Unstable Angina Flashcards
On the EKG, inversion of T waves and, when more severe, displacement of ST segments is indicative of what?
ischemia;Transient T-wave inversion probably reflects nontransmural, intramyocardial ischemia; transient ST-segment depression often reflects patchy subendocardial ischemia; and ST-segment elevation is thought to be caused by more severe transmural ischemia.
Most patients who die suddenly from IHD do so as a result of ischemia-induced what?
ventricular tachyarrhythmias
Transient T-wave inversion probably reflects nontransmural, intramyocardial ischemia - what does transmural mean?
through the septal wall
when myocardial ischemia leads to electrical instability, what are the three consequences in terms of rhythm that will happen?
vtach, vfib, and pvc - esp the first two represent ischemic ventricular rhythms
what does the EKG tell you about the pulse of a patient who is experiencing angina?
NOTHING - EKG does not measure pulse!! you can have no pulse and have normal sinus rhythm
what is the radiation pattern of angina with MI?
radiations to neck, jaw, shoulder, arm
what happens to patients lung sounds when they have UA? why?
wide basilar rales, due to left ventricular failure; patients also will develop acute CHF and hypotension
what is the best lead to look at for myocardial ischemia?
5
new t wave inversion of what size is diagnostic of myocardial ischemia?
> .3mV
your patient presents as pain free and have negative biomarkers, do you send them for a stress test?
YES
your patient presents with no pain, but has positive biomarkers, do you send them for a stress test?
NO
what are your seven factors that comprise the TIMI? ‘Thrombolysis In Myocardial Infarction’
A Age, Aspirin, Angina B Biomarker C CAD risk factors D Diagnosis of CAD E EKG changes; age 65 years (A), three or more risk factors for CAD (C), documented CAD at catheterization (D), development of UA/NSTEMI while on aspirin (A), more than two episodes of angina within the preceding 24 h (A), ST deviation 0.5 mm (E), and an elevated cardiac marker (B)
chest pain early in the morning (MONDAY) within a few hours of waking is indicative of what?
MI
Although STEMI may commence at any time of the day or night, _______ have been reported such that clusters are seen in the morning within a few hours of awakening.
circadian variations (remember, your heart rate and metabolic rate slows down when you are sleeping)
what are the 5 differential diagnoses of pain of STEMI?
acute pericarditis, PE, acute aortic dissection, costochondritis, and gastrointestinal disorders. Lau also included GERD, and variant angina.
The combination of substernal chest pain persisting for >30 min and diaphoresis strongly suggests what?
STEMI
_____ is essential in the management of patients with suspected STEMI and is effective across the entire spectrum of acute coronary syndromes.
aspirin; but remember, pts must chew the aspirin so the saliva can activate the enzymes!!!! DO NOT give water, b/c you don’t want them to swallow
_______ (treatment) can be given safely to most patients with STEMI. Up to THREE doses of___mg should be administered at about 5-min intervals.
sublingual nitroglycerin; .4mg
nitroglycerin may be capable of doing what to preload? and myocardial o2 demand? and myocardial o2 supply? How does it do all of these?
nitroglycerin may be capable of both decreasing myocardial oxygen demand (by lowering preload) and increasing myocardial oxygen supply (by dilating infarct-related coronary vessels or collateral vessels)
Therapy with nitrates should be avoided in patients who present with what? (2)
low systolic pressures (less than 90mmHg); suspicion of right ventricular infarction
Nitrates should not be administered to patients who have taken what other drugs? why?
phosphodiesterase-5 inhibitor sildenafil (viagara) for erectile dysfunction within the preceding 24 h, because it may potentiate the hypotensive effects of nitrates.
what is the antidote for accidentally giving a pt nitrate with viagara?
IV atropine
_____(drug) is a very effective analgesic for the pain associated with STEMI, but what is the one requirement for the patient profile? why?
morphine; good BP (cannot have low BP); b/c morphine may reduce sympathetically mediated arteriolar and venous constriction, and the resulting venous pooling may reduce cardiac output and arterial pressure
morphine is a good DOC for what other major heart disease? THINK …
CHF b/c of it’s venodilator effects
beta blockers or ccb for use during acute setting MI? and why?
Beta blocker! b/c ccb can cause vasodilation which can promote CHF which is already a big problem post MI.
PVA doc of what? what’s the next line therapy? (prinzmetal variant angina)
CCB; nitro
what drug should absolutely not be given to pts suffering from PVA? (prinzmetal variant angina) why?
aspirin. b/c may actually increase the severity of ischemic episodes, possibly as a result of the exquisite sensitivity of coronary tone to modest changes in the synthesis of prostacyclin.
how can you tell the difference between a person having unstable angina and pva? (prinzmetal variant angina)
you cannot tell! best bet is to coronary angiography.
any pt that comes into the ER with chest pain must be treated with what?
aspirin - even though if the person has PVA it might actually make it worse
what do you give a patient who comes in with chest pain, but is allergic to aspirin? (both names)
Plavix (clopidogrel) -keeps the platelets in your blood from coagulating (clotting) to prevent unwanted blood clots that can occur with certain heart or blood vessel conditions.
The proportion of painless STEMIs is greater in patients with ______ and it increases with age.
diabetes mellitus; this patient may present with diaphoresis
Intermittent claudication is significant for what?
peripheral vascular disease - remember, intermittent claudication is a clinical diagnosis given for muscle pain (ache, cramp, numbness or sense of fatigue), classically in the calf muscle, which occurs during exercise, such as walking, and is relieved by a short period of rest.
