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Flashcards in Clin Med Deck (177)
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1

fever is a rise in body temperature in response to ____

endogenous cytokines

2

fever is controlled by the ____ area of the hypothalamus

preoptic (thermoregulatory)

3

what cytokines act on the thermoregulatory portion of the hypothalamus?

endogenous pyrogens (IL-1, TNF, IFNa)

4

range for fever

99.4-100.4F (37.4-38C)

5

normal range of body temperature

96.8-100.0F (36.0-37.8C)

6

universal core body temperature for fever

100.9F (38.3C)

7

what mediates fever production?

PGE2, Na, Ca2+, cAMP, monoamines

8

temperatures of hyperthermia

105.8F (41C)

9

what is the mechanism of hyperthermia?

loss of homeostatic mechanism that makes the body unable to dissipate heat

10

what is the underlying cx of CAD? (90% cases of MI and HF)

atherosclerosis --> supply and demand imbalance

11

describe supply angina

decreased O2 delivery to tissue causes ischemia (ex: coronary stenosis, vasoconstriction)

12

describe demand angina

increased myocardial O2 requirement and workload leads to ischemia (ex: stress, exercise, fever, thyrotoxicosis, LVH, anemia)

13

symptoms of stable angina

chest discomfort (pain, squeezing, pressure, tightness)
brought on by exertion, emotion, stress
substernal pain
lasts 5-10-15 min
relieved by rest or nitro
predictable, not changing frequency, duration, or intensity
50% normal ECG
others have ST depression or elevation

14

cause of unstable angina

atherosclerotic plaque rupture or erosion --> platelet aggregation and thrombus with partial occlusion of artery

15

symptoms of unstable angina

new or worsening chest pain
tempo change
occurs more often
increasing severity
lasts longer than 15-20 min
brought on by less effort, require more meds for relief
may occur at rest
normal cardiac enzymes (troponin I, CKMB)

16

if cardiac enzymes are elevated and ECG shows ST depression/T wave inversion, what does this result in?

Non-STEMI (NSTEMI)

17

clinical presentation of STEMI

substernal CP
radiation to jaw and left arm
crushing sensation
nausea and diaphoresis

18

lab findings of STEMI

initial cardiac enzymes may be normal if early presentation
cardiac enzymes may become positive as early has 4-6hrs
troponin may stay elevated for 5-7 days after STEMI

19

ST elevations in II, III, aVF =

inferior wall STEMI

20

new LBBB in pt with symptoms of AMI =

STEMI

21

indications for percutaneous coronary intervention (PCI)

patients with ACS and high risk features:
recurrent angina/ischemia at rest
elevated troponin or ST segment depression
recurrent ischemia with evidence of HF
high risk stress test result
EF <40%
hemodynamic instability
sustained VTach
PCI w/in 6 min
prior CABG

22

indications for stress testing to risk stratify

ACS patients without high risk features or otherwise low risk pts

23

mainstays of tx for ACS

antiplatelet and anticoagulation therapies
coronary intervention

24

why is it essential to distinguish ACS in patients with and without ST elevation?

determines the need for reperfusion therapy

fibrinolytic/thrombolytic therapy in NSTE-ACS is harmful
only helpful in STE-ACS

25

how to manage STEMIs

ASA + P2Y12 inhibitors (clopidogrel, ticragelor) + reperfusion therapy

26

reperfusion therapy choices for acute STEMI

choice 1: immediate coronary angiography and primary PCI (door to balloon time <90 min)
choice 2: if primary PCI unavailable, give thrombolytics and transfer pt to facility capable of primary PCI (door to balloon time <120 min)
choice 3: if total time from first contact to balloon time is >120 min, give thrombolytics and transfer to capable facility

27

if a STEMI pt comes in and PCI is not available and pt cannot have thrombolytics, what must be done?

proceed with medical tx (nitro, P2Y12 inhibitors, etc.) and transfer anyway

28

other treatment measures for STEMI

CCU monitoring
low flow O2 therapy if SaO2 is reduced
analgesia = sublingual nitro or IV opiate analgesia
beta blockers
nitrates
ACEi/ARBs
aldosterone antagonists

29

most common cause of death in the first 24 hrs of MI =

ventricular arrhythmia

30

most common complication in inferior MI or with meds =

sinus bradycardia