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Flashcards in Chest Pain Deck (24)
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1
Q

What are the Inferior leads?

What are the Lateral leads?

What are the Anterior leads?

A
  • Inferior: II, III, aVF
  • Lateral: I, aVL, V5, V6
  • Anterior: V1-V4
2
Q

What are some classic EKG findings in STEMI?

A
  • ST segment elevation 1 mm in two or more continguous leads
  • Q waves
3
Q

What are some classic EKG findings in NSTEMI?

A
  • EKG may be normal (rare)
  • ST depression
  • T wave inversion (often symmetric)
4
Q

Finding ST depression in leads separate from the region of ST elevation (increases/decreases) the probability of MI>

A

increases

5
Q

Lateral wall MI

  • Where is the ST elevation?
  • Occlusion of which artery?
  • Reciprocal depression where?
A
  • Leads I, aVL, V5, V6
  • Left circumflex artery
  • Leads II, III, aVF
6
Q

Inferior wall MI

  • Where is the ST elevation?
  • Occlusion of what artery?
  • Reciprocal depression where?
A
  • Leads II, III, aVF
  • Right coronary artery (RCA)
  • May have associated RV infarct
  • Leads I, aVL
7
Q

Where is ST elevation most sensitive & specific for a RV MI?

A

V2R, V3R, V4R

8
Q

Anterior wall MI

  • Where is the ST elevation?
  • Occlusion of what artery?
  • Reciprocal depression where?
A
  • Leads V1-V4
  • LAD
  • Inferior leads
9
Q

Posterior wall MI

  • Where is the ST elevation? depression?
  • Occlusion of what artery?
A
  • Elevation: V8, V9
  • Depression: V1-V4
  • RCA or circumflex (depends)
10
Q

What are the common cardiac medications administered for an MI?

A
  • Aspirin
  • Nitroglycerin
  • Morphine
  • Heparin
  • Beta blockers
  • Plavix
11
Q

What medication should you NOT give to a hypotensive patient?

A

Nitroglycerin

12
Q

You should give this medication to all patients getting fibrinolytic therapy

A

Heparin

13
Q

Fibrinolysis has the greatest benefit when started within ___ hours of onset of pain

A

3

14
Q

How do you treat a pulseless VT?

A

defibrillate ASAP with 200 J

load w/ amiodarone

15
Q

How do you treat unstable VT?

A

cardioversion 100-200 J

load w/ amiodarone

16
Q

What are the main troponins expressed in the heart?

A

Cardiac troponin I (cTnI)

Cardiac troponin T (cTnT)

17
Q

What are the main cardiac causes of elevated troponin?

A
  • Heart failure
  • Myocarditis
18
Q

CTn

  • Begins to rise:
  • Peak:
  • Persists for:
A
  • Begins to rise 2-3 hrs after
  • Peak around **48 hrs **
  • Persists for up to **10-14 days **
19
Q

CK-MB

  • Begins to rise:
  • Peak:
  • Persists for:
A
  • Beings to rise 4-6 hrs after
  • Elevated at 12 hrs
  • Retruns to base w/i 36-48 hrs
20
Q

cTn or CKMB?

  • More specific
  • Can be used for late diagnosis of MI
  • Can detect late infarct
A

Cardiac troponins

21
Q

Where are these commonly located?

  • Aneurysms
  • Dissections
A
  • Aneurysms: abdominal aorta
  • Dissection: ascending aorta
22
Q

What are troponins?

Where are they expressed?

A
  • Cardiac regulatory proteins that control the calcium-mediated interaction of actin & myosin
  • cTnI - heart only
  • cTnT - heart, skeletal muscle
23
Q

The diagnosis of acute MI is traditionally relied upon the combination of….

A
  • chest pain
  • electrocardiogram manifestations
  • elevated biomarkers
  • pathology
24
Q

What is creatinine kinase?

What are the combinations?

What do they do?

A
  • Exist as isoenzymes (dimers of M & B chains)
    • CK-MM
    • CK-MB
    • CK-BB
  • Reside in the cytosol & faciliate transfer of high-energy phosphates in and out of mitochondria