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21 Cards in this Set
- Front
- Back
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Chest pain suggestive of MI: must rule out?
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aortic dissection (CXR, mediastinal widening; US)
pneumothorax (CXR) Boerhaave's (ruptured esophagus) |
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Chest pain suggestive of MI: immediate medications and support
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MONA: morphine, O2, nitro, aspirin to chew
also beta blockers establish IV and monitor consider thrombolytics if STEMI |
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What is the difference in cause of STEMI and NSTEMI?
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STEMI: occlusion, transmural infarct
NSTEMI: subendocardial infarct UA: ischemia |
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Chest pain suggestive of MI: What diagnostic tests should be ordered?
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ECG within 10 minutes
cardiac enzymes (troponin, myoglobin, CKMB) CBC, Chem 7 sometimes type and cross, CXR (to rule out other causes and ID pulmonary edema) |
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Chest pain suggestive of MI: if the ECG shows STEMI that is less than 12 hours old, what is next step?
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Either PCI (angioplasty / stenting) or thrombolysis. PCI is preferred.
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What does the TIMI score measure?
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Risk of MI, death or revascularization within two weeks by points.
2 points, 8% 3 points, 13% 4 points, 20% 6 points, 21% |
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What is the mnemonic for the risk factors in the TIMI 2-week risk score?
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ARKANASAS
age > 55 risk factors 3+ known CAD aspirin in last 7 days ST elevation or depression angina x 2 in last 24 hours serum cardiac markers |
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What is the usual treatment for NSTEMI?
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reperfusion is NOT done for NSTEMI or UA.
aspirin, nitro, beta bloackers, use TIMI score. consider adding heparin, plavix, and/or glycoprotein inhibitors if TIMI is 3+. |
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area of heart and vessel for V1-V3 on ECG
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anteroseptal, LAD
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area of heart and vessel for V2-V4 on ECG
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anterior
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What leads are lateral on ECG?
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I, avl, v 4-6
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What leads are posterior on ECG
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mirrored in V1, V2 (R waves)
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R waves in V1 and V2
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posterior infarct
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What area of heart and vessel are indicated by I, avl, V4-6 on ECG?
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lateral, LCA
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ECG indications for reperfusion in STEMI:
1. ST elevation - what parameters? 2. What other sign? |
STE > 1 mm in two contiguous leads, < 12 hours from onset
2. New left bundle branch block |
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How do you distinguish NSTEMI from UA?
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NSTEMI will have cardiac enzyme changes, but UA will not
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What are the four factors that influence coronary blood flow?
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physical (aortic pressure, extravascular compression)
neural (alpha and beta receptors) metabolic (vasodilators which increase in ischemia) endothelial factors Most important of these are metabolic |
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Prostacyclin is a [vasoconstrictor, vasodilator].
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vasodilator
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Endothelin - 1 is a [vasoconstrictor, vasodilator].
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vasoconstrictor
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Beta blockers negatively affect [contractility, heart rate, both].
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both
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Which calcium channel blockers are negative chronotropes?
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nondihydropines
diltiazen and verapamil |
