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HPIM 19th Cardio > ACS > Flashcards

ACS Flashcards

(55 cards)

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1
Q

Absolute contraindications for nitrate use

A

Hypotension

Use of sildenafil or PDE5 inhibitors within the previous 24-48 hours

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2
Q

Oral BB target heart rate

A

50-60 bpm

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3
Q

Antiplatelet in TIMI trial

A

Prasugrel

increased major bleeding compared to clopidogrel

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4
Q

Antiplatelet in PLATO trial

A

Ticagrelor

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5
Q

May be used in NSTE and UA patients whose symptoms are not relieved adequately by nitrates or BBs, or unable to tolerate these agents

A

CCBs

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6
Q

May be given for symptoms not relieved after 3 serial SL NTG tablets

A

Morphine

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7
Q

Coronary plaques prone to disruption

A

Rich lipid core and thin fibrous cap

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8
Q

Activated in the coagulation cascade converting prothrombin to thrombin which converts fibrinogen to fibrin

A

Factor VII

Factor X

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9
Q

MC presenting complaint of patients with STEMI

A

Pain (deep and visceral)

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10
Q

Painless STEMI is greater

A

Patients with DM, increases with age

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11
Q

PE manifestations of anterior MI

A

Usually sympathetic

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12
Q

PE manifestations of inferior MI

A

Usually Parasympathetic

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13
Q

Temporal stages of STEMI

A

Acute: first few hours-7days
Healing: 7-28 days
Healed: >29 days

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14
Q

Cardiac troponins remain elevated after STEMI

A

7-10 days after STEMI

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15
Q

Two serious complications of STEMI

A

VSD
Mitral Regurgitation

(by Doppler echo)

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16
Q

Prognosis relates to 2 general classes of complications of STEMI

A

Electrical complications

Mechanical compilations

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17
Q

Cause of most out-of-hospital deaths from STEMI

A

VFib

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18
Q

Classification of Myocardial Infarction Type I

A

Spontaneous MI

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19
Q

Classification of Myocardial Infarction Type II

A

MI 2 to an Ischemic Imbalance

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20
Q

Classification of Myocardial Infarction Type III

A

MI resulting in death when biomarker values are unavailable

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21
Q

Classification of Myocardial Infarction Type IVa

A

MI related to PCI

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22
Q

Classification of Myocardial Infarction Type IVb

A

MI related to stent thrombosis

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23
Q

Classification of Myocardial Infarction Type V

Study These Flashcards
A

MI related to CABG

24
Q

Time to initiate fibrinolytic therapy

Study These Flashcards
A

Door-to-Needle (D-N) time

= 30 mins

25
Time to move the patient to cath lab for PCI
Door-to-Balloon (D-B) | = 60 mins
26
Goal of initiating PCI
Within 120 minutes of first medical contact
27
Role of buccal absorption of aspirin in STEMI
Rapid inhibition of cyclooxygenase1 in platelets followed by a reduction in thromboxane A2 levels
28
Role of SL NTG
Capable of decreasing o2 demand (lowering preload) and increasing o2 supply (dilating infarcted or collateral vessels)
29
AE of morphine
May reduce cardiac output and arterial pressure Vagotonic effect
30
STEMI candidate for reperfusion therapy
ST elevation of at least 2mm: two contiguous precordial leads 1mm: two adjacent limb leads
31
Meds avoided in STEMI
Glucocorticoids and NSAID(except asprin) may result in a larger infarct scar
32
Principal goal of fibrinolysis
prompt restoration of full coronary arterial patency
33
Role of fibrinolytics
Promoting conversion of plasminogen to PLASMIN, which subsequently lyses fibrin thrombi
34
Absolute contraindications to use of fibrinolytic agents
Hx of CV hemorrhage at ANY TIME Non hemorrhagic stroke or other cerebrovascular event within 1 YEAR Marked hypertension (>180 and/or >110mmHg) anytime of the attack Suspicion of aortic dissection Active internal bleeding (EXCLUDING menses)
35
Relative contraindications to fibrinolytic therapy
Concurrent use of anticoagulants (INR >2) Recent (<2weeks) invasive or surgical procedure or prolonged (>10min) CP resuscitation Bleeding diathesis Pregnancy Hemorrhagic ophthalmic condition Active PUD Hx of severe HPN currently controlled
36
Allergic reaction to streptokinase
Avoided if had received the preceding 5 days to 2 years
37
Most frequent and potentially the most serious complication of fibrinolysis
Hemorrhage
38
Cardiac carh and coronary angio should be carried out after fibrinloysis
Failed reperfusion (persistent chest pain and ST elevation >90mins) Coronary artery reocclusion
39
Rationale for dangling the feet over the side of bed or sitting in a chair within the first 24hours
Reduction of pulmonary capillary wedge pressure
40
Primary goal of treatment with antiplatelet and anticoagulants in conjunction with reperfusion strategies
Maintain patency of infarct-related artery
41
Benefits of ACEI in STEMI
Reduction in ventricular remodeling after infarction with a subsequent reduction in the risk of CHF
42
LV undergoes series of changes in shape, size and thickness in both infarcted and non infarcted segments
Ventricular remodeling
43
Primary cause of in-hospital death from STEMI
Pump failure
44
MC clinical SSx of pump failure
Pulmonary rales | S3 and S4 gallop
45
Prescribed for EF<40% +|- heart failure
ACEI or ARBS
46
Agent effective in abolishing ventricular ectopic activity in patients with STEMI and in the prevention of VFib
Beta Blockers
47
Electrolyte imbalances which are risk factors for Vfib
Hypokalemia (goal: 4.5) Hypomagnesemia (goal: 2)
48
Sustained Vtach and hemodynamically stable
IV amiodarone or procainamide
49
Ventricular rhythm with a rate of 60-100bpm often occuring transiently during fibrinolytic therapy at the time of reperfusion
Accelerated Idioventricular Rhythm | benign; do not require therapy
50
MC supraventrecticular arrhythmia
Sinus tachycardia
51
ICD after STEMI indications
At least 40 days after STEMI No spontaneous VT or VF post-STEMI FC I: LVEF <30-35% FC II-III: LVEF <30-40% NO ICD FOR LVEF >40%
52
Treatment of choice for supraventricular arrhythmias if heart failure is present
Digoxin
53
Treatment for persistent bradycardia despite atropine
Electrical pacing Other indications: Mobitz II second-degree AV block Third degree heart block Bilateral bundle branch block
54
Can cause tamponade in the presence of acute pericarditis
Anticoagulants
55
After recovery from STEMI, recommended for stable patients to prevent reinfarction
Submaximal exercise stress test to detect residual ischemia and ventricular ectopy Maximal (symptom-limited) exercise stress test 4-6 weeks after

HPIM 19th Cardio (8 decks)

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