Acute Coronary Syndrome + Shock Flashcards Preview

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Flashcards in Acute Coronary Syndrome + Shock Deck (20)
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1

Acute Coronary Syndrome (ACS) RF

Age, tobacco, hyperlip, DM, HTN, obesity, fam hx

2

ACS Presentation

- CP or pressure
- Levine's sign (clutching chest)
- Radiation to arm, neck, jaw
- Heartburn
- SOB
- Diaphoresis
- NV
- Syncope
- Fatigue

3

ACS physical exam

- BP, HR and rhythm
- SPO2
- Distress? Anxious?
- JVD?
- Diaphoresis?
- Heart sounds
- Rales?

4

ACS tests/labs to perform

- EKG
- Troponin
- CPK (muscle damage)
- CPK-MB (heart muscle damage)
- CXR (heart size, fluid in lungs)
- CBC
- CMP

5

ACS tx

- MONA
- If nitro causes hypoTN, MI is on right heart
- Morphine: pt in pain has high HR, requires more O2 (want to decrease HR and O2 demand)

6

Unstable angina

Plaque obstructing flow, but flow is still happening

7

Unstable angina presentation

Sx at rest (vs stable angina, sx w/ exertion)

8

Unstable angina test/lab results

- Biomarkers are NOT elevated
- Normal EKG

9

Unstable angina tx

Observe for >12 hrs:
- If no pain or neg f/u studies --> d/c
*If + stress test --> ACS, admit
- If pain recurs or + f/u studies --> ACS, admit

10

STEMI

Acute clogged pipe, full occlusion, no O2 to heart

11

STEMI test/lab results

- EKG: diffuse ST elevations
- Elevated biomarkers

12

STEMI tx

- REFER to cardiology for cath
- Cardiac rehab after d/c

13

NSTEMI

Not fully occluded, but bloodflow is blocked enough to produce sx

14

NSTEMI test/lab results

- EKG: no ST changes
- Elevated biomarkers

15

NSTEMI tx

- Aspirin + Plavix + Statin + ACEI
- Cardiac rehab after d/c

16

Cardiogenic shock

PUMP FAILURE
- HypoTN and hypoperfusion due to poor CO (10% of MI pts)

- Low CO
- High filling pressures (velocity thru vessels)
- High vasc resistance
- Low circulating O2

17

Cardiogenic shock RF

Recent MI, recent viral illness, age, HTN, DM, valvular heart disease

18

Cardiogenic shock sx/types and what do they mean?

- Warm + dry: no tx
- Warm + wet: diuresis
- Cold + dry: functional intolerance
- Cold + wet: in CS, inotrope or vasopressor and diuretic

19

Cardiogenic shock labs to perform

EKG, echo, ABG, CBC, CMP, CE (troponin)

20

Cardiogenic shock tx

- Pulm artery cath
- Intra-aortic balloon pump
- Impella device (temporary)
- Percutaneous ventricular assist devices
- ECMO
- Meds: inotropes, vasodilators, vasopressors