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NSER 7210 - Theory > Module 3 - ACS, Cardiogenic Shock, Cardiac Arrest > Flashcards

Module 3 - ACS, Cardiogenic Shock, Cardiac Arrest Flashcards

(73 cards)

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1
Q

What area of the heart does the LAD serve?

A

Anterior surface of the LEFT ventricle (and septal and lateral)

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2
Q

What area of the heart does the LCX serve?

A

Lateral surface of the heart

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3
Q

What area of the heart does the RCA serve?

A

Right atrium and Right ventricle
And INFERIOR OF THE LEFT VENTRICLE!

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4
Q

What leads are supplied by the LAD?

A

I (or LCX)
aVL (or LCX)
V1 - V4

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5
Q

What leads are supplied by the LCX?

A

I
aVL
V5
V6

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6
Q

What leads are supplied by the RCA?

A

II
III
aVF

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7
Q

What leads show the lateral view of the heart?

A

I
aVL
V5
V6

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8
Q

What leads show the inferior view of the heart?

A

II
III
aVF

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9
Q

What leads show the septal view of the heart?

A

V1
V2

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10
Q

What leads show the anterior view of the heart?

A

V3
V4

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11
Q

What characteristics will you see for unstable angina?

A
  • ST depression / T wave inversion
  • (-) Troponin
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12
Q

What characteristics will you see for NSTEMI?

A
  • ST depression / T wave inversion
  • (+) Troponin
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13
Q

What characteristics will you see for STEMI?

A
  • ST elevation in two or more leads
  • (+) Troponin
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14
Q

What are the two reperfusion strategies for a coronary artery blockage?

A
  1. Thrombolytics
  2. Angioplasty
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15
Q

What is the gold standard for the treatment of an acute STEMI?

A

PCI
Percutaneous coronary intervention

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16
Q

What are the four goals of myocardial reperfusion therapy?

A
  1. Re-establish early patency of the coronary artery
  2. Save myocardial tissue
  3. Preserve L ventricular function
  4. Increase chance of survival from MI
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17
Q

What is the optimal door to balloon time?

A

< 90 minutes

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18
Q

What is the goal for door to needle time? (If PCI not available)

A

30 minutes

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19
Q

What medications are given for DAPT (dual antiplatelet therapy?

A
  • ASA
  • Clopidogrel or Ticagrelor
  • Heparin (anticoagulant)
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20
Q

What are the three key features associated with successful thrombolysis?

A
  • Relief of chest pain
  • Regression of ST segment elevation
  • Reperfusion arrhythmias
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21
Q

What is the major difference between unstable angina and NSTEMI?

A

NSTEMI has (+) troponin

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22
Q

What are some examples of antiplatelet medications?

A
  • ASA
  • Ticagerolor
  • Clopidogrel
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23
Q

Why are antiplatelet medications given to AMI patients?

A

Prevent blood clot formation by inhibiting platelet aggregation
- reduces risk of further clots

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24
Q

Why are anticoagulant medications given to AMI patients?

A

Prevent formation and growth of blood clots by inhibiting the activity of clotting factors
- prevents new clots from forming

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25
What are two example of anticoagulant drugs given in AMI?
Heparin Bivalirudin
26
Why are beta-blockers given to AMI patients?
Reduce HR - decrease O2 demand - decrease workload - decrease further damage Decrease BP - decrease afterload, decrease workload, decrease O2 demand
27
What are some examples of beta-blockers given in AMI?
Carvedilol Metoprolol Bisoprolol
28
Why are nitrates given to AMI patients?
Vasodilation - relax and widen blood vessels - increase blood flow to coronary arteries - decrease preload = decrease workload
29
What is an example of a nitrate given for AMI?
Nitroglycerin
30
Why are opioids given to AMI patients?
Pain management - decrease workload on heart - goal is 0/10 pain
31
What are some examples of pain medications given for AMI?
- Hydromorphone - Fentanyl - Morphine - cause vasodilation - Tylenol
32
Why are statins given to AMI patients?
Stabilize plaque - reducing the risk of plaque rupture and subsequent clot formation
33
What are some examples of statins given for AMI?
Atorvastatin Rosuvastatin
34
Why are fibrinolytics (thrombolytics) given for patients with AMI?
Dissolve clots that are blocking coronary arteries
35
What are two examples of fibinolytics given for AMI?
TNK (Tenecteplase) TPA
36
How do women present with ACS?
- Unusual fatigue - SOB - Indigestion - Weakness - Dizziness - Palpitations - Anxiety
37
What is the worst case scenario FOLLOWING an MI (other than cardiac arrest)?
Cardiogenic Shock
38
What is the VIP rule for cardiogenic shock?
V = Ventilate (oxygen administration) I = Infuse (fluid resuscitation) P = Pump (vasoactive and inotropic agents)
39
What are the three criteria for diagnosis of Cardiogenic Shock?
1. SBP < 90 for 30 mins, vasopressors required 2. Pulmonary congestion or elevated left ventricular filling pressures 3. Impaired organ perfusion (ALOC, cold, clammy skin, oliguria, increased lactate)
40
What are clinical signs of cardiogenic shock?
- Cold, clammy skin (vasoconstriction and cyanosis) - Kidney (urine output < 0.5 mL/kg/hr) - Brain (ALOC, disorientation, confusion) - weak, rapid pulse - crackles on auscultation - restlessness & anxiety - delayed cap refill - worsening chest pain
41
What is the vasoactive drug of choice in cardiogenic shock?
Norepinephrine
42
What is the inotrope drug of choice for cardiogenic shock?
Dobutamine - Increases contractility - Decreases SVR (vasodilates)
43
Why do you have to give Norepinephrine with Dobutamine in Cardiogenic Shock?
Norepinephrine balances out the vasodilation effects of Dobutamine
44
What rhythms are defibrillated?
Pulseless VT Vfib
45
What is transthoractic impedence?
Resistance of the chest wall to the flow of current at the interface between the patient's chest wall and the adhesive pads used for electrical therapy
46
What is cardioversion?
Electrical therapy when a shock is delivered during ventricular depolarisation (QRS complex)
47
What is the dose of adenosine in ACLS?
6mg IV push If no response, given 12 mg
48
What is adenosine used for in ACLS?
- Stable tachycardias (narrow QRS) - Unstable tachycardias (narrow QRS), while making preparation for cardioversion
49
What is the dose of amiodarone in ACLS?
300 mg IV push Repeat dose of 150 mg IV push
50
When is amiodarone used in ACLS?
- pVT / VF that is unresponsive to CPR, defibrillation, and epi
51
What is the first line drug for bradycardia (symptomatic)?
Atropine
52
What is the total dose that can be given for atropine?
3 mg (dose = 0.5 - 1 mg)
53
What is the effect of Dopamine?
Increases HR and contractility
54
When is Dopamine used?
- Symptomatic Bradycardia (not responded to Atropine) - Hypotension after ROSC
55
What are the H's and T's? (5 of each)
- Hypothermia - Hydrogen (Acidosis) - Hypoxia - Hypovolemia - Hypo/Hyper-kalemia - Tension pneumothorax - Tamponade, cardiac - Toxins - Thrombosis, cardiac - Thrombosis, pulmonary
56
What happens if CO2 is < 10 mmHg during CPR
ROSC is unlikely
57
How much time should CPR be delivered during a code?
At least 80% of the time
58
What are risk factors for ACS?
- HTN - Diabetes - Afib - Dyslipidemia - Smoking / ETOH - Previous MI - CAD - Family history
59
What are some classic signs of MI?
- Chest pain (crushing / pressure) - Radiating to L arm or jaw - Diaphoretic - SOB - Feeling of doom - Dizziness - Nausea
60
What are interventions that need to be done in "C" for suspected MI?
- IV - Cardiac monitor - ECG - Crash cart - Apply defib pads
61
True or False: ST depression = ischemia
True
62
What does ST elevation on an ECG represent?
Infarct (death!)
63
What are the drugs for standard ACS treatment?
- ASA - Clopidogrel, Ticagrelor - Opioids - Nitroglycerin - Heparin
64
What are the two treatment options for a STEMI?
1. PCI - door to balloon 90 mins (120 mins for no cath lab) 2. Fibrinolysis - door to needle 30 mins (if PCI not available)
65
What are signs of RIGHT sided HF?
- Lower limb edema - Sacral edema - Hepatomegaly - Increased JVD - Regurgitant murmur in the tricuspid area
66
What are signs of LEFT sided HF?
- lung crackles - respiratory wheeze - displaced cardiac index - L-sided heart murmurs
67
What are signs that are shared by BOTH right and left HF?
- Cool peripheries - Cyanosis - Orthopnea - Delayed Capillary refill
68
What are the goals of treatment in Cardiogenic shock?
1. Decrease preload - nitroglycerin, lasix, narcotics 2. Decrease afterload - nitropursside (vasodilator on arteries), nitroglycerin 3. Increase contractility - Dobutamine (increase contractility and decrease afterload)
69
What area of the heart do Inferior MIs affect?
Right side of the Heart - RCA Interior of Left Ventricle!
70
What is different about a RIGHT sided MI?
They are preload dependent
71
What drugs do you have to be careful using with right sided MIs?
Nitro / Morphine - affects preload
72
What is the equivalent of a STEMI?
New LBBB
73
What can obscure ST elevation on an ECG?
LBBB

NSER 7210 - Theory (6 decks)

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