Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
25 Cards in this Set
- Front
- Back
Is morphine indicated in STEMI?
|
Yes, with chest discomfort unresponsive to nitro (class I,C)
|
|
Is morphine indicated in NSTEMI/UA?
|
Use with caution (Class IIA, C)
|
|
What is the preferred time to initiation of fibrinolytics?
|
Within 30 minutes of 1st medical contact
|
|
When is it reasonable for EMS to divert to PCI capable hospital?
|
Short transport times (<30m)
Medical Contact to balloon <90min |
|
What are time frames for reperfusion?
|
Door to ballon 90 minutes
Door to drug 30 minutes |
|
What does an increased troponin mean?
|
Elevated troponin correlates with an increased risk of death, greater elevation predicts greater risk of adverse outcome
|
|
What should be done in patients not eligible for thrombolytics?
|
Transfer for PCI regardless of the delay
|
|
What is preferred reperfusion strategy in </=3hours?
|
TPA unless no delay to PCI
or medical contact to balloon 90 minutes or door to balloon - door to needle <1hour or contraindications to fibrinolysis or high risk STEMI, CHF, Killip>/=3 |
|
What separates NSTEMI from UA?
|
Elevated biomarkers, which indicates increased risk of AE and benefit from an invasive strategy
|
|
What is the TIMI risk score?
|
7 independent prognostic variables which are significantly associated with occurrence within 14 days of death, new or recurrent mi or need for urgent revascularization
|
|
What is the NNT for ASA to prevent first mi or stroke?
|
1667
NNH for major bleeding event requiring hospital admission and transfusion is 3333 |
|
Do chest pain units decrease adverse events or reduce mortality in patients with possible ACS, normal troponins and non-diagnostic ECG?
|
No
|
|
Should ASA be used for primary prevention of cardiovascular events in patients with DM?
|
Not clearly beneficial (AHA 2010 statement)
|
|
What is the definition of LR+?
|
The likelihood that a positive test result would be found in a patient with the target disorder compared to a positive result in a patient without the disorder
|
|
What is the LR-?
|
The likelihood that a negative test result would be found in a patient with the disorder compared to a negative test in a patient without the disorder
|
|
When are LR useful?
|
LR>10 or LR<0.1 may have a substantial impact
|
|
What is the benefit of LR?
|
Combine the stability of sensitivity and specificity with the utility of predictive values
|
|
Which patients with ACS require O2?
|
Breathlessness, signs of heart failure, shock or SpO2 <94%
|
|
What are the contraindications to ASA?
|
Known ASA allergy
active GI bleed |
|
What if patients can't take PO ASA?
|
suppository 300mg
|
|
When is nitro contraindicated?
|
Hypotension (<90mmHg)
Bradycardia <50bpm or tachycardia >100bpm RV infarction Phosphodiesterase inhibitor in the past 24-48 hours |
|
Contrast PPCI vs fibrinolytics?
|
Fibrinolysis - achieves normal coronary flow in 50-60%
PPCI achieves normal coronary flow in >90% therefore decreased re-infarction and mortality, the benefit is even greater in cardiogenic shock, also there are lower ICH and stroke rates |
|
What is the time window for fibrinolytics?
|
within 12 hours of symptom onset (but sooner is better) especially within 3 hours of symptom onset
|
|
What is the NNT for fibrinolytics?
|
NNT: 43
NNH 143 for major bleeding (0.7%) 250 - hemorrhagic stroke (0.4%) |
|
Do inferior STEMIs benefit from thrombolysis?
|
Yes but less than others, the benefit is greater if the mi is bigger (ie RV involvement)
|