CARDIO Flashcards
(47 cards)
criteria for ECG in STEMI
1. ST elevation in 2 consecutive leads at J point all leads (except 2,3) >0.1mv 2,3 Female - >0.15 2,3 Males < 40 - >2.0 2,3 Males >40 - >2.5
- New LBBB
- Posterior MI
treatment of STEMI
MONA morphine 0.1mg/kg Oxygen - maintain O2 stats at 93% Nitrates - 2 spray GTN Aspirin 300mg PO chewed STAT
Emergency acute and unstable tx STEMI
Emergency revascularization - ACLS protocol Thrombolysis - 30 minutes PCI - w/i 90 min PCI CABG
Adjunctive
- inotropic support
intra-airotic ballon pump
Acute and HD stable STEMI TX
Early revascularization
- PCI
- thrombolysis
Anticoagulant
- Heparin
LMWH - enoxaparin 1mg/kg
G2b/3a (Abiximab)
Anitplatlet
- Aspirin
ADP inhibitor (ticragrelor, prasugrel clopidogrel
Others
Bblocks
stain
ongoing treatment post STEMI
DUAL Antiplatlet (aspirin, ADP inhibitor )
- NO stent - 12 months
Bare mental sent - 12 months
dual eluting stent - 12 month
Ace inhibitor
B blocker
Statin
Lifestyle
CARDIAC REHABILITATION
ECG criteria for Non SSTEMI
- ST depression
+ / - T wave inversion
Risk stratification NSTEMI
ACA/ AHA guidelines
TIMI score
Fillip classification
Grace score
TIMI Score
Age > 65 CAD R.F > 3 Stenosis > 50% ST segment deviation elevated cardiac enzymes Angina like episodes >2 in 24 hours aspirin use in past 7 days
HIGH RISK TIMI SCORE > 5-7
ACC/AHA
think the up down risk stratification
Ge >75
Pain at rest
New or worsening murmur or heart sounds
DOWN: - ST in initial ECG - BP UP: - troponin UP / DOWN - HR
> 1 = high risk
Killip risk score
LOOKING AT LV FAILURE
Class 1: no evidence Class 2: - s3 gallop - raised JVP - basal rales and crackles Class 3: - pull edema Class 4: - cariogenic shock
treatment NSTEMI
MONA-C
- asses both invasive or conservative approach
NETEMI Invasive approach - NOT PLANNED
Anti-coagulate - LMWH or UFH
MONA
invasive approach planned NSTEMI
MONA
anticogulate - enoxaparin 1mg/kg every 12 hours
PCI
Post PCI / secondar y perversione
DUAL Antiplatlet (aspirin, ADP inhibitor )
- NO stent - 12 months
Bare mental sent - 12 months
dual eluting stent - 12 month
Ace inhibitor
B blocker
Statin
Lifestyle
CARDIAC REHABILITATION
Definition for pull edema
- fluid accumulation in the lungs (air spaces and parenchyma) which impairs gas exchange and MAY lead to respiratory distress and failure, hypoxia, cardiac arrest and health
- can be cariogenic (LV failure) § or NON cariogenic (ARDS, barotrauma)
CXR of palm edema
Alveolar edema B - kerly B lines *fluid accumulation in interstium lower L Cardiomegaly (>0.5 on PA Diversion in upper lobes E pleural effusion
PE ECG findings
S1Q3T3 (prominent S wave in lead I, Q wave and inverted T wave in lead III)
Sinus tachycardia
Right axis deviation
RBBB complete or incomplete
T wave inversions in reciprocal leads
treatment of palm edema
LMNPO
Furosemide 40-160mg
Morphine sulphate 2-10mg every 2-6 hours
Nitrates - PO or IV isosorbide denigrate
Position - sit up
Oxygen - ventilate CPAP - 5mmH2O to begin with
if LMNPO does not work for pulm edema
- for diuretics
- non loop diuretic (METOLAZONE)
ultra filtrate with dialysis - if poor urine output - for refractory HYPOTENSION
- ionotrope (DIGOXIN, AMIODARON) +/- vasoactive agents
- IABP
- KV assisted device - Ongoing schema - coronary revascularization
- Valvuloplasty (post STEMI MV tendon rupture
how often do u check cardiac enzymes post chest pain
0,6,12 hours post event
symptoms of unstable a.fib
Neuro (agitated, anxious, aggressive, decrease consciousness, confusion, drowsiness, syncope)
Cardio (chest pian, fast irregular pulse)
Resp (SOB)
Other (hot and sweaty)
Signs of A.fib
Neuro - decrease GCS CARDIAC - hypotensive - COLD peripheries - Cap refil - skin mottling - pulm edema evidence - murmurs
Resp - tachypnoea
Others - oliguria
2 indication for Enoxaparin
- prior to electrical cardioversion
2. TE prophylaxis
ECG criteria for A. fib
- irregular heart rhythm
- no P wave
- absence ventricular isoelectric baseline
- variable ventricular rate
- QRS < 129 ULESS
- BBB
- accessory pathways
- rate related aberrant conduction - Fibrillary waves (fine < 0.5 or coarse > 0.5)
- fibrillary waves may mimic P wave
