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HPIM 19th Cardio > ACS > Flashcards

ACS Flashcards

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

A

MI related to CABG

24
Q

Time to initiate fibrinolytic therapy

A

Door-to-Needle (D-N) time

= 30 mins

25
Q

Time to move the patient to cath lab for PCI

A

Door-to-Balloon (D-B)

= 60 mins

26
Q

Goal of initiating PCI

A

Within 120 minutes of first medical contact

27
Q

Role of buccal absorption of aspirin in STEMI

A

Rapid inhibition of cyclooxygenase1 in platelets followed by a reduction in thromboxane A2 levels

28
Q

Role of SL NTG

A

Capable of decreasing o2 demand (lowering preload) and increasing o2 supply (dilating infarcted or collateral vessels)

29
Q

AE of morphine

A

May reduce cardiac output and arterial pressure

Vagotonic effect

30
Q

STEMI candidate for reperfusion therapy

A

ST elevation of at least

2mm: two contiguous precordial leads
1mm: two adjacent limb leads

31
Q

Meds avoided in STEMI

A

Glucocorticoids and NSAID(except asprin)

may result in a larger infarct scar

32
Q

Principal goal of fibrinolysis

A

prompt restoration of full coronary arterial patency

33
Q

Role of fibrinolytics

A

Promoting conversion of plasminogen to PLASMIN, which subsequently lyses fibrin thrombi

34
Q

Absolute contraindications to use of fibrinolytic agents

A

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
Q

Relative contraindications to fibrinolytic therapy

A

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
Q

Allergic reaction to streptokinase

A

Avoided if had received the preceding 5 days to 2 years

37
Q

Most frequent and potentially the most serious complication of fibrinolysis

A

Hemorrhage

38
Q

Cardiac carh and coronary angio should be carried out after fibrinloysis

A

Failed reperfusion (persistent chest pain and ST elevation >90mins)

Coronary artery reocclusion

39
Q

Rationale for dangling the feet over the side of bed or sitting in a chair within the first 24hours

A

Reduction of pulmonary capillary wedge pressure

40
Q

Primary goal of treatment with antiplatelet and anticoagulants in conjunction with reperfusion strategies

A

Maintain patency of infarct-related artery

41
Q

Benefits of ACEI in STEMI

A

Reduction in ventricular remodeling after infarction with a subsequent reduction in the risk of CHF

42
Q

LV undergoes series of changes in shape, size and thickness in both infarcted and non infarcted segments

A

Ventricular remodeling

43
Q

Primary cause of in-hospital death from STEMI

A

Pump failure

44
Q

MC clinical SSx of pump failure

A

Pulmonary rales

S3 and S4 gallop

45
Q

Prescribed for EF<40% +|- heart failure

A

ACEI or ARBS

46
Q

Agent effective in abolishing ventricular ectopic activity in patients with STEMI and in the prevention of VFib

A

Beta Blockers

47
Q

Electrolyte imbalances which are risk factors for Vfib

A

Hypokalemia (goal: 4.5)

Hypomagnesemia (goal: 2)

48
Q

Sustained Vtach and hemodynamically stable

A

IV amiodarone or procainamide

49
Q

Ventricular rhythm with a rate of 60-100bpm often occuring transiently during fibrinolytic therapy at the time of reperfusion

A

Accelerated Idioventricular Rhythm

benign; do not require therapy

50
Q

MC supraventrecticular arrhythmia

A

Sinus tachycardia

51
Q

ICD after STEMI indications

A

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
Q

Treatment of choice for supraventricular arrhythmias if heart failure is present

A

Digoxin

53
Q

Treatment for persistent bradycardia despite atropine

A

Electrical pacing

Other indications:
Mobitz II second-degree AV block
Third degree heart block
Bilateral bundle branch block

54
Q

Can cause tamponade in the presence of acute pericarditis

A

Anticoagulants

55
Q

After recovery from STEMI, recommended for stable patients to prevent reinfarction

A

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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