EM Chest Pain and CV Emergencies (incomplete) Flashcards
what is stable angina
stable, chronic lesion of coronary artery leading to reliable chest pain with exertion, resolves at rest
what is unstable angina
acute cardiac ischemia
clinical dx
worrisome if increase in freqency, severity, length of symtpoms
What is an acute myocardial infarction
heart muscle death resulting in ECG changes and/or increase in cardiac biomarkers (troponin)
what is an NSTEMI
incomplete occulsion of artery. may see ST depression or T wave inversions. Troponin will be elevated.
What is a STEMI
ischemia that affects the entire thickness of the myocardium. completel occulsion of artery
What are high risk features for ACS
increase in exertional symptoms
symptoms that last >20 min after cessation of activity
pulmonary edema
new murmur
hypotension
diaphoresis
ST elevation on ECG, new block, dysrhythmia
elevated troponin
radiation of pain
known hx of CAD
what type of MI can you not give Nitro
inferior MI
What is the Sgarbossa Criteria
used for diagnosis of STEMI with LBBB
When are troponin levels taken with cardiac concerns
when they initially present and 3 hours later.
will begin to elevate 3 hours after onset, peak at 12 hours, can remain elevated for 7-10 days
What are STEMI mimics
early repolarization
pericarditis
LV hypertrophy
LBBB
WPW
brugada
hyperkalemia
hypothermia
PE
CAD
what is the initial management of ACS
ABC, IV/O2/Monitor
concerns for ACS:
- chew 325mg non-enteric coated ASA
- nitroglycerin for active CP
what is the management of STEMI
cath lab with goal of 90 min door to balloon
if >90min to PCI, consider thrombolytic (tPA)
start anticoagulation with heparin
clopidogrel
statin
What are contraindications for tPA
- prior intracranial hemorrhage
- known cerebral anteriovenous malformation
- known cerebral neoplasms
- ischemic stroke within 3 months (friable tissue)
- suspected aortic dissection
- active bleeding or bleeding diathesis
- significant trauma within past 3 months
What is the TIMI and Heart Score
risk statifies NSTEMI
what is the treatment of unstable angina
treat as we did for NSTEMI
- pain relief
- ASA
- consider dual antiplatelet therapy
- consider anticoagulation
- repeat ECG, troponin
