STEMI, NSTEMI, UA Flashcards Preview

ClinMed Exam 4 CARDS 1 > STEMI, NSTEMI, UA > Flashcards

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

Immediate treatment of UA/NSTEMI

1. Conservative management appropriate for low-risk patients based on TIMI or GRACE scores

- Aspirin and clopidogrel
- Anticoagulation

2. Invasive treatment for high risk patients or patients with progressive symptoms / EKG findings

- Cardiac catheterization (Angiography, PCI)