Flashcards in STEMI, NSTEMI, UA Deck (28)
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1
What portion of patients will die from acute MI before reaching hospital - and usually from what?
1/5
*usually of ventricular fibrillation*
2
What portion of acute MI's are "silent" - minor pain, attributed to GI tract
1/3
*Women, elderly, diabetes patients*
3
Result of prolonged myocardial ischemia
- usually result of thrombus formation on atherosclerotic plaque
Myocardial Infarction
4
Most common presenting factor in ACS
Nontraumatic chest pain
5
Other typical chest pain feature of ACS
Crushing retrosternal pain / pressure
Heaviness or tightness
Unexplained indigestion / epigastric pain
6
Describe progression of pain in acute MI
Increasingly severe, prolonged (>30min) anterior chest pain at rest
Most often during early morning hours
7
Be sure to ask specifically about these 5 things in PMH history:
1. Prior coronary bypass graft
2. Percutaneous coronary intervention (catheterization)
3. Angina on effort
4. MI
8
Vital signs in MI?
Bradycardic or Tachycardic
Hypotensive or Hypertensive
9
Cardiovascular exam in MI?
MAY BE NORMAL
1. Possible JVD
2. Soft heart sounds
3. transient murmur of MITRAL REGURGITATION
4. S4 gllop
10
What kind of murmur might you hear in someone with acute MI?
Mitral Regurgitation
11
What extra heart sound might you hear in someone w acute MI?
S4 gallop
12
Syndrome which includes pericarditis, fever, leukocytosis, pericardial or pleural effusion that develops 1-2 weeks post-MI
Dressler's syndrome
13
Fever in MI?
YES - low grade fever may develop after 12 hours and last a few days
14
EKG identification of STEMI
ST-segment elevations of >1mm in TWO contiguous leads
15
Describe the classic progressive changes found in EKG over hours to days in STEMI
Peaked T waves > ST-segment elevations > Q waves > T-wave inversion
**not present in all cases of MI!!**
16
How would you consider a patient presenting with chest pain and an EKG with ST-segment depression?
Unstable Angina or NSTEMI
17
What would cause you to diagnose this patient with ST-segment depression with NSTEMI?
If cardiac biomarkers become elevated during evaluation
18
How do EKGs of NSTEMI patients develop?
Usually will develop EKG evidence of non-Q-wave MI
25% will develop EKG evidence of Q-wave MI
19
Timing of initial elevation of Troponin T/I?
3-12 hours
20
Peak elevation of Troponin T/I
12-48 hours
21
When should Troponin T/I be measured?
12 hours after onset of pain, then repeated every 8-12 hours
22
Highly sensitive test to quantify extent of infarction?
MRI with gladonium contract
23
What all patients with ACS and ongoing discomfort should receive
IV Fluids
O2
NTG (0.4mg sublingual every 5 mints x3)
Morphine
*Oral Beta Blocker within first 24 hours, unless contraindicated (HF, brady, heart block)*
24
When is IV NTG indicated?
In first 48 hours for treatment of persistent ischemia, heart failure, or HTN
25
TIMI test for risk (of death) stratification
MACES 65 3+
Thrombolysis In Myocardial Infarction
1 point for each of the following - score 3 or more considered high risk:
1. More than one episode rest angina in past 24 hrs
2. Aspirin within past 7 days
3. Known CAD with stenosis 50%+
4. Elevated cardiac markers
5. ST-segment deviation
6. >65 years
7. 3+ risk factors for CAD
26
GRACE test prediction
6-month risk of death after discharge
Global Registry of Acute Coronary Events
Age, gender, vital signs, ST-segment changes, historical factors
27
Immediate treatment of STEMi
1. Aspirin and clopidogrel
2. Coronary angiography and Primary PCI (balloon angioplasty / stent) within 90 mins
28
