Sketchy cardio Flashcards
Therapy for angina
Beta blockers
Calcium channel blockers
Nitrates short acting sublingual
Coronary arterial dilation
Sublingual nitrates should be taken every 5 min at 3 doses
Prophylaxis before physical exertion
Isosorbide dinitrate
Tolerance, tachyphylaxis.
Nitrates free interval
Contraindications PDE 5
Ranolazine is for stable angina with refractory symptoms
Preventative: 2nd preventation
Aspirin for MI, p2y22 receptor inhibitor, clopidogrel
Statina too
ACS
Stemi, nstemi, unstable angina
Rupture of plaque leading to thrombosis
Rest, new onset pain
Can occur with or without ECG changes
St segment elevation or depression or new inversion of T wave
Stemi complete transmural infarct nstemi
Both present w elevation of troponins
Diffuse, radiating, diaphoresis, nausea vomiting
>30 min. Not improved w rest or NG
Atypical: SOB, palpitations, weakness( diabetes,elderly🥳🥳, women)
Prev MI
ABC pulse BP and peripheral pulse if no pulse, chest compression
prepare with Bipap or intubated if respiratory distress IV lines asap, fluid for perfusion. Give supplemental oxygen
Keep them on cardiac monitor and pulse oximeter
V tach can develop
12 lead in 10 min arrival check for ischemia or infarction
STEMI
1 or more ST elevation in 2 contiguous leads or 2 mm or more ST elevation in V2 and V3
New BBB on ECG
UA and NSTEMI differentiated w biomarkers and new ECG changes that are persistent in NSTEMI.
Repeat ECG every 10-15 min
History
HPI symptoms, characterize pain, assess associated symptoms
Give 325 mg aspirin immediately. Irreversible inhibitor of COX, prevents thromboxane A2, less thrombosis
Contraindications for thrombolysis
Prev ICH, AVM , intracranial neoplasm ischemic stroke, head trauma within 3 months, suspected aortic dissection, active bleed
Medic
Sildenafil not with nitrates
Signs of pe
Diaphoresis, MI signs S3 (fluid enters LV and hits the residual fluid living there or S4 gallop(stiff wall) and signs of mitral regurgitation due to papillary muscle
Large MI>HF> cardio genic shock
Lethargic, cool pale extremities, hypotension w tachycardia
Signs of hf in MI
S3 gallop, jvp elevation, bibasilar crackles, hypotension
Keep an eye out for bradycardia
Check for neurological deficits ( fibrinolytic)
Normal PE on ACS doesn’t exclude ACS
Investigations
CBC, BNP, cardiac biomarkers. Inc troponins in 2-3 hr
Peaks at 12 h, elevated for weeks
CK MB
12 h peak, baseline 36-48 h
Tells about re infarction
Repeat troponins and ECG every 6 h
Neurological+bradycardia monitor
UA not elevation, EKG can have ischemic changes
Nstemi and stemi change biomarkers
Differential
Esophageal rupture, sub CT emphysema and sharp chest pain. Watch for mediastinal air in CXR
Tearing chest pain radiating to back> AD
PE: pleuritic chest pain, dyspnea and tachycardia
DVT symptoms and D-dimer
CTA
No breath sounds and resonant lungs pneumothorax
Cardiac tamponade:
hypotension,raised jvp, muffled HS
ECG: low voltage, electrical alternans
Vasospastic angina
Young pts and angina at night
ACS management Mona B’s
Morphine oxygen(<90 PC) nitrates SABA
aspirin beta blockers statin
IV nitrates venous preload
Arterial dilation: afterload
Nitrates avoid in
Rt ventricle MI cuz they need preload, hypotension, pts w PDE 5 inhibitor ( ED+pul HTN)
B blocker
Mortality Dec, give in first 24 h
Contraindications
Bradycardia, heart failure asthma, give CCB
Morphine
Only if nitrates are insufficient
contraindications
Rt ventricular infarcts, hypotension
Statins
High intensity
Cardio genic shock
Pul edema
Vasopressin like norepinephrine
Nitrates+diuretics for pul edema(unload the left ventricle) less hydrostatic pressure, less CVP, don’t give in RV infarct, Cardio genic shock
RVI
Hypotension
Inf wall+ clear lungs and shock
Give fluids
Sinus bradycardia
Treat w atropine
Definitive treatment
STEMI
Immediately reperfusion
Coronary angiography , balloon catheter within 90 min
PCI immediately place a stent
Metal or drug eluting stents
Duration
Sometimes CABG if LCA is stenosed or 3 vessel disease
Before PCI we used to give fibrinolytic T-PA
PCI give within 120 min
If not possible,give thrombolysis
Thrombolysis
AVM, ischemic stroke,trauma, stress,bleeding, prev ICH
STEMI
Aspirin+clopidogrel ( for pt going thrombolytic therapy)both dual antiplatelet therapy
Therapy for anti coag in STEMI
UFH continuous infusion short HL
Fondaparinux, enoxaparin more HL
NSTEMI treated
Dual antiplatelet therapy
Anticoagulation
Immediately angiogram for high risk pt
In 24-48 h
Timmy and GRACE score
NSTEMI
No thrombolysis therapy
Indications for immediately angiography
Hemodynamic unstable, HF, recurrent rest angina, acute MR VSD
Sustained V tach , dynamic ST, t wave changes
aeiouS for urgent dialysis
Acidemia
Electrolytes
Inflammation
Intoxication
Overload
Uremia
Pericarditis
ASA+ Colchicine
Not use immediately after MI cuz scar formation is impaired
Systemic glucorticoids. Primary treatment for underlying cause
Avoid strenuous activity
