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Flashcards in 3: ACS Deck (25)
1

pattern of pain with ACS

pain at rest of crescendo pattern of pain on minimal exertion

2

TIMI risk scores

count up the following risk factors:
-over 65 y/o
-at least 3 risk factors for CAD
-ST deviation on admit EKG
-priory coronary stenosis more than 50%
-at least 2 anginal episodes in last 24 h
-elevated cardiac markers
-use of ASA (aspirin) in last 7d

3

high risk for ACS

one of the following:
-accelerating tempo of ischemic sx in preceding 48h
-prolonged ongoing (>20min) rest pain
-pulm edema, most likely from ischemia
-new or worsening MR murmur
-S3 or new/worsening rales
-hypotension, bradycardia, tachycardia
-older than 75
-angina at rest with transient ST changes
-bundle branch block, new or presumed new
-sustained ventricular tachycardia
-elevated troponin

4

intermediate risk for ACS

one of the following:
-prior MI, peripheral or cerebrovasc disease, CABG, ASA use
-prolonged rest angina, now resolved, with mod-high risk of CAD
-rest angina less than 20min or relieved with rest/NTG
-age less than 70
-T wave inversions
-path Q waves
-slightly elevated cardiac markers

5

low risk for ACS

one of the following:
-new onset or progressive CCS class 3 or 4 angina the past 2 weeks w/o prolonged rest pain but with mod-high risk of CAD
-normal or unchanged EKG during episode of chest pain
-normal cardiac markers

6

ddx when: ST elevation everywhere w/ no reciprocal changes

pericarditis
-also associated with PR depression
-the ST elevation will be subtle

7

ddx when: DEEP, symmetric T wave inversion in multiple leads in a person w/ headache

intracranial hemorrhage

8

contraindications of nitrates in ACS

phosphodiesterase inhibitors
RV infarction

9

what does RV infarction look like?

hypotension
JVD
clear lungs

10

contraindications to B-blockers in ACS

hypotension
severe bronchospasm
bradycardia (heart block)
suspected coronary spasm (Prinzmetal angina or cocaine)

11

function of B-blockers in ACS

decreases demand and increases supply to decrease O2 deficit
-decreased: HR, afterload, contractility, O2 wastage, exercise vasoconstriction
-increased: heart size, diastolic perfusion, collaterals

12

what is considered standard of care now? aka your ass will get sued if you don't give it to a patient with ACS

B-blockers

13

why use 81mg aspirin?

still get desired response + decreases risk of bleeding to use lower dose

14

what type of clopidogrel treatment is preferred?

pretreatment - reduces deaths

15

what about clopidogrel and CABG?

hold clopidogrel for 5d before CABG

16

what's the deal with prasugrel? how do you dose it?

loading dose 60mg
maintenance 10mg daily

decreased combined endpoints of death/MI/revascularization than plavix, but higher bleeding complications

17

prasugrel indications

over 70 y/o
stroke

18

heparin deal? what kind of heparin?

heparin decreases risk of death/MI more than no heparin
low MW heparin better than un-fractionated heparin (UNH)

19

name 3 GPIIb/IIIa inhibitors

abciximab
integrilin (most used)
tirofiban

20

benefit of GPIIb/IIIa inhibitors

increased reduction in death/MI
best for stented diabetics (only use for high risk patients, not for everybody)

21

look up ticagrelor?

dunnnnnooo

22

who goes straight to cath lab?

recurrent ischemia despite treatment attempts
CHF
cardiogenic shock
prior PCI w/i 6 mo (restenosis)
prior CABG

23

when is there no benefit to aggressive strategy?

if no EKG changes + no troponins

24

early secondary prevention focuses on what two things?

early diabetes control
early cholesterol control

25

do you still use meds when you opt for invasive strategy?

yes - invasive strategy is not a substitute
medical therapy for long-term shit