STEMI, NSTEMI, UA Flashcards
What portion of patients will die from acute MI before reaching hospital - and usually from what?
1/5
usually of ventricular fibrillation
What portion of acute MI’s are “silent” - minor pain, attributed to GI tract
1/3
Women, elderly, diabetes patients
Result of prolonged myocardial ischemia
- usually result of thrombus formation on atherosclerotic plaque
Myocardial Infarction
Most common presenting factor in ACS
Nontraumatic chest pain
Other typical chest pain feature of ACS
Crushing retrosternal pain / pressure
Heaviness or tightness
Unexplained indigestion / epigastric pain
Describe progression of pain in acute MI
Increasingly severe, prolonged (>30min) anterior chest pain at rest
Most often during early morning hours
Be sure to ask specifically about these 5 things in PMH history:
- Prior coronary bypass graft
- Percutaneous coronary intervention (catheterization)
- Angina on effort
- MI
Vital signs in MI?
Bradycardic or Tachycardic
Hypotensive or Hypertensive
Cardiovascular exam in MI?
MAY BE NORMAL
- Possible JVD
- Soft heart sounds
- transient murmur of MITRAL REGURGITATION
- S4 gllop
What kind of murmur might you hear in someone with acute MI?
Mitral Regurgitation
What extra heart sound might you hear in someone w acute MI?
S4 gallop
Syndrome which includes pericarditis, fever, leukocytosis, pericardial or pleural effusion that develops 1-2 weeks post-MI
Dressler’s syndrome
Fever in MI?
YES - low grade fever may develop after 12 hours and last a few days
EKG identification of STEMI
ST-segment elevations of >1mm in TWO contiguous leads
Describe the classic progressive changes found in EKG over hours to days in STEMI
Peaked T waves > ST-segment elevations > Q waves > T-wave inversion
not present in all cases of MI!!
How would you consider a patient presenting with chest pain and an EKG with ST-segment depression?
Unstable Angina or NSTEMI
What would cause you to diagnose this patient with ST-segment depression with NSTEMI?
If cardiac biomarkers become elevated during evaluation
How do EKGs of NSTEMI patients develop?
Usually will develop EKG evidence of non-Q-wave MI
25% will develop EKG evidence of Q-wave MI
Timing of initial elevation of Troponin T/I?
3-12 hours
Peak elevation of Troponin T/I
12-48 hours
When should Troponin T/I be measured?
12 hours after onset of pain, then repeated every 8-12 hours
Highly sensitive test to quantify extent of infarction?
MRI with gladonium contract
What all patients with ACS and ongoing discomfort should receive
IV Fluids
O2
NTG (0.4mg sublingual every 5 mints x3)
Morphine
Oral Beta Blocker within first 24 hours, unless contraindicated (HF, brady, heart block)
When is IV NTG indicated?
In first 48 hours for treatment of persistent ischemia, heart failure, or HTN
TIMI test for risk (of death) stratification
MACES 65 3+
Thrombolysis In Myocardial Infarction
1 point for each of the following - score 3 or more considered high risk:
- More than one episode rest angina in past 24 hrs
- Aspirin within past 7 days
- Known CAD with stenosis 50%+
- Elevated cardiac markers
- ST-segment deviation
- > 65 years
- 3+ risk factors for CAD
GRACE test prediction
6-month risk of death after discharge
Global Registry of Acute Coronary Events
Age, gender, vital signs, ST-segment changes, historical factors
Immediate treatment of STEMi
- Aspirin and clopidogrel
2. Coronary angiography and Primary PCI (balloon angioplasty / stent) within 90 mins
Immediate treatment of UA/NSTEMI
- Conservative management appropriate for low-risk patients based on TIMI or GRACE scores
- Aspirin and clopidogrel
- Anticoagulation
- Invasive treatment for high risk patients or patients with progressive symptoms / EKG findings
- Cardiac catheterization (Angiography, PCI)
