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25 Cards in this Set
- Front
- Back
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Is morphine indicated in STEMI?
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Yes, with chest discomfort unresponsive to nitro (class I,C)
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Is morphine indicated in NSTEMI/UA?
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Use with caution (Class IIA, C)
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What is the preferred time to initiation of fibrinolytics?
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Within 30 minutes of 1st medical contact
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When is it reasonable for EMS to divert to PCI capable hospital?
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Short transport times (<30m)
Medical Contact to balloon <90min |
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What are time frames for reperfusion?
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Door to ballon 90 minutes
Door to drug 30 minutes |
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What does an increased troponin mean?
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Elevated troponin correlates with an increased risk of death, greater elevation predicts greater risk of adverse outcome
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What should be done in patients not eligible for thrombolytics?
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Transfer for PCI regardless of the delay
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What is preferred reperfusion strategy in </=3hours?
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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 |
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What separates NSTEMI from UA?
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Elevated biomarkers, which indicates increased risk of AE and benefit from an invasive strategy
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What is the TIMI risk score?
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7 independent prognostic variables which are significantly associated with occurrence within 14 days of death, new or recurrent mi or need for urgent revascularization
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What is the NNT for ASA to prevent first mi or stroke?
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1667
NNH for major bleeding event requiring hospital admission and transfusion is 3333 |
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Do chest pain units decrease adverse events or reduce mortality in patients with possible ACS, normal troponins and non-diagnostic ECG?
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No
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Should ASA be used for primary prevention of cardiovascular events in patients with DM?
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Not clearly beneficial (AHA 2010 statement)
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What is the definition of LR+?
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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
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What is the LR-?
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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
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When are LR useful?
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LR>10 or LR<0.1 may have a substantial impact
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What is the benefit of LR?
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Combine the stability of sensitivity and specificity with the utility of predictive values
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Which patients with ACS require O2?
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Breathlessness, signs of heart failure, shock or SpO2 <94%
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What are the contraindications to ASA?
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Known ASA allergy
active GI bleed |
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What if patients can't take PO ASA?
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suppository 300mg
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When is nitro contraindicated?
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Hypotension (<90mmHg)
Bradycardia <50bpm or tachycardia >100bpm RV infarction Phosphodiesterase inhibitor in the past 24-48 hours |
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Contrast PPCI vs fibrinolytics?
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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 |
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What is the time window for fibrinolytics?
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within 12 hours of symptom onset (but sooner is better) especially within 3 hours of symptom onset
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What is the NNT for fibrinolytics?
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NNT: 43
NNH 143 for major bleeding (0.7%) 250 - hemorrhagic stroke (0.4%) |
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Do inferior STEMIs benefit from thrombolysis?
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Yes but less than others, the benefit is greater if the mi is bigger (ie RV involvement)
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