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Flashcards in Chest Pain - Adams Deck (14)
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1
Q

What groups are alternative presentations of MI most common?

A

Women, young, elderly

2
Q

What might an S3 sound indicate?

A

left ventricular dysfunction

3
Q

What might an S4 sound indicate?

A

decreased left ventricular compliance
(Note: this cannot occur in atrial fibrillation since it is caused by atria contraction driving blood into the ventricles and against an abnormal ventricular wall)

4
Q

Why it it important to diagnose unstable angina?

A

10% of those with unstable angina will have an MI within 7 days

5
Q

Angina as a symptom has what kind of duration?

A

It lasts no more than 30 minutes

6
Q

Describe the 3 types of angina:
Stable
Prinzmetal’s
Unstable

A
Stable: 
-Can be frequent and still stable
Prinzmetal's: 
-Vasospasm
-associated w/ ST elevation
-occurs at rest, often at night, rarely with exercise
Unstable:
-10% Will have MI in 7 days
-Increasing duration, frequency, or intensity
-Occurring with less and less activity
7
Q

Let’s grade some anginas:

Real brief grades: 1,2,3,4

A

Grade 1: Ordinary activity produces no angina
Grade 2: Slight limitation of ordinary activity
Grade 3: Angina even occurs when walking
Grade 4: Can happen at rest, activity very limited

8
Q

Specific criteria defining a heart attack:

A

Elevation of troponin and AT LEAST ONE of the following:

1) Symptoms of ischemia
2) Q wave development
3) New ST/T wave changes or new LBBB
4) Intracoronary thrombus
5) Loss of cardiac wall

9
Q

Why does Dr. Adams say we can’t automatially discharge a patient with a normal EKG and troponin levels?

A

EKG can be normal in 1/3 of early MI’s
At 3 hours after an MI, troponin sensitivity is only 50%
(if normal for 6 hours, AMI can be excluded usually)

10
Q

EKG reading in a STEMI?

A

-ST elevation in all leads (greater than 1 box)
but V2/V3 (greater than 2 boxes)
-If ST’s are depressed, can be posterior MI

11
Q

EKG reading for NSTEMI?

A

Horizontal or downward ST depression is 2 contiguous leads
AND/OR
T wave inversion with prominent R wave or R/S ratio

12
Q

How do you manage a patient with low risk ACS vs a patient with moderate/sever risk?

A

Low: aspirin, observation with repeate troponin every 6-12 hours
Mod/High: Nitroglycerin, heparin, repeat troponin every 6-12 hours

13
Q

When should you use notroglycerin?

A

For angina, and selectively for MI (not good for RV infarct)

14
Q

What medicines are usually not urgent, but important for mortality reduction in 1st 24 hours?

A
ACE inhibitors (for pts with CHF or low LV ejection)
Beta-blockers