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Flashcards in acute coronary syndrome Deck (32):
1

what are acute coronary syndromes

spectrum of clinical syndromes char. by ischemia

2

2 types of ACS

1. unstable angina
2. MI
- STEMI
- non-STE MI

3

def. unstable angina

CLINICAL SYNDROME char. by new or worsening coronary ischemia

4

def. MI

myocardial necrosis due to cor. art. occlusion

5

what does a Q wave indicate

Q waves tend to imply more loss of myocardium

6

** central mech of ACS

plaque rupture

7

when is plaque rupture more common

soft plaques with thin caps
- areas of positive remodeling

8

what happens when platelets exposed to collagen

1. platelet activations
2. thrombus formation
3. may have coronary spasm

9

** what does acute ST elevation mean

occlusive thrombus

10

2 options for non-ST eleveation

1. non STEMI
2. unstable angina

11

what can help on Hx

chest pain or angina equivalent
- unstable pattern
> 20 mins suggest infarct

12

4 bad Sx for unstable angina

1. new onset
2. accelerated angina
3. rest angina
4. post-MI

13

use of Phx

not specific for ACS
- more for complications

14

5 possible ECG signs and what they mean

unstable angina/non-STEMI
1. normal
2. T inversion
3. ST depression
STEMI
4. ST elevation
5. new LBBB

15

what do different leads tell you about locations

v1-v4 - anterior wall - LAD
2,3,aVF - inferior wall - RCA
v5-v6 - lateral wall - circumflex

16

what are cardiac enzymes (2)

1. creatine kinase
2. troponin
reasonably specific for MI
elevated within 4-6 hours

17

what are high sens. troponin assays

- ultra-hjigh sens., but at loss of spec.
- stable CAD 11%

18

what is relationship with enzymes

unstable angina is a CLIN SYNROME
- can have without enzymes
- may have worse angina due to anemia, CO

19

3 helpful therapies for Sx

1. rest
2. O2
3. pain control
- nitro
- morphine

20

*** 5 ways to help survival

1. thrombus - heparin
2. platelets - ASA/clopidegril
3. B-blockers
4. CAD - statins, ACEi
5. education

21

use of angiography/revasc

- improve prog.
- treat refractory Sx

22

what is tool to assess prog

TIMI

23

7 parts of TIMI ****

1. age >65
2. 3 CAD risks
3. known CAD
4. ASA use before
5. Angina x2
6. ST-changes
7. high enzymes

24

what is STEMI

= occlusion
- 90% will be infarcted withing 3 hours

25

Hx for STEMI

angina>30mins
- dyspnea
- diaphoresis
- N/V

26

Phx for STEMI

- sweating
- tachy
- S3, S4, murmur of mitral regurg
- finding of heart failure

27

3 important mimics of MI and why important

1. PE
2. pericarditits - NO HEPARIN
3. aortic dissection - NO HEP

28

what is seen in ECG

ST elev in 2 leads
- 1mm in limbs
- 2mm in precordial
New LBBB is equivalent to STelevation

29

complications of MI

- tachyarrhymia
- brady arrhtmia
- LV failure
- rupture
- pericardidits
- RV failure
- stroke

30

** main goal in STEMI therapy

reperfusion

31

2 options to reperfuse

1. pharma
- TPA
2. angio
- most reliable

32

5 aspects for post MI prog, and 2 most important

1. age*
2. LV funct*
3. resdiual coronoary disease
4. vent. arrythmia
5. comorbid disease

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