Acute Coronary Syndromes Flashcards Preview

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Flashcards in Acute Coronary Syndromes Deck (22)
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1
Q

Patho phys

A

Takes decades

Begins with intimal thickening and xanthom fomration

Progression leads to dz extension into media and adeventitia

Stbale plaques

ACS after plaque ruptures and exposes necoritc ocre…then thrombotic event occurs

2
Q

Pathophys of ACS

A

STEMI - complete coclusion

NSTE - partial…could be NSTEMI and unstable angina

LEads to pump dysfunction and electrical instability

3
Q

Goal of tx

A

Interrupt platelet aggregation and thrombus formation

Prevent/minimize myocardial damage

4
Q

Sx

A

Angina - pressurel ike, substernal chest discomfort

Radiates

Diaphoresis, dyspnea, nausau, lighthededness and syncope

Duration exceed 5-10 minutes and may have stuttering or waxing and waning course

5
Q

Guidelines for eval

A

ECG within 10 minutes and repeat every 5-10

High sensitivity troponin

GRACE or TIMI score

6
Q

Tx

A

Invasive - medical therapy, catheterization lab within 72 hours

Ischemia guide - medical tx…eval for ischemia despite medical therapy

7
Q

When to give O2

A

If hypoxic - yes

If not hypoxic - probably

8
Q

Aspirin

A

Everyone unless contraindication

30-50% reduction in risk of MI

9
Q

Nitrates

A

Give SL…if still having pain, consider IV

No mortality benefit

10
Q

Morphine

A

Do not give unless going to the cath lab

11
Q

Heparin and enoxaparin

A

Hepatin - bolus and drip, higher bleeding rates, reversible, monitoring, control in cath lab

Enox - simple, give IV bolus, less bleeding, better if conservative approach

Bivalirudin - reserved for cath lab

12
Q

P2Y12 inhibitor

A

Preferred - clopidogrel or ticagrelor

13
Q

B blockers

A

Do NOT need to be given acutely but can be useful if HTN or tachy…can perpetuate shock as SE

Start oral dose in 24 hours unless contraindication

14
Q

Fibrinolytics

A

Only given for STEMI

15
Q

GLycoprotein 2b/3a inhibitors

A

Not routinely used

If used, check platelets…thrombocytopenia

Abciximab eptifibatide, tirofiban

16
Q

Stress testing

A

No indicaiton for stress testing in someone with ACES and chest discomfort/ischemia

Can be performed AFTER stabiliation ofr risk stratificaiton in pts with conservative approach

17
Q

Angiography

A

Probably a reasonable option

Mortality benefit in some high risk groups

18
Q

STEMI management

A

PCI - preferred, esp if sx over 12 hours or shock…door to balloon time 90 minutes

Thrombolytics - if cannot get PCI within 2h ours…given with 30 minutes of walking into ER

19
Q

Odd contraind tot thrombolytcis

A

High BP…always check BP!!!!!!!!!!

20
Q

STEMI effect on ECG

A

Acute - ST elevation

Hours - ST elevation, dec R wave with Q wave beginning

1-2 days - T wave inverison and Q wave deepr

Days - ST normalizes, T wave inverted

Weeks later - ST and T noromal and Q wave persists

21
Q

POst ACS event tx

A

Aspirin and high intesnity statin for life

P2Y12 inhibt and BEta block for 1 year…no B blocker if LVEF low or anginal

SL Nitroglyc

SMoking cessation and exercise

Risk factor reduction - diabetes, HTN, weight

22
Q

Cocaine induced chest pain

A

Tx like regular ACS

Liberal use of benzos, nitrates and CCBs

Beta blockers are controversial