7857642
Description
Flashcards by brittny beauford, updated more than 1 year ago
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Created by brittny beauford
about 8 years ago
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| Question | Answer |
| Leading cause of death in the US? Most common type of cardiovascular disease? | Cardiovascular disease CAD most common Atherosclerosis most common cause of CAD |
| ______________ (CRP) – marker of inflammation. Chronically elevated CRP associated with unstable plaques. _________ often given to these patients | C-reactive protein Folic acid |
| Goals for Ideal CV Health for Adults 20 years and older | Total 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) |
| Pathophysiology ACS specific to OCCLUSION | OCCLUSION OF CORONARY ARTERY endothelial damage occurs--> ARTHEROSCLEROTIC PLAQUE DISRUPTION AND PLATELET AGGREGATION thrombus formation |
| Pathophysiology ACS specific to VASOSPASM | Vasospasm 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. |
| Management of ACS | Assess immediately to diagnose STEMI or NSTEMI? Normal ECG - low risk for AMI, but important to continue evaluating |
| Managment of ACS STEMI vs NSTEMI | STEMI- get the artery open ASAP NSTEMI- provide anti-ischemic and anti-platelet therapy ASAP |
| ACS time frame: Door to needle____ Door to ballon____ | Door to Needle<30 min Door to Balloon <90 min |
| What should be administer for a patient with chest pain after a history and focus physical exam? | ASA |
| Acute Coronary Syndrome: work up includes completed H&P, Trop I, CK MB, EKG what do these findings indicate: No ST-segment elevation Neg Markers | Unstable angina |
| Acute Coronary Syndrome: work up includes completed H&P, Trop I, CK MB, EKG what do these findings indicate: No ST-segment elevation Pos Markers | NonSTEMI |
| Acute Coronary Syndrome: work up includes completed H&P, Trop I, CK MB, EKG what do these findings indicate: ST-segment elevation Pos Markers | STEMI |
| Difference between how men and women present with ACS/MI women | Women: 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 |
| What 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 |
| Difference between how men and women present with ACS/MI Men | More traditional signs of a MI |
| What’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. |
| Tx 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! |
| Patient History and Physical Exam with ACS/MI | assess pain- PQRST (PAIN, QUALITY, RADIATION AND RECURRENCE, SEVERITY & TIME FRAME) dyspnea, epigastric, upper extremity pain? age, race, co-morbidites, family/social hx |
| The 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 |
| EKG 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 |
| ST DEPRESSION tend to imply | ISCHEMIA |
| ST ELEVATION tends to imply | INFARCTION |
| Anterior STEMI results from occlusion of the ________________ | LEFT ANTERIOR DESCENDING (LAD) |
| Anterior myocardial infarction CARRIES THE ______ PROGNOSIS of all infarct locations, mostly due to larger infarct size. | WORST |
| ST SEGMENT ELEVATION IN THE ______LEADS AND THE ________ LEADS | PRECORDIAL LEADS (V1-6) HIGH LATERAL LEADS (I AND aVL) Reciprocal ST depression in the inferior leads (mainly III and aVF). |
| __________MI account for 40-50% of AMIs USUALLY OCCURRING IN THE________ | inferior MI RCA |
| Inferior 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) |
| Pharm management in MI first medication priority and why | ASPRIN TO DECREASE PLATELET ADHESIVENESS- CHEWABLE |
| Pharm management of MI and why | Morphine: 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 |
| Considerations with pharm management in a MI patient | Start 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 |
| Cardiac Markers: ________ is the preferred biomarker! | TROPONIN Troponin is sensitive and specific, it detects even minimal damage to the myocardium ultra sensitive |
| HOW TO PROPERLY MONITOR TROPONIN | OBTAIN BASELINE THEN IN 6 HR AND 12 HR. CHEST PAIN CENTERS MAY OBTAIN EVERY 4 POSITIVE IS > OR = 0.04 |
| OTHER CAUSES OF ELEVATED TROPONINS | cardiac contusion myocarditis sustained tachycardia apical ballooning (angioplasty) chronic renal disease HF, sepsis, burns extreme exertion |
| Other 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. |
| What 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 |
| KEY 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 |
| If 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 |
| OBJECTIVES OF EXERCISE STRESS TESTS | Diagnose functionally significant coronary artery disease Evaluating functional capacity need for medical or surgical therapy |
| LIMITATIONS OF THE EXERCISE STRESS TEST | Women- high false positive BETA BLOCKERS BLOCKS MAX HR & MAX WORK SO DECREASED SENSITIVITY BBB and pre-excitation conduction abnormalities make stress tests uninterpretable |
| What would make us want to immediately stop a stress test? | in class |
| When 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 |
| Pharmacologic 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 |
| If 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 possible | cardiac catheterization coronary angioplasty |
| stable vs unstable angina | unstable is different angina then their regular angina |
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