ACS- STEMI

Question 1

Steps on how to clinically diagnosis ACS (non stable angina, NSTEMI, STEMI)

Answer 1

1). Get ECG- if ST elevation is present = STEMI
(No ST elevation means its NSTEMI or unstable A)
2). Look at cardiac biomarkers (troponins)- negative = unstable angina (positive = NSTEMI)

Question 2

Describe the arterial occlusion for NSTEMI/unstable angina vs STEMI

Answer 2

STEMI is complete arterial occlusion whereas the other group is an unstable plaque occluding PART of the artery

Question 3

Out of the 600,000 people who die from CAD (MI, etc) every year, how many die before receiving medical care?

Answer 3

50%

Question 4

What treatment for STEMIs has decreased mortality over the years

Answer 4

coronary angioplasty

Question 5

What are two main causes of an STEMI?

Answer 5

1) . vulnerable atherosclerotic plaques rich in foam cells rupture
2) . Cardio embolus can send clot to healthy coronary arteries (clot from afib)`

Question 6

What test is necessary to diagnosis a STEMI

Answer 6

serum biochemical markers of myocardial necrosis (troponin)

**these are INITIAL tests run on a pt

Question 7

Besides elevated troponin to diagnosis a STEMI, you need one of the following five things

Answer 7

ischemic symptoms
development of pathologic Q waves
ST segment elevation
echo imaging to show new loss of viable myocardium/wall motion
see the thrombus on an angioplasty/autopsy

Question 8

How can you tell if a patient has had an MI

Answer 8

established/old MI determined by new pathologic q wave on multiple EKGS

Question 9

What symptoms will you have for an inferior MI that might not be present for other types?

Answer 9

diaphoresis (sweating), along with nausea & vomiting

Question 10

What is key about a physical exam on a suspected MI patient?

Answer 10

a normal exam does not rule out an MI

Question 11

What does a normal EKG for angina pectoris not exclude & what can it confirm?

Answer 11

it doesn’t exclude severe CAD

it does imply normal LV function

Question 12

If EKG ST elevation is present in a patient with chest pain, what are the chances that it is an acute MI?

Answer 12

90%

Question 13

What is a crucial component related to EKG ST segment elevations when trying to recognize an MI

Answer 13

there needs to be 3 contiguous leads of ST elevation to determine MI
(single lead is less diagnostic)

Question 14

Name EKG leads that signify inferior, lateral, septal, and anterior MI

Answer 14

inferior: II, III, aVF
lateral: aVL, I, V5, V6
septal: V1, V2
anterior: V3, V4
aVR by its lonesome

Question 15

What is the first tx to give an ACS-STEMI pt within 10 minutes of arriving?

Answer 15

IV morphine- dilates coronary arteries

think of MONA-B from pharm

Question 16

Within what time frame is it MOST beneficial to have a STEMI pt undergo reperfusion therapy (PCI or thrombolysis)?

Answer 16

less than 6 hours

**however the graph goes from 100% to 40% benefit within the first 2 hours

Question 17

What is the gold standard for a STEMI pt?

Answer 17

Reperfusion therapy- improves short and long term outcomes in patients

Question 18

For patients with a STEMI, which type of reperfusion therapy is superior than the rest?

Answer 18

PCI is better than fibrinolytic therapy (TPA)

Question 19

How do you determine if you transfer a STEMI pt to another hospital with a cath lab?

Answer 19

if you can get the patient there within 90 minutes after ONSET of symptoms = TRANSFER (strategy of choice for STEMI pts)

Question 20

When do you consider fibrinolytic therapy for a STEMI pt?

Answer 20

if a pt cant be promptly transported for PCI within 90 mins or ST elevation in 2 or more EKG leads & less than 6 hrs of chest pain

Question 21

How can fibrinolytics cause death

Answer 21

hemorrhage (so drugs are contraindicated in pts with high risk for bleeding or have had a recent stroke)

Question 22

What is the best fibrinolytic to use?

Answer 22

TPA (compared to streptokinase)

Question 23

What is the recommended pharmacological tx post PCI therapy?

Answer 23

dual antiplatelet therapy (DAPT)
aspirin (low dose) and Plavix (75 mg)
DAPT should be for 1 year (ASP indefinitely)

Question 24

What type of drug should you initiate within 24 hours of an MI?

Answer 24

statin