may stay elevated for 5-7 days after STEM
How do you treat STEMI?
- Aspirin
- PG2Y12 inhibitor (clopidrgel/ Ticagrelor)
If high risk: Gp2a/3b inhibitors
- Reperfusion therapy: via coronary angiography & PCI or thrombolytics (if facility of Primary PCI is not available) d/t ST elevation
Only give thrombo if cannot do CA or PCI in a cath lab
PCI: door to ballon is 90 minutes
If no cath lab, but you can transfer pt to hospital in 120 minutes, DO IT
what are absolute CI for thrombolytics in STEMI?
- Prev hemorrhagic stroke
- Other strokes
- Intracranial neoplasms
- recent head trauma
- Active internal bleeding (not menstruation)
- Suspected aortic dissection
- ANY bleeding
1 treatment for STEMI?
SEND TO CATH LAB
Post MI complications (5)
Post infarct ischemia
Arrhythmia
Right ventricular infarction
Mechanical complications
Myocardial dysfunction
Post MI Ischemia can occur when?
Tx?
- After thrombolytic therapy for STEMI
- After medically treating a NSTEMI.
Treat with vigorous medical therapy. If refractory, undergo early aniography and revascularization
What arrythmias can occur after a MI?
- Sinus bradycardia (MCC in inferior MI)
- Supraventricular tachycardia, including a-fib
- Conduction disturbances
- Ventricular arrhythmias
AV node supplied by _______
RCA
Post-MI, patient has
1st degree AV block
2nd degree AV block
Complete AV block
describe them
- 1st degree AV block: most common and no treatment
- 2nd degree AV block: only treat if symptom
- Complete AV block: most common in an inferior MI.
If occurs with an anterior MI => worse.
complete AV block is most common in an ____ MI and worse with an _____ MI? What is the treatment?
inferior
anterior = worse bc sign of BAD infarction
Permenant pacing
What is the most comon conduction abnormality in the first few hours after MI and how is it treated?
Ventricular arrythmia (VT/VF)
if hemodynamically signifiant: defibrillate
Stable: antiarrhythmic meds + amiodrone
how do you treat RV infarction, which occurs in 1/3 of all inferior MIs.
IV fluids
- AVOID VASODILATORS (NG)
- DO NOT REDUCE PRELOAD
Right ventricular infarcts (RV infarcts) presents with what sx?
- HypoTN with NL LV function
- High JVP
- Clear lungs
How are LV/RV infarcts different?
RV infarcts
RV infarcts will have clear lungs
Dx by: ST elevation in the right sided anterior leads
LV infarcts
LV infarcts do NOT have clear lungs
Dx: ST elevation in the left sided anterior leads
A pt with recent MI presents with systolic BP <90. They have cold extremities, decreased urine output and are confused; what are you thinking?
Cardiogenic shock
- these patients will not respond with fluid resucitation
- give inotropic support (DA, dobutamine, NE)
- poor prognosis
NAME THAT SHOCK
should be considered for urgent coronary angiography, revascularization and possible placement of intra-aortic balloon pump.
cardiogenic shock
NAME THAT SHOCK
Echocardiagram should be taken and will show function of the LV is moderately - severely reduced.
Cardiogenic shock
• Essentials of Diagnosis in a patient with shock (4)
Hypotension (low BP)
Tachycardia
Oliguria
Altered mental status (confusion)
Name that shock
Blood loss or dehydration causes decreased intravascular volume. To treat, we replete the intravascular volume
hypovolemic shock
NAME THAT SHOCK!
Shock caused by [cardiac tamponade, tension pneumothorax and massive PE] that is treated by treating underlying cause
Obstructive shock
NAME THAT SHOCK
A category of shocks, where the most common in septic shock!
distributive
NAME THAT SHOCK!
Shock most commonly caused by gram (-/+) organism where hypotension does NOT respond to fluid. Systolic BP are < 100mmHg, serum lactate levels are high (> 2mmol/L) and requires vasopressors to keep MAP above 65mmHg.
SEPTIC SHOCK
NAME THAT SHOCK!
Type of shock treated by fluids + ABX + hope for the best!
septic shock
