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35 Cards in this Set
- Front
- Back
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quality of pain in STEMI (5)
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• May be severe
• Deep and visceral • Heavy, squeezing, crushing (may be stabbing or burning) • Occasionally radiates to the arms (abdomen, back lower jaw, and neck are less common) • If started during a period of exertion it does not usually subside upon cessation of activity similar to anginal pain but more severe/lasts longer |
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• Painless infarction most common in (2)
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diabetics and the elderly
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7 s/sx of acute MI
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pain
anxiety/restlessness pallor diaphoresis cool extremities tachycardia/htn (anterior MI) bradycardia/hypotension (inferior MI) |
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EKG of acute MI (STEMI vs NSTEMI)- what you will see
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elevated – ST-segment changes
NSTEMI will be inverted T waves and ST segment depression |
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2 abnormal lab tests in STEMI
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– Creatinine Phosphokinase (CK)
– Troponin |
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Recommend drugs that should be initiated asap in a patient with an acute myocardial infarction unless otherwise contraindicated. (7)
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Thrombolytic (if can't get to cath lab)
Anti-platelet asap: Aspirin/plavix - as soon as possible GP IIb/IIIa inhibitors - if PTCA (angioplasty)/PCI Antithrombotic therapy BB ACEI nitrates |
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thrombolytics- most effective when?
increased risk of what? |
Most effective in 6hr
increased risk of intracranial hemorrhage |
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treatment options for re-establishing blood flow in a pt (2)
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thrombolytics
PCI |
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Name three drugs that patients who have suffered an acute myocardial infarction should be prescribed upon discharge unless otherwise contraindicated.
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BB
low dose ASA ACEI |
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patient risk factors for coronary heart disease (8)
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age
htn (>140/90 or on antihypertensive) cig smoking low hdl < 40 men < 50 women (>60 subtract one risk factor as its protective) fam hx DM obesity microalbuminuria??? GFR <60 wtf DOMACH3 |
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age of risk for CHD (men vs women)
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men >= 45
women >= 55 or premature menopause without estrogen replacement MEN HAVE GREATER RISK EARLIER IN LIFE |
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2 fam hx risk for CHD
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MI/sudden death before 55 for father/first degree males
MI/sD before 65 for mother/female first degree |
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Patient’s with 0-1 risk factor (Lower risk) LDL goal and when to give drug therapy
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LDL goal <160 mg/dl
Drug therapy when LDL >190 mg/dl |
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Patient’s with 2 or more risk factors
LDL goal, unless... ; what do you have to do to determine goal |
LDL goal <130 mg/dl unless 10 year risk >20%
Determine Framingham score (10 year risk) |
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Factors that favor a decision to reduce LDL-C levels to ≤70 mg/dL: (4)
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Presence of established CVD plus:
Multiple or uncontrolled major risk factors (especially diabetes, smoking, etc.) Multiple risk factors of the metabolic syndrome (especially high triglycerides ≥200 mg/dL plus non-HDL-C ≥130 mg/dL with low HDL-C ≤40 mg/dL on the basis of PROVE IT, patients with acute coronary syndromes |
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when would LDL goal be < 100? (3)
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CHD or Risk Equiv or 10 yr > 20%
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monitoring program for a patient receiving atorvastatin: baseline (3)
when to retest (new dose or dose adjustment) 2 tests you check as needed |
baseline: Lipids/LFTs (aka CMP) + CK (do not repeat unless myalgia)
lipids in 2-4 weeks or if dose adjustment LFTs/CK if clinically warranted |
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monitoring for niacin: monitor what at baseline
new dose/change in dose? routine monitoring (2) |
baseline: CMP
new dose or change in dose: Lipids, glucose, LFTs at 2 months Lipids, glucose, LFTs every 3 months for first year then every six months |
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non-pharmacologic interventions for the management of hyperlipidemia (5)
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avoid saturated/trans fats
reduce caloric intake eat monosaturated fats, fiber, fruits/veggies exercise 30 min+ about 5 days a week plant sterols/stanols |
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risk factors for PVD (6)
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over the age of 50,
smokers, diabetic, overweight, people who do not exercise, or people who have high blood pressure or high cholesterol |
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STEMI- antithrombotics (2)
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UF Heparin or LMWH
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give antithrombotics to whom? (4)
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No streptokinase use is anticipated (least selective so high risk of bleeds)
Alteplase, recteplase, or tenecteplase is to be administered Patient will undergo percutaneous or surgical revascularization Risk of embolic complication appears high (anterior-wall MI) basically everyone... |
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purpose of BBs (3)
use which one usually |
Reduce chest pain
Reduce myocardial-wall stress Limit infarct size metoprolol oral or IV |
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do not use BB if...(5)
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hypotension, bradycardia, heart block, cardiogenic shock or bronchospastic disease
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purpose of ACEI in STEMI (2)
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Reduce left ventricular dysfunction and dilation
Slow progression to congestive heart failure |
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ACEI started when? for STEMI
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Started soon after MI (first 24 hours after blood pressure stabilized)
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nitrates for STEMI- does what? (3)
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Increase supply of oxygen by decreasing vasospasm
Limits infarct size and improves LV dysfunction |
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control for dyslipidemia in STEMI
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statins...
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ASA 75 mg- onset
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Complete inhibition of cycloxygenase in platelets and vessel walls occurs at a dose of 75 mg daily in a matter of a few days
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use how much asa if you want to achieve emergency immediate inhibition of COX
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Use at least 160 mg to achieve immediate inhibition in emergency situations
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gp iib/iiia inhibitors (3)
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(abciximab, eptifibatide, tirofiban)
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give plavix to whom, in STEMI?
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plavix- everyone, unless CABG within 5 days
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give GP iib/iiia inhibitors to whom in STEMI? (2)
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Gp iib/iiia inhibitor if PCI or continuing ischemia/troponins
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ABCDEs of STEMI treatment
(3 As, 2 Bs, 2 Cs, 2Ds, E) |
Antiplatelet (plavix/asa 325 mg chewed)
anticoag ACEI/ARB Beta blockade BP control (130/85 goal) cholesterol treatment (statins) cig smoking diabetes mgmt diet exercise |
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MONA
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morphine
oxygen (first 6 hours) nitrates asa |
