Ischemic heart disease, angina, and MI Flashcards
(22 cards)
Can you recommend surgery to individual that doesn’t smoke, doesn’t have HTN or DM, has a normal EKG and exercises regularly without pain of SOB?
Yes - without additional testing
No extra risk factors
Regulat exercise without pain serves as a stress test
Retrosternal pain (20 min x2 over 4 hrs) Negative troponin and CPK T wave flattening No HTN or DM LDL ok 3rd episode of ST depression that is relieved with nitro BP 130/70 and HR 50
Admit and treat angina
Order stress test to evaluate angina
No need for cath lab yet
Initial treatment for angina
Morphine (pain and anxiety), O2, Nitro (rapidly acting coronary vasodilator), Aspirin (anti-platelet effect)
Follow up treatment for angina
Beta blocker: atenolol or metoprolol
CCB: amlodipine, long acting or sustained
Long-acting nitrate: isosorbide dinitrate and/or nitro tablets
162-325 mg/day aspirin
After initial treatment for angina, a stress test shows no ST changes and patient is able to reach max HR, what should your approach be?
Tested treatment with stress test
Discharge and schedule follow up in 2 weeks
Retrosternal pain with nausea and diaphoresis Relieved with 2 nitro EKG and enzymes unremarkable Poorly controlled DM High cholesterol HTN BP 138/88 Creatinine 1.8
Should you transport to cath lab 3 hrs away?
No, patient is NOT stable
Start by admitting then CAD therapy
How do you classify unstable angina?
New onset
At rest
Crescendo
Celecoxib’s effect on platelets?
Little or no effect on aggregation
COX-2 selective inhibitor
COX-2 selective NSAIDs
Reduce side effects like bleeds/platelet inhibition
Only go to inflamed tissues
*Increased risk of CV events but hard to conclude increased risk in comparison to non-selective NSAIDs
If patient had unstable angina and takes Celebrex, what treatment approach should be taken?
Add aspirin, stop celecoxib, and perform stress test
Patient with unstable angina takes aspirin and nitrates and stress test leads to ST depression in V1-V4 that stop at rest. Patient is unable to reach max heart rate - what is next approach?
Anginal therapy already enhanced and stress test already performed
**Coronary angiography
DM (poorly controlled), HTN, high cholesterol
SOB and sweating
Crackles and edema and S3
BP 150/90
EKG: atrial enlargement and ST depression
Diagnosis and treatment approach?
CHF
**Ischemic heart disease
Manage BP and CHF, then coronary angiography
Treatment reducing mortality in patient with CHF, DM and ischemic heart disease?
Lisinopril and insulin
Angioplasty only reduces morbidity
DM and HTN SOB and sweating HIGH BP and pulse LBBB but neg troponin JVD and Edema Furosemide provides temporary relief, next recommendation?
Cath lab to evaluate ischemia
17 hrs retrosternal chest pain Inferior wall MI on EKG BP 80/50 HR 120 How do you improve BP?
Give IV saline bolus
3 hrs retrosternal chest pain SOB and sweating Anterior wall MI Elevated CPK-MB and troponin Three hours away from cath lab - what should you do?
Initiate thrombolytic therapy
Door to cath lab should be 90 min
Contraindication for use of fibrinolytic therapy?
Closed head trauma 2 mo ago -> BRAIN BLEEED
A patient presenting to the ED with acute onset chest pain is given nitroglycerin (NTG). Which of the following statements concerning this treatment is correct?
Sublingual administration avoids first pass metabolism
(NTG is contraindicated if the patient is to receive a beta blocker.
NTG decreases the work and O2 consumption of the heart.
Sublingual administration avoids first pass metabolism.
The patient will become refractory to the effects of NTG if more than two doses are given within 15 min.
This drug is typically given initially by IV infusion.)
65 y/o male presents to the Emergency room with an acute ST segment elevation MI and ultimately undergoes coronary artery bypass grafting. He is discharged on an HMG-CoA reductase inhibitor, aspirin, and a beta blocker. What other intervention may help his overall mortality?
An ACE-inhibitor
(An ACE-inhibitor Clopidogrel Nitrates Verapamil Folic acid)
A patient presents with ST segment elevation on ECG, elevated troponin, and chest pain. Cardiac catheterization is not available and he is treated with tenecteplase. The activity of which of the following will be elevated by this treatment?
Plasmin
(Factor Xa Fibrin Plasmin Thrombin Thromboplastin)
42 y/o female comes into the emergency room with retrosternal chest pressure associated with diaphoresis and shortness of breath. It is brought on by jogging and in the ER relieved with two nitroglycerin. Her EKG is unremarkable. She does not smoke, have hypertension, her cholesterol is normal and she has no cardiac family history. You should stratify her by performing which test:
Exercise stress test without augmentation, after medical therapy maximized
(Cardiac catheterization
Echocardiogram stress test, after medical therapy maximized
Coronary bypass grafting
Exercise stress test without augmentation, after medical therapy maximized
Dobutamine stress test, after medical therapy maximized)
Following an anterior wall MI, a patient goes into cardiogenic shock with a LVEF
Dopamine
(Dobutamine Dopamine Epinephrine Inamrinone Norepinephrine)
