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29 Cards in this Set
- Front
- Back
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3 components of acute coronary syndrome
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unstable angina, Non-STEMI, STEMI
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Basic differentiation from unstable angina and NSTEMI from STEMI
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STEMI has completely obstructive thrombus
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Which of the three levels of ACS do not release biomarkers?
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unstable angina
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Triggers for ACS
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strenuous PA, emotional stress, SNS activation
exacerbated by endothelial dysfunction |
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infarct spanning thickness of myocardium
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transmural infarct
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infarct of only the innermost layers of myocardium
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subendocardial infarct
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How quickly does irreversible cell injury occur with an MI?
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within 20 min (without intervention)
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Time for fibrosis and scarring to occur
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7 weeks
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local region with reduced contraction
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hypokinesis (systolic dysfunction)
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local region with NO contraction
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akinesis (systolic dysfunction)
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local region that bulges "outward" with contraction
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dyskinesis (systolic dysfunction)
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Impaired relaxation causes what?
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diastolic dysfunction (results in reduced compliance and inc ventricular filling pressures)
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Summarize ischemic preconditioning
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perhaps angina or ischemia before MI could make it more resistant/protective
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symptoms of MI
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chest pain (substernal and persistent)
N/V diaphoresis, cool/clammy skin fever SOB |
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high risk features for MI
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inc age
low BP inc HR heart failure (Killip classification) anterior location |
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Two indicators of inc risk of hospital mortality
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acute pulmonary edema
cardiogenic shock |
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Necessary for STEMI dx
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>1mm ST-segment elevation in 2 anatomically contiguous leads
OR >2mm ST-segment elevation in 2 contiguous precordial leads OR new Left BBB |
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Which 3 leads are related to inferior heart?
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II,III,aVF
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Which 3 leads are related to anterior heart?
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V2-V4
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Which 4 leads relate to lateral heart?
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I,aVL,V5,V6
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Coronary artery indicated by lateral changes on ECG
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LCx > LAD
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What can V1,V2 depressions signify?
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changes on posterior heart (RCA >> LCx)
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Q wave inc indicates what?
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necrosis
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Potential qualifiers of unstable angina
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rest angina >20min
new onset angina that limits activity inc angina in unstable pattern +/- ECG changes negative troponin (biomarkers) |
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How do NSTEMI ECGs differ from STEMI?
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no Q waves in NSTEMI (more difficult to see/rely on)
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7 TIMI risk factors for NSTEMI/Unstable Angina
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Age >65yrs
Known CAD >3 risk factors for CAD ASA use within past 7d >2 episodes of angina within past 24 hrs ST changes (>0.5mm) Elevated cardiac markers |
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Predominant biomarkers
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troponin, CKMB
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Non-cardiac causes of troponin elevation
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Acute HF
PE Shock aortic dissection myocarditis trauma ICD discharge |
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How long should troponin levels be observed?
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6 hours
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