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CPR II Exam 1 > Stable Angina, ACS, and Aortic Dissection > Flashcards

Stable Angina, ACS, and Aortic Dissection Flashcards

1
Q

how is stable angina defined?

A

chest pain or pressure for at lest 2 months duration that is precipitated by exertion and has not worsened

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2
Q

what three things are considered for acute coronary syndrome (ACS)?

A

unstable angina, non-ST elevated MI, STEMI

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3
Q

what are three non-traditional risk factors for CAD?

A

CKD, proteinuria, and inflammatory states (HIV, RA, psoriasis)

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4
Q

what is the diamond-forrester criteria of chest pain?

A

angina pectoris chest pain has 3 components: 1. substernal chest pain or discomfort 2. provoked by exertion/ emotional stress 3. relieved by rest and/or nitroglycerin

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5
Q

what are the three different types of angina according to the diamond-forrester criteria?

A

typical: all 3 components; atypical: 2 components; non-angina: 1 or less components

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6
Q

if a patient has stable angina and intermediate pretest probability of CAD, what testing should they have done next?

A

cardiac stress testing

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7
Q

patients with positive stress testing should have what test done next?

A

invasive coronary angiography

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8
Q

how do you pharmacologically stress the test?

A

using vasodilators (adenosine, dipyridamole, and regadenoson; or using inotropes and chronotropes (dobutamine)

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9
Q

what are three stress test modalities?

A

Stress ECG, stress echo, and stress MPI (aka nuclear stress test)

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10
Q

how do you evaluate the contractility of the heart?

A

dobutamine stress ECHO

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11
Q

what are the terms used to describe regional wall motion abnormalities (RWA)?

A

hypokinesis, akinesis, or dyskinesis

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12
Q

when using coronary angiography, what defines significant stenosis?

A

if a lesion is greater than 70%

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13
Q

what is the ECG criteria for a STEMI?

A

ST segment elevation of >2mm in continuous leads or new LBBB

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14
Q

what is the ECG criteria for NSTEMI?

A

new ST-depression >.5 mm in two contiguous leads and/or T wave inversions >1mm in two contiguous leads with prominent R waves or R/S ratio >1

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15
Q

What is a type 1 acute myocardial infarction (AMI)?

A

infarction due to coronary atherothrombosis

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16
Q

what is a type 2 acute myocardial infarction (AMI)?

A

infarction due to a supply-demand mismatch not the result of acute atherothrombosis

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17
Q

what is the generalized treatment for stable angina?

A

lifestyle modification, aspirin, statin, and anti-anginal drugs

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18
Q

what are the anti-anginal drugs used for chronic angina prevention?

A

beta-blockers, calcium channel blockers, long-acting nitrates, and ranolazine

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19
Q

what is ranolazine used for?

A

reserved for more refractory angina

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20
Q

what is ranolazine’s MOA?

A

inward sodium channel blocker and ultimately decreases myocardial oxygen consumption

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21
Q

what are the anti-anginal drugs that are used for acute angina relief?

A

short-acting nitrates

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22
Q

what are the indications for a patient to have a CABG instead of a PCI stent?

A

3 vessel disease >70% stenosis, left main disease, and LV dysfunction

23
Q

what is the generalized treatment for unstable angina, NSTEMI, and STEMI?

A

initial: MONA: morphine, oxygen, nitrates, and aspirin; anti-platelet therapy, anticoagulation, revascularization therapy, and thrombolytics (only used for stemi)

24
Q

what is included in antiplatelet therapy?

A

aspirin and P2Y12 inhibitors

25
Q

what is included in anticoagulation therapy?

A

unfractionated heparin or subcutaneous enoxaparin

26
Q

what are two examples of revascularization therapy?

A

percutaneous coronary intervention (stents) or CABG

27
Q

what is long-term therapy for all ACS?

A

aspirin, P2Y12 inhibitors, beta-blockers, ACEi or ARB, Statins, nitro

28
Q

what drugs have shown to improve mortality in MI?

A

aspirin, beta-blockers, or ACEi

29
Q

if a patient presents to the ED with a STEMI, what is the treatment and management?

A

PCI capable hospital: <90 minutes; non-PCI capable hospital: transfer to PCI hospital in less than 120 minutes or start thrombolytics in less than 30 minutes and then transfer to a PCI capable hospital

30
Q

if a patient presents to the ED with a STEMI, what should the initial medical treatment be?

A

aspirin, beta-blocker, nitrates, heparin

31
Q

what does the TIMI score predict?

A

risk of 14 day death, recurrent MI, or urgent revascularization

32
Q

if a patient presents to the ED with unstable angina or NSTEMI, what should the initial medical treatment be?

A

aspirin, beta-blocker, nitrates, statin

33
Q

an inferior MI will appear where on the EKG?

A

II, III, aVF

34
Q

a septal MI will occur where on an EKG?

A

V1-V2

35
Q

an anterior MI will occur where on an EKG?

A

V2-V4

36
Q

a lateral MI will occur where on an ekg?

A

v5-v6 or I, AVL

37
Q

a posterior MI will appear how on an EKG?

A

Tall R waves and ST depression in V1-V3

38
Q

what artery supplies the inferior heart?

A

RCA

39
Q

what artery supplies the septal heart?

A

LAD

40
Q

what artery supplies the anterior heart?

A

LAD

41
Q

what artery supplies the lateral heart?

A

left circumflex

42
Q

what are 4 general complications of an MI?

A

arrhythmias, tissue necrosis, cardiogenic shock, embolism

43
Q

tissue necrosis following an MI could lead to what 3 things?

A

cardiac tamponade, CHF/shock, mitral regurgitation

44
Q

what is Dressler syndrome?

A

postmyocardial infarction syndrome; immunologically based syndrome that typically presents weeks to months after MI; presents as pericarditis

45
Q

there are two classification systems for thoracic aortic dissections. What are they?

A

Debakey and Stanford

46
Q

what are the different types of thoracic aortic dissections according to the stanford classification system?

A

type A: ascending aorta (more severe); Type B: descending aorta

47
Q

what are some risk factors for aortic dissection?

A

long term HTN, smoking, dyslipidemia, drug use, marfan syndrome,trauma

48
Q

younger patients who have aortic dissection probably had one of these risk factors:

A

marfan syndrome, trauma, cocaine or meth use, or syphilis syndrome

49
Q

how does aortic dissection present?

A

sudden onset of chest pain described as tearing or ripping which radiates to the back; hypertension

50
Q

how do you go about making the diagnosis of aortic dissection?

A

ECG and cardiac biomarkers (rule out myocardial infarction); CXR (look for widen mediastinum), CTA (most commonly used); TEE (used more in hemodynamically unstable patients

51
Q

how do you treat an aortic dissection?

A

anti-impulse therapy: which lowers HR and diminishes force of LV ejection thus reducing shear stress on intima: goal: BP less than 120 and HR less than 60; first line therapy IV B-blockers and then add in vasodilators; opiates for pain control

52
Q

how do you surgically manage an aortic dissection?

A

open surgery if stanford type A; endovascular stenting if stanford type B

53
Q

what is the best course of treatment for a type B aortic dissection?

A

endovascular management (endovascular stenting)

CPR II Exam 1 (13 decks)

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