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CPR II Exam #2 > NSTEMI, STEMI, Cardiac Shock > Flashcards

NSTEMI, STEMI, Cardiac Shock Flashcards

1
Q

Initial steps in management of CP include:

A

M, O, N, A

ECG
Labs

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2
Q

P2Y12 inhibitors to know (2)

A

Clopidogrel

Ticagrelor

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3
Q

When should GpIIB/IIIA inhibitors be given?

What are some? (3)

A

In high risk NSTE-ACS

Tirofiban
Eptifibatide
Abciximab

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4
Q

2 common drugs used in anti-coagulation therapy

A

IV heparin

Enoxaparin

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5
Q

Patients who are risk for MI should receive:

Patients who are low risk:

A

PCI

Stress test

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6
Q

In what cardiac event should a fibrinolytic/thrombolytic absolutely NOT be given?

When is it OK?

A

ACS w/o ST elevation

Beneficial in STEMI

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7
Q

3 pieces of the “mainstays” of treatment of NSTE-ACS:

A

Anti-platelet therapy
Anti-coagulation therapy
Coronary intervention

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8
Q

4 ECG changes w/ STEMI

A

ST elevation
Peaked T waves
Q waves
T wave inversion

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9
Q

What are lab findings in a STEMI?

A

Cardiac enzymes might be OK if presenting early enough. They can become positive by 4-6 hrs.
Troponin can be elevated for 5-7 days.

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10
Q

Management of a patient with a STEMI (3)

A

Aspirin
P2Y12 inhibitors
Reperfusion therapy (PCI or thrombolytics)

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11
Q

What must be the door to balloon time for PCI?

A

90 min or less

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12
Q

If the patient presents to a hospital without PCI abilities, how long do they have to transfer them?

A

120 min, PCI is still preferred to thrombolytics

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13
Q

When would you use thrombolytics in a patient with STEMI?

A

If there is not PCI abilities within 120 min away

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14
Q

Absolute C/I for thrombolytic therapy (6)

A 
Previous hemorrhagic stroke
Other strokes within 1 year
Intracranial neoplasm
Head traume
Active internal bleed
Aortic dissection
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15
Q

Patients being discharged post STEMI should be given which meds?

A

BB

ACE-I/ARB

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16
Q

Post MI complications (5)

A 
Post infarct ischemia
Arrhythmias
RV infarct
Mechanical complications
Myocardial dysfunction
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17
Q

When is post infarct ischemia seen? (2)

A

After thrombolytic therapy for STEMI

After NSTEMI treated medically

18
Q

Treatment for post infarct ischemia

A

Vigarous medical therapy

If refractory, should undergo early coronary angiography and revascularization

19
Q

Kinds of arrhythmias seen post MI (4)

A

Sinus bradycardia
SVT including AFib
Conduction problems
Ventricular arrhythmias

20
Q

When is sinus bradycardia seen mostly?

A

After an inferior MI or w/ meds

21
Q

SVT and AFib should be treated with:

A

Metoprolol or CCBs
Can do a cardioversion if pt. is hemodynamically unstable
Amiodarone if the patient is in HF

22
Q

1st degree AV block

A

Most common, no Tx

23
Q

2nd degree AV block (Mobitz type 2) - Wenckebach

A

Transient and usually no Tx unless symptomatic

24
Q

Complete AV block

A

More common in inferior MI which may be transient

Prognosis with anterior MI is worse, as it is a sign of significant infarct and needs permanent pacing

25
Q

Hemodynamically significant ventricular arrhythmias (VT/VF) should be treated with:

What about hemodynamically stable ventricular tachy?

A

Prompt defibrillation

Anti-arrhythmic (Amiodarone)

26
Q

Rv infarct occurs in a 1/3 of…

What does it present with?

What should be avoided?

What suggests Dx?

Treat with:

A

Inferior MIs

Hypotension with normal Lv function, elevated JVP and clear lungs

Avoid VDs including NTG

ST elevation in right anterior leads

IV fluids

27
Q

Lv aneurysms occurs in…

A

Completed infarctions

28
Q

Pericarditis is treated with…

A

High dose aspirin

29
Q

Mural thrombus occurs most in…

What is the Tx?

A

Large anterior infarctions

Anti-coagulation therapy

30
Q

Myocardial dysfunction presents with…

What should you do?

Acute LV failure presents with:

A

Hypotension not responsive to fluid resuscitation, refractory HF or cardiogenic shock

Urgent echo: RV, LV and r/o mechanical complications

Pulm edema

31
Q

Cardiogenic shock is defined as:

Does it respond to fluids?

What should be done if that is the Dx?

How is LV function usually?

A

Systolic Bp < 90 mmHg and signs of diminished perfusion

Does not respond to fluids

Urgent coronary angio, revascularization and possible placement of intra-aortic balloon pump

LV function is usually moderately to severely reduced

32
Q

What is the treatment for cardiogenic shock?

What is the prognosis?

A

If not as sick, give IV diuretics
Give inotropic support with dobutamine, NE or dopamine

Poor, 30 day mortality is 40-80%

33
Q

Hypovolemic shock

How does it occur?

Tx?

A

Decreased intravascular volume secondary to loss of blood/fluids

Blood loss or dehydration

Replete intravascular vol

34
Q

Obstructive shock causes

A

Cardiac tampanade
Tension PTX
Massive PE

Underlying cause should be treated

35
Q

Most common type of shock is….

A

Distributive shock

36
Q

Septic shock requirements

What causes it?

A

Fluid-unresponsive hypotension (SBP < 100 mmHg)
Serum lactate > 2 mmol/L
Need for vasopressors to keep MAP above 65 mmHg

G+ or G- orgs

37
Q

Tx for septic shock

A

Initial resuscitation
Ventilation
Cardiac monitoring
IV access and fluid restriction

38
Q

Hemodynamic measurements in cardiogenic shock (5)

A

Reduced CO, CI

Elevated SVR, CVP and PCWP

39
Q

Hemodynamic measurements in septic shock (5)

A

CO and CI increase first, but in severe cases they can be lowered due to myocardial depression
Low SVR, CVP and PCWP.

40
Q

Mainstay of therapy in septic and hypovolemic shock:

What else should be done?

A

Vol replacement

Vasoactive therapy w/ NE or dopamine, vasopressin.

Early treatment with empiric broad IV abx.

41
Q

What areas of the heart are supplied by which vessels?

A

LAD - apex, LV anterior wall, anterior 2/3 of septum

RCA - RV free wall, LV posterior wall, posterior 1/3 of septum

LCX - LV lateral wall

CPR II Exam #2 (20 decks)

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