ACS2 Flashcards
(87 cards)
1
Q
Angioplasty superior ti thrombolytics bs
A
- Better survival and mortality
- Less bleeding
- complications of MI decreased
- Less arrhythmia,less CHF, fewer ruptures of septum, free wall( tamponade)and papillary muscles(valve rupture)
2
Q
90min of arriving in ED with chest pain
A
PCI
3
Q
“Door to balloon time”
A
Under 90 minutes
4
Q
Complications of PCI
A
- Rupture of coronary artery
- Restenosis
- Hematoma at entry site into artery
5
Q
Most important in decreasing the risk of restenosis of CA after PCI?
A
Placement of drug-eluting stent( paclitaxel, sirolimus)
6
Q
PCI=
A
Angioplasty
7
Q
For DVT and PE ( VENOUS thrombosis) not Arteries
A
Warfarin
8
Q
Restenosis within 6 months of PCI without stent
A
30-40%
9
Q
Restenosis within 6 months of PCI with bare metal stent
A
15-30 %
10
Q
Restenosis within 6 months of PCI with drug-eluting stent
A
10%
11
Q
If contraidications to thrombolitics
A
Transfer to facility performing PCI
12
Q
Abs. Contraindications to Thrombolitics
A
- Major bleeding( bowel= melena, brain)
- Recent surgery (within last 2 weeks)
- Severe HTN> 180/110
- Nonhemorrhagic stroke within last 6 months
13
Q
NOT an absolute contraindication to the use of thrombolitics
A
Heme-positive brown stool
14
Q
Best initial therapy, everyone
A
Aspirin
15
Q
All MI undergoing angioplasty and stenting
A
Clopidigrel
16
Q
Everyone, effect not dependent on time during admission
A
Beta blockers
17
Q
Everyone, benefit best with ejection fraction< 40 %
A
ACEi/ARBs
18
Q
Everyone, best with LDL > 100 mg/dl
A
Statins
19
Q
No clear mortality benefit
A
Oxygen, nitrates
20
Q
After thrombolitics/ PCI to prevent restenosis, initial Tx with NSTEMI and unstable angina
A
Heparin
21
Q
If can’t use BB, cocaine-induced pain, Prinzmetal angina
A
Calcium-channel blockers
22
Q
In the process if forming clot in CAD= ST depression= unstable angina, after aspirin
A
Low molecular-weight heparin
23
Q
Abciximab, Tirofiban,Eptifibitide
A
Glycoprotein IIb/IIIa inhibitors
24
Q
- for pt who undergo angioplasty and stenting
* not beneficial in acute ST elevation infarctions
A
Glycoprotein IIb/IIIa inhibitors
25
New LBBB or ST elevation within 12 hours
Thrombolitics
26
Glpr IIb/ IIIa inhibitors
Inhibits platelet aggregation
27
Reduction in mortality with ST depression, particularly in pts whose troponin or CK-MB rise and then develop MI requiring PCI with stenting
Glycoprotein IIb/IIIa inhibitors
28
? Do you need Aspirin for
• Stable angina
• UA/ NSTEMI
• STEMI
* +
* +
* +
29
?Do you need BB for
• stable angina
• UA/NSTEMI
• STEMI
+++
30
? Do you need nitrates for
• stable angina
• UA/NSTEMI
• Nitrates
+++
31
?Do you need Heparin for:
• Stable angina
• UA/NSTEMI
• STEMI
* No
* YES
* Yes, only after thrombolytics
32
Do you need GP IIb/IIIa meds for
• Stable angina
• UA/NSTEMI
• STEMI
* no
* yes
* no
33
? Do you use thrombolytics for:
• Stable angina
• UA/ NSTEMI
• STEMI
* No
* No
* yes, but not as good as PCI
34
Do you use CCBs, Warfarin for
• SA
• UA/NSTEMI
•STEMI
No no no( no mortality benefit)
35
tPA ( thrombolytics) are beneficial only for
STEMI
36
Heparin is best for
NSTEMI
37
LMW heparin superior to
Unfractionated heparin for mortality benefit
38
Unfract. Hep
Short half life ( last shorter period of time)
39
In non-ST elevation ACS, when all meds have been given and pt is NOT better
Urgent angiography and possibly angioplasty( PCI) should be done
40
" Not better" for NSTE ACS means
* persistent pain
* S3 gallop or CHF developing
* worse EKG changes
* rising troponin levels
41
Tx for STEMI, Non-STEMI/UA
Aspirin/ Clopidogrel
BB, ACE
Statins, nitrates
Morphine
42
STEMI tx
* PCI ( if available< 90 min after pr arrives)
| * Thrombolitics( if PCI not available. Use within 12 hours from start of chest pain)
43
If PCI failed, ischemia refractory to ALL Tx
Perform Emergency CABG
44
Why sinus bradycardia happen with MI( very common)
From ischemia of sinoatrial node ( SA)
45
Why cannon "a" waves( 3rd degree= complete AV block) happen
From atrial systole against closed tricuspid valve
46
Distinguishes 3rd degree block from sinus bradycardia before EKG
Cannon "a" waves
47
Why tricuspid valve closed in 3rd degree block
Bs atria and ventricles contracting separately( out of coordination)
48
Jugulovenous wave bouncing up into the neck
" Cannon"
49
What to look for, if pt has cannon wave
RV infarction, 3rd degree block
50
1st tx for bradycardias
Atropine
51
If atropine is not effective for bradycardia
Place pacemaker
52
For all 3rd degree block tx
Pacemaker
53
RV infarction look for:
New inferior wall MI& clear lungs on auscultation
54
Flip EKG leads from left side to right side of chest, Most specific finding:
ST elevation in right lead 4( RV4)
55
Right coronary supplies:
* RV
* AV node
* inferior wall of the heart
56
RV infarction Tx
High-volume fluid
57
Avoid in RV Tx
Nitroglycerin( markedly worsens filling)
58
New inferior wall MI & clear lungs on auscultation
RVInfarction
59
Tamponade due to free wall rupture
Several days after MI
60
* Sudden loss of pulse
* Lungs clear
* Pulseless electrical activity. Dx
Tamponade
61
Tamponade test
Echo KG
62
Tamponade Tx
Pericardiocentesis on way into operating room for repair
63
Most common cause of death MI
Ventr tachycardia/fibrillation( no wsy to distinguish without EKG)
64
Ventr tachycardia/fibrillation Tx
Cardiovert/defibrillate
65
If ventr tachycard without pulse Tx
Defibrillate
66
Reason why pts after MI monitored in ICU several days
Vtach/fib
67
New onset murmur and pulmonary congestion after MI
Valve or septal rupture
68
Best heard at apex with radiation to axilla
Mitral regurgitation
69
Best heard at lower left sternal border
Ventricular septal rupture
70
Look for a step-up in oxygen saturation as you go from the R atrium to the R ventr to ds
Septal rupture
71
Most accurate test for tamponade, septal rupture
EchoKG
72
42% oxygen saturation found on blood from RA and 85% in RV sample
Septal rupture
73
Pump failure from anatomic problem that can be fixed in operating room
Intraaortic balloon pump( IABP)
74
* contracts&relaxes in sync with natural hearbeat
| * gives a "push" forward to blood
IABP
75
Never a permanent device( bridge to surgery)- valve or septal rupture, keep alive
Intraaortic balloon pump
76
Most myoc. aneurysms don't need specific therapy. If mural thrombi -> tx
Heparin followed by warfarin
77
Preparation for discharge from hospital( detection of persistent ischemia)
Stress test prior to discharge. Determines if angiography needed( => revascularization with PCI or bypass surgery)
78
MI Everyone should go home on
```
Aspirin
Clopidogrel
BB
Statins
ACE inh
```
79
Best for anterior wall infarctions bs of likelihood of developing syst dysfunction
ACE inhibitors
80
Person intolerant for both aspirin and clopidogrel
Ticlopidine
81
All MI or intolerant of aspirin or post- stenting
Clopidogrel
82
Do not be fooled by the Q describing " frequent PVCs and ectopy". Do not treat
Prophylactic antiarrhythmics increase mortality
83
Don't combine nitrates with sildenafil bs
They're both vasodilators
84
ED postinfarction is most commonly from
Anxiety
85
Most common medication causes ED
BB
86
Wait after MI for sexual activity
2-6 weeks
87
If post MI stress test is normal,
Any form of exercise program can be started including sex
