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Flashcards

453: Test 2 ACS and MI

brittny beauford English 45 cards

Cards in this deck (45)

  1. 1Leading cause of death in the US? Most common type of cardiovascular disease?Cardiovascular disease
    CAD most common
    Atherosclerosis most common cause of CAD
  2. 2______________ (CRP) – marker of inflammation. Chronically elevated CRP associated with unstable plaques. _________ often given to these patientsC-reactive protein
    Folic acid
  3. 3Goals for Ideal CV Health for Adults 20 years and olderTotal cholesterol < 200 mg/dL
    BP < 120/80 (some caveats here)
    Fasting glucose - < 100 mg/dL
    BMI < 25
    Smoking abstinence
    Physical activity > 150 min/week, moderate intensity
    Heart Healthy Diet (eg. DASH)
  4. 4Pathophysiology ACS specific to OCCLUSIONOCCLUSION OF CORONARY ARTERY
    endothelial damage occurs-->
    ARTHEROSCLEROTIC PLAQUE DISRUPTION AND PLATELET AGGREGATION
    thrombus formation
  5. 5Pathophysiology ACS specific to VASOSPASMVasospasm is primary but much less common then plaque rupture.
    10 % 0f MI’s occur with no CAD. May be higher in women!
    Secondary vasospasm occurs in reaction to rupture and contributes to→ thrombus formation.
  6. 6Management of ACSAssess immediately to diagnose
    STEMI or NSTEMI?
    Normal ECG - low risk for AMI, but important to continue evaluating
  7. 7Managment of ACS STEMI vs NSTEMISTEMI- get the artery open ASAP
    NSTEMI- provide anti-ischemic and anti-platelet therapy ASAP
  8. 8ACS time frame: Door to needle____ Door to ballon____Door to Needle<30 min
    Door to Balloon <90 min
  9. 9What should be administer for a patient with chest pain after a history and focus physical exam?ASA
  10. 10Acute Coronary Syndrome: work up includes completed H&P, Trop I, CK MB, EKG what do these findings indicate: No ST-segment elevation Neg MarkersUnstable angina
  11. 11Acute Coronary Syndrome: work up includes completed H&P, Trop I, CK MB, EKG what do these findings indicate: No ST-segment elevation Pos MarkersNonSTEMI
  12. 12Acute Coronary Syndrome: work up includes completed H&P, Trop I, CK MB, EKG what do these findings indicate: ST-segment elevation Pos MarkersSTEMI
  13. 13Difference between how men and women present with ACS/MI womenWomen: SOB and fatigue are very common presenting factors
    Absence of chest pain at presentation is associated with higher mortality.
    #1 cause of death in women
  14. 14What in the heck differentiates stable and unstable angina??Unstable angina is in a patient who usually has angina but this time is different then before
  15. 15Difference between how men and women present with ACS/MI MenMore traditional signs of a MI
  16. 16What’s the Evidence for Women with ACS?*Women’s Ischemic Syndrome Evaluation (WISE) study.
    *Half of the women have microvascular disease – blockage in the smallest vessels. Doesn't always show up in coronary angiography.
    Stroke accounts for a larger % of CVD events in women compared with men.
  17. 17Tx of MI in ED**Triage appropriately
    **Cardiac monitor (12 lead EKG)
    **Meds: ANTI-PLATELET (ASA), nitrates, beta blockers and anticoagulants
    **Urgent cardiac cath for NSTEMI
    **Direct PCI (percutaneous coronary intervention) or fibrinolytic agent for STEMI and cath lab!
  18. 18Patient History and Physical Exam with ACS/MIassess pain- PQRST (PAIN, QUALITY, RADIATION AND RECURRENCE, SEVERITY & TIME FRAME)
    dyspnea, epigastric, upper extremity pain?
    age, race, co-morbidites, family/social hx
  19. 19The million other things chest pain could be besides an MI (reference not memorization)♥ Aortic Dissection ♥ GERD
    ♥ Pulmonary Embolism ♥ Pleurisy
    ♥ Perforating Ulcer ♥ Chest wall pain
    ♥ Tension Pneumo ♥ Peptic Ulcer
    ♥ Pericarditis ♥ Panic Attack
    ♥ Myocarditis ♥ Bilary/pancreatic pain
    ♥ Vasospastic angina ♥ Cervical disc
    ♥ Neuropathic Pain♥ Takotsubo disorder
    ♥ Psychiatric ♥ Cardiomyopathy
  20. 20EKG and MI*Goal: 12 lead in first 10 minutes
    *NORMAL EKG DOESNT DX ACS/MI
    *ST SEGMENT ELEVATION is primary identifier of STEMI
    *T-wave inversions and pathologic Q-waves develop. These differentiate “old” MIs
  21. 21ST DEPRESSION tend to implyISCHEMIA
  22. 22ST ELEVATION tends to implyINFARCTION
  23. 23Anterior STEMI results from occlusion of the ________________LEFT ANTERIOR DESCENDING (LAD)
  24. 24Anterior myocardial infarction CARRIES THE ______ PROGNOSIS of all infarct locations, mostly due to larger infarct size.WORST
  25. 25ST SEGMENT ELEVATION IN THE ______LEADS AND THE ________ LEADSPRECORDIAL LEADS (V1-6)
    HIGH LATERAL LEADS (I AND aVL)
    Reciprocal ST depression in the inferior leads (mainly III and aVF).
  26. 26__________MI account for 40-50% of AMIs USUALLY OCCURRING IN THE________inferior MI
    RCA
  27. 27Inferior MI ST ELEVATION IN LEADS_________II, III AND aVF
    Progressive development of Q waves in II, III and aVF
    Reciprocal ST depression in aVL (± lead I)
  28. 28Pharm management in MI first medication priority and whyASPRIN TO DECREASE PLATELET ADHESIVENESS- CHEWABLE
  29. 29Pharm management of MI and whyMorphine: decrease pain & Myocardial 02 consumption/vasodilates vasculature
    O2: 02 demand & optimizes delivery
    Nitrates: Relieve ischemic pain by ^ flow & decreasing the workload through vasodilation. Give: Nitroglycerin (sublingual, spray,topical,IV)
    Beta Blockers: Relieve ischemia by decreasing contractility, HR & ventricular wall tension
    Give: Atenolol, Metoprolol
  30. 30Considerations with pharm management in a MI patientStart PO in 1st 24 hours unless heart failure, low CO, heart block, prolonged PR, active asthma, reactive airway Dx
    Do not give IV Beta blockers to STEMI patients
  31. 31Cardiac Markers: ________ is the preferred biomarker!TROPONIN
    Troponin is sensitive and specific, it detects even minimal damage to the myocardium ultra sensitive
  32. 32HOW TO PROPERLY MONITOR TROPONINOBTAIN BASELINE THEN IN 6 HR AND 12 HR.
    CHEST PAIN CENTERS MAY OBTAIN EVERY 4
    POSITIVE IS > OR = 0.04
  33. 33OTHER CAUSES OF ELEVATED TROPONINScardiac contusion
    myocarditis
    sustained tachycardia
    apical ballooning (angioplasty)
    chronic renal disease
    HF, sepsis, burns
    extreme exertion
  34. 34Other cardiac markers: What are they? What do they measure?CK/CK-MB: Iso leak in 6-24 hrs. Can cause false positive if only marker used. CK-MB fraction is specific for cardiac damage.
    MYOGLOBIN: (sensitive) elevation 1-2 hr after symptom onset. Not specific for MI cause lg amount in skeletal muscles.
  35. 35What is BNP? WHAT DOES IT TRIGGER?B-Type Naturetic Protein is a marker that is released when there is stretch occurring in the ventricle.
    The more stretch the more the muscle is placed under jeopardy of failure.
    NORMAL BNP <100
  36. 36KEY COMPONENTS OF RELIABLE EVIDENCE BASED ACUTE MI CARE (7 steps)1. Early administration of Aspirin
    2. Aspirin ordered as a dc medication
    3. Early administration of beta blockers
    4. Beta Blockers ordered as a dc med
    5. ACE1 or ARB ordered as a dc med for patients with LV systolic dysfunction
    6. Timely reperfusion w/ fibrinolytics or PCI 7. Smoking cessation counseling given
  37. 37If a patient has 2 sets of negative cardiac enzymes and no significant ECG changes he/she will be sent for some form of direct evaluation of the heart What will this include?exercise stress test or stress echo
    nuclear stress i.e. Persantine, Thalium
    Dobutamine Echo
  38. 38OBJECTIVES OF EXERCISE STRESS TESTSDiagnose functionally significant coronary artery disease
    Evaluating functional capacity need for medical or surgical therapy
  39. 39LIMITATIONS OF THE EXERCISE STRESS TESTWomen- high false positive
    BETA BLOCKERS BLOCKS MAX HR & MAX WORK SO DECREASED SENSITIVITY
    BBB and pre-excitation conduction abnormalities make stress tests uninterpretable
  40. 40What would make us want to immediately stop a stress test?in class
  41. 41When to use a chemical stress tests?Preferable to standard exercise stress in patients with:
    abnormal resting ECG, BBB, LVH, pacemaker. It also helps to localize the culprit lesion which may help direct PCI
  42. 42Pharmacologic Stress Test: Uses___________,___________, or____________ which:Dobutamine, Adenosine, Dypridamole
    ↑ myocardial work load in patients unable to exercise
    *Adenosine & Dypridamole are contraindicated in patients with bronchospasm or high grade AV block
    *Theophylline and caffeine decrease the effectiveness of the test
  43. 43If the stress test is positive then the patient will be sent for a ________ _______ where direct visualization of the______ arteries can be done. If significant occlusions are noted, they are opened with______ and possible stent placement whenever possiblecardiac catheterization
    coronary
    angioplasty
  44. 44stable vs unstable anginaunstable is different angina then their regular angina
  45. 45—

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Flashcards on 453: Test 2 ACS and MI, created by brittny beauford on 25/02/2017.
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