Trigger - IHD part 2 Flashcards
what could a new LBBB on an EKG indicate
suspicious for STEMI
what are reasons a trop can be elevated aside from MI
false positive could be caused by exercise, trauma, or DM
CK-MB
also see: muscle disease, PE
what EKG abnormalities make an exercise stress test contraindicated
- preexcitation syndrome WPW
- electronically paced ventricular rhythm
- greater than 1mm of resting ST depression
- Complete LBBB
to increase sensitivity and specificity of a stress test, what could be added
Echo
a patient has a complete LBBB on EKG. are they eligible for an exercise stress test?
NO. do a pharm stress test.
adenosine, dipyridamole, regadenoson are all used for what?
used as vasdilative agents in pharmacological stress testing.
causes coronary artery vasodilation
Contraindicated in patients with bronchospasms
Pharmacologic vasodilation agents used in stress tests (dipyrimadole, adenosine, regadenoson)
when is dobutamine with atropine used
andrenergic stimulants used as second line pharmacological stress test agents
CI in sustained arrhythmias and systemic HTN
dobutamine and atropine
metformin is CI and must be held prior to what procedure
cardiac cath/coronoary angiogram!
what type of consent is required in cardiac cath/ coronary angiogram
WRITTEN
SE include tachycardia, increased SBP and PVCs
andrenergic stimulating agents (dobutamine an atropine)
also see: palps, angina, HA, nausea, dyspnea
HR must be less than 50bpm in order to perform which test?
CT of the coronary arteries
for ACS management, when should BB not be used
CHF
Bradycardia
AVblock
decreases SVR and preload by dilating coronary vessels and increasing blood flow
MOA of NTG
also enters vascular smooth muscle and converted to nitric oxide, leading to activation of cGMP and vasodilation
also enters vascular smooth muscle and converted to nitric oxide, leading to activation of cGMP and vasodilation
MOA of NTG
decreases SVR and preload by dilating coronary vessels and increasing blood flow
first line therapy in patients with ACS except in patients with a IWMI
NTG
IWMI involves the RV, which will affect preload too much if treated.
SE includes reflex tachycardia and paradoxical bradycardia. MC SE is headache, postural hypotenstion
NTG
this medication decreases sympathetic tone, decreases SVR, and deceases O2 demand. therefore reducing afterload
morphine
use caution in hypotension, hypovolemia, and respiratory depression
morphine
used for stabilizing plaque and antiplatelet aggragation
ASA
600mg of plavix is bolused prior to what procedure
cardiac cath
plavix must be postponed 5 days prior to what procedure? (reminder ticagrelor is 7 days)
CABG
inhibition of platlet aggregation and support of PCI for HIGH RISK PTS only. What drug?
Aggrastat, integrillin, reopro
glycoprotein 2b/3a inhibitors
if pain persists, IV NTG can be given until MAP drops by how much?
10%
this drug reduces infarct size, rate, cardiac remodeling and cardiac enlargement
BB
also deceases life threatening tachycarrhythmias
SE of QT prolongation in this drug. Used cor chronic stable angina
Ranolazine (late Na channel blocker)
reduces fibrosis and remodeling post MI
ACEs and ARBs
when is alteplase and tenecteplase used
fibrinolytic therapy used in STEMI TX ONLY
SE is ICH
tPA administration
when is LMWH used with ASA
post-tPA or in surgery
when do you use tPA
only when cardiac cath cannot be done within a few hours of the STEMI. ideally you want tPA administered within 30 min of ED arrival
when are PPIs indicated
after the use of fibrinolytics in a STEMI
alternate options to PPI is antacids and H2 blockers while hospitalized
what is the GOLD standard tx for unstable CAD
PCI
this type of stent has a longer period of DAPT, but is still the preferred type of stent
drug-eluting stent
when do you use DAPT?
Post PCI
P2Y12 receptor blocker + ASA for 3-12 months
