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21 Cards in this Set
- Front
- Back
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Stable angina associated with what type of atherosclerotic lesion?
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lesion with fibrous cap
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Unstable angina/NSTEMI associated with what type of atherosclerotic lesion?
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Rupture plaque without full thrombus
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STEMI associated with what type of atherosclerotic lesion?
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ruptured plaque with thrombus
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How does vessel compensate for growing atherosclerotic plaque?
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Expands to keep lumen the same size
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What is the problem with Coronary angiogram?
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only shows vessel lumen; Its possible for the plaque to huge but still have a nice looking lumen
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What type of imaging is best for actually looking at plaque?
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IVUS
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What types of tx do we use to try and convert an unstable plaque to a stable one?
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Statins, Control BP, Stop smoking, Inhibit Renin
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General clotting sequence?
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thrombin forms at site of injury, Thrombin converts fibrinogen to fibrin, Fibrin strands make meshwork, Platelets activated by plaque agents/thrombin, Activated platelets express Iib/IIIa receptors link to fibrin, provide framework for more thrombin
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What two types of drugs do we use to break the cycle of coronary thrombosis?
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Antiplatelets (aspirin, clopidogrel), Antithrombin - heparin;
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How do you differentiate unstable angina from NSTEMI?
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NSTEMI will have elevated enzymes; Unstable angina, no;
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What phsyical exam findings can diff between high and low risk STEMI?
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Rales, S4, Tachycardia, Hypotension
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What are the 4 areas of treatment to think about for USA/NSTEMI?
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Break thrombosis cycle, Address O2 supply/demand, Break symp stim of heart, If really bad reperfuse;
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What meds should you start immediately with USA/NSTEMI/STEMI?
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Statins, BBs, Nitrates, Antiplatelets, Antitthrombin
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In what 3 situations does your pt need a trip to the Cath lab?
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Pain despite maximal treatment, Pain resolves with treatment, but high TIMI score, Low risk with recurrent symptoms;
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7 elements of the TIMI score?
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SHAAA3E - ST segment changes, History, Aspirin in last 7 days, 2 or more rest angina in last 24 hours, Age over 65, 3 or more risk factors, Elevated Enzymes
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Risk of death in the next 14 days with each STEMI score?
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0/1 - 5%, 2 - 8%, 3 - 13%, 4 - 20%, 5 - 26%, 6/7 - 40%
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Immediate therapy for STEMI?
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Immediate reperfusion therapy
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What is the basic process of PCI?
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Insert cath through femoral, radial artery; Inject dye; Suction up clot, give anticlot drugs, Balloon and place stent;
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Which is more effective fibrinolytic drugs or PCI?
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PCI, in pretty much every way;
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What is the time limit for getting a cath into someone for a stemi?
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90 minutes
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How long does it take for fibrinolytics to take effect?
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90 minutes
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