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CPR Money > Khalid CIS > Flashcards

Khalid CIS Flashcards

Cry

1
Q

In what form of ACS is the patient quickly responsive to NG/Vasodilators? What form do you not typically see have that immediate relief?

A

Non ST elevated ACS (NSTE-ACS) ST elevated ACS (STE-ACS)

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2
Q

What are the initial tests/imaging modalities do you use for NSTE-ACS?

A

1- ECG 2- Cardiac enzymes (CK-MB, Troponin) 3- CMP to get renal function

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3
Q

What are the initial steps of treatment for NSTE-ACS?

A

1- ASA

2- O2 via nasal cannula

3- Pain relief- NG, opiate analgesia

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4
Q

What is JVP measuring?

A

Right atrial pressure

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5
Q

What medications will you give NSTE-ACS?

A

1- ASA

2- P2Y12 inhibitors

3- Glycoprotein IIB/IIIA inhibitors (These are very strong anti-platlet agents)

4- Anticoag therapy

5- Beta blockers

6- Statins

7- ACEI for BP

8- NG (only for pain)

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6
Q

What are the two most important P2Y12 inhibitors?

A

1- Clopidogrel 2- Ticagrelor Less importantly: Prasugrel Cangrelor

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7
Q

What type of presentation would indicate usage of glycoprotein IIB/IIIA Inhibitors having the most impact?

A

For HIGH risk NSTE-ACS

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8
Q

What are the (3) glycoprotein IIB/IIIA inhibitors most commonly used?

A

1) Tirofiban
2) Eptifibatide
3) Abciximab

(one, TWO, THREE, let’s get some TEA)

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9
Q

What anticoagulation therapy drugs do you give to NSTE-ACS?

A

1) IV heparin
2) Enoxparin

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10
Q

What class of drugs are ABSOLUTELY contraindicated in NSTE-ACS?

A

Thrombolytic/fibrinolytics

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11
Q

What are the indications for coronary angiography and Percutaneous Coronary Intervention (PCI)?

A

1- recurrent angina/ischemia at rest/ low lvl of activity

2- Elevated Troponin or **ST depression**

3- Recurrent ischemia w/ HF

4- LVEF <40%

5- Hemodynamic instability

6- Sustained VTs

7- PCI within 6 months

8- Prior CABG (bypass surgery) These are all high risk features

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12
Q

What testing would you do in a LOW risk NSTE-ACS?

A

Do a stress test to see what’s cookin with their heart and to stratify how bad it is (non invasive)

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13
Q

After going through the whole shabang of meds with NSTE-ACS patients, what’s the most important alteration for getting a better prognosis?

A

Smoking cessation

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14
Q

What is a normal left ventricular ejection fraction percentage?

A

LVEF= 55%-60%

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15
Q

What is the most important treatment of coronary artery stenosis?

A

PCI with drug eluting stent (usual from femoral)

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16
Q

Why is it so important to distinguish between NSTE and STE?

A

To determine repurfusion therapy. REMEMBER: fibrinolytic therapy is harmful in ACS with a non elevated ST

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17
Q

What artery is associated with leads 2,3, AVF?

A

Right coronary artery (RCA) Less commonly: Left circumflex artery (LCA)

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18
Q

What artery is associated with V1-V4?

A

Left anterior descending A. (LAD)

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19
Q

How does an EKG change with a patient presenting with STE-ACS?

A

In order:

1) Hyperacute/peaked T waves
2) ST segment elevation
3) Q wave formation
4) T wave inversion

(happens over a few hours to several days)

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20
Q

What heart arrhythmia MUST you treat like a STEMI?

A

A (NEW) LBB with symptoms of an acute MI

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21
Q

What are the mainstay treatments of a STEMI?

A

1) ASA
2) P2Y12 inhibitors (Clopidogrel, Ticagrelor, Prasugrel)
3) Repurfusion therapy

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22
Q

What are the repurfusion therapies for STEMIs?

A

1) MUST DO PCI
2) Thrombolytics

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23
Q

When is it indicated to start thrombolytics and PCI?

A

1) Must do PCI in less than <90 minutes if available on site
2) If PCI is not available on site, transfer to a neigboring hospital <120 minutes (still better than thrombolytics)
3) ONLY when the PCI ETA is >120, then you administer them (IV Heparin, Enoxparin) and then you STILL transfer to a hospital for a PCI

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24
Q

What are the absolute contraindications for thrombolytic therapy?

A

1) If they had a previous hemorhagic stroke
2) Intracranial neoplasms
3) Recent head trauma
4) Internal bleeding
5) suspected aortic dissection
6) Cerebrovascular events this past year

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25
Q

What are the post MI complications?

A

1) Post MI ischemia
2) Arrhythmias
3) RV infarction
4) Mechanical complications
5) Myocardial dysfunction

26
Q

When would you get post MI Ischemia?

A

1) After thrombolytic therapy for STEMI
2) After NSTEMI that is treated medically

27
Q

How do you treat post MI ischemia?

A

Vigorous medical therapy and if it’s refractory, undergo early coronary angiography and revascularization

28
Q

When is sinus bradycardia most common and do you need to treat it?

A

When you get an inferior MI or with meds

Nah, only temporary pacing and that’s rarely required

29
Q

How do you treat post MI SVT/A fib?

A

Rate controlling agents like metoprolol or CCB if there is a contraindication to beta blockers

30
Q

How do you treat if the patient is hypotensive with severe chest pain and HF?

A

Amiodarone

Shock them

31
Q

Where are the most common conduction problems?

A

At the level of the AV node and less commonly distal/infra nodal to the AV node

32
Q

What is the treatment for first degree AV block?

A

Sike, it does not require treatment

33
Q

What is the treatment for second degree AV block?

A

Sike, it does not require treatment unless they’re very symptomatic

34
Q

What is the treatment for complete AV block and when do they most commonly occur?

A

Occurs most with inferior MIs

Prognosis is worse with ant MI

Requires permanent pacing

35
Q

When are V arrhythmias most common and how do you treat it?

A

Most commonly occurs in the first few hours of MI and most common COD

MUST treat with prompt defibrillation if unstable If stable treat with amiodarone

36
Q

When do you most commonly get RV infarctions and how does it present?

A

Present in 1/3 of inf MIs

Presents with hypotension and normal LV function, elevated JVP, and clear lungs

37
Q

How do you recognize and treat RV infarction?

A

ST elevation in right sided anterior chest leads (V1-3/4)

Treat with IV fluids

38
Q

What treatments are contraindicated in RV infarction?

A

Vasodilators including NG

39
Q

When do you see papillary muscle rupture?

A

3-7 days after MI

40
Q

What does a papillary rupture present with clinically?

A

Systolic murmor due to mitral regurg (check apex)

Deterioration can also come with added pulm edema

41
Q

How do you treat papillary muscle rupture?

A

Must do echocardiogram

Intra aortic balloon pump

Surgery is a definitive treatment

42
Q

When do you see a VSD wall rupture?

A

3-7 days after MI

43
Q

What does a VSD rupture present with clinically?

A

Systolic murmor due to mitral regurg (check apex)

Deterioration can also come with added pulm edema

44
Q

How do you treat papillary muscle rupture?

A

Must do echocardiogram

Intra aortic balloon pump

Surgery is a definitive treatment

45
Q

When do you see a myocardial rupture?

A

2-7 days post MI

46
Q

What does a myocardial rupture present with clinically?

A

Usually associated with immediate death and is present on the anterior wall

47
Q

Myocardial dysfunction/shock patients present with what and how do you diagnose it?

A

1) Hypotenion
2) Unresponsiveness to fluid resusitation
3) Refractory HF or cardiogenic shock

Need echocardiogram to rule out mechanical complications

48
Q

What does acute LV failure present with?

A

Pulmonary edema

49
Q

How do you treat acute LV?

A

O2, IV morphine, Diuretics, vasodilators to treat associated edema

50
Q

What do all shock present with?

A

1) Hypotension
2) Signs of diminished perfusion that include clammy extremities, oliguria, confusion
3) Tachycardia

Could have altered mental status

51
Q

How do you treat cardiogenic shock?

A

1) Get coronary angiography
2) Possible placement of intra aortic balloon pump
3) Echocardiogram (to asses LV function that is usually reduced)
4) Inotropic support with dopamine, dobutamine, NE If they are less sick, treat with IV diuretics

52
Q

What is hypovolemic shock a result of?

A

Decreased intravascular volume secondary to loss of blood or fluids due to dehydration or hemorrhage

53
Q

How do you treat hypovolemic shock?

A

Treat with intravascular volume (just give them fluids)

54
Q

What are some potential causes of obstructive shock?

A

Cardiac tamponade, PE, pneumothorax

55
Q

How do you treat obstructive shock?

A

Treat underlying condition

56
Q

What is the most common form of distributive shock?

A

Septic shock

57
Q

What is septic shock?

A

Sepsis with fluid unresponsive hypotension and serum lactate level > 2mmol/L and a need for vasopressors to keep mAP above 65 mm Hg (bc there is systemic vasodilation)

58
Q

What is the most common cause of septic shock?

A

Infection with gram positive or gram negative bacteria

59
Q

How do you generally approach shock?

A

1) Prompt diagnosis and initial resuscitation
2) Cardiac monitoring
3) Mechanical ventilation if required
4) IV fluids

60
Q

What are the hemodynamic measurements associated with cardiogenic shock?

A

1) Reduced Cardiac Output (CO)
2) Reduced Cardiac Index (CI)
3) elevated Systemic Vascular Resistance( SVR)
4) Elevated Central Venous Pressure (CVP)
5) Elevated Pulmonary Capillary Wedge Pressure (PCWP)

*(Cardio shock is a central process with aggressive vasoconstriction)*

61
Q

What are the hemodynamic measurements associated with septic shock?

A

1) CO, CI may be initially elevated or normal but in severe cases CO and CI can be decreased due to myocardial depression
2) Low SVR, CVP, PCWP

*Aggressive vasodilation*

62
Q

What are the most important treatments to septic shock?

A

Since they’re in hypovolemic shock you must give fluids and vasopressors (NE, dopamine, vasopressin) Then IV antibiotics to treat infection

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