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45 Cards in this Set

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(5)* deadly causes of chest pain
TAPUM:
Tension pneumothorax;
Aortic Dissection;
PE;
Unstable Angina;
MI
TAPUM
how is the maximum HR determined?
220-patient's age = Max HR
(6) Major risk factors for CAD which is most prevetable?

which is the greatest risk?
Diabetes (greatest);
Smoking (most preventable);
HTN;
Hypercholesterolemia;
Family Hx;
Age
Dx:
Chest pain that has an established character, timing and duration; pain is transient, reproducable and predictable.

What is cause?

What is Tx? (2 together)
Dx: Stable Angina

Cause: Reduced coronary blood flow through fixed athrosclerotic plaque in vessel of heart

Tx: rest + Nitroglyerin
exertional substernal (precordial) chest pressure and pain radiating to left arm, jaw or back. N/V, diaphoresis, dyspnea, HTN and tachycardia can accompany it.
Name the types
Angina:

Stable

Unstable

Variant (Prinzmetal's)
Angina type that is also considered an Acute Coronary Syndrome (ACS).
What (3) factors must it have for diagnosis?
Unstable Angina

1) New-onset
2) angina that changes or accelerates in pattern, location or severity
3) Occurs at REST
Dx:
Similar characteristics of stable angina, but due to vasospasm instead of atherosclerosis.

Tx? (2 drugs together)
Variant (Prinzmetal's) Angina

Tx:
1. Calcium Channel blockers
+
2. Nitrates
what (2) groups of patients may not show the classic signs pain seen in stable angina?

Why?
Elderly and diabetics (b/c: neuropathies)
What does the EKG look like for the (3) angina types?
Stable + Unstable:
- ST Depression
- T-wave Inversion

Variant:
- ST elevation
62-yo smoker w/ 3 episodes of severe heavy chest pain in the morning. Each lasted 3 - 5 minutes, but he has no pain now. He has never had this before.
What is it?
Unstable Angina
62-yo man w/ frequent episodes of chest pain on and off for 8 months. He says the pain wakes him from sleep at night.
What is it?
Variant (Prinzmetal's) Angina
what is the alternative to an exercise Stress Test if the patient cannot get on a treadmill?
IV Dobutamine is given to stimulate myocardial function
What is the criteria for a "positive" Stress Test? (5)
either:
- ST elevation
- ST depression >1 mm in multiple leads
- Dec BP
- failure to go more than 2 minutes
- failure to complete for reason other then cardiac symptoms (i.e. arthritis)
what does Myocardial Perfusion Imaging detect? (3)
- Myocardial perfusion
- Ventricular volume
- Ejection Fraction
An ultrasound of the heart revealing abnormal wall motion due to ischemia or infarction. It also assesses left ventricular function and EF
Echocardiography
What are (5) Dx that need a cardiac catherization?

Describe procedure for each
1) MI / Unstable angina: stent or angiography
2) Valvular disease: valvuloplasty
3) Arrhythmias: mapping bypass tracts
4) Myocardial dz Bx: glycogen storage dz or cardiomyopathies
5) Congenital heart dz identification: angiography and closure of defects
(4) serum markers for MI
Myoglobin;
Troponin T/I;
CK;
Lactate Dehydrogenase
How is the right heart accessed in a cardiac catherization? (2)

Left heart? (2)
Right:
Femoral or Internal Jugular

Left:
Femoral or Radial artery (from right heart)
what is the wave morphology changes sequence in a MI ECG? (6)
1. peaked T-waves
2. T-wave inversion
3. ST elevation
4. Q-waves
5. ST normalization
6. T-waves return upright
which cardiac enzyme is the most sensitive and specific for acute MI?
Troponin-I/T
which cardiac enzyme remains increased (peaked) the longest?
LDH
what does ST depression mean?
ST goes in the opposite direction of the QRS
what does a Q-wave on an EKG in the presence of an infarction indicate?
Transmural infarction
(extends through full thickness of the myocardial wall)
Time of onset for the (4) serum markers for MI
Myoglobin (1-4 hrs)

Troponin-I/T (3-12)

CK-MB (3-12)

LDH (6-12)
which cardiac enzyme has the shortest duration?
Longest?
Myoglobin (1 day)

Troponin-I/T (7-10 days)
ST elevation in II, III & aVF
Inferior wall MI
ST depression in II, III & aVF
Cor Pulmonale

(right-sided heart failure)
None
ST elevation in V1, V2, V3
Anterior/septal MI
ST elevation in V4, V5, V6
Lateral wall MI
ST depression in V1, V2
Posterior wall MI
difference b/t unstable angina & non-ST elevation MI? (2)
non-ST elevation MI has:
1. more severe lack of Oxygen (more severe myocardial damage)
2. Enzyme leakage (Unstable angina has none)
Tx for Unstable angina & MI (6)
MONA has HEP B:
Morphine
Oxygen
Nitrates
Aspirin
HEParin
Beta-blockers
primary Tx (2) for the acute MI w/in 6 hours of infarct
(name 3 other drugs)
Throbolytics:

1. tPA
+
2. Heparin (DOC)

- Urokinase
- streptokinase
- Alteplase
At what level should LDL be in person w/ MI history?

What is given to lower it?
less then 100

statins
When are throbolytics indicated in MI? (3)
- patients < 80 yo
- within 6-12 hrs of chest pain
- evidence of infarct on ECG
Contra-indications of Throbolytics (9)
Having Some Breaks A Blood Clot In Small Pieces:
- Hx of intracranial bleed
- stroke < 1 year - BP > 180/110
- active internal bleed
- bleeding disorder
- CPR
- Intracranial tumor
- suspected aortic dissection
- Peptic ulcer
drug class that is used to break up clots
thrombolytics
name a specific drug that prevents future clots from forming
heparin
None
procedure Tx of choice for MI if there is a high risk of ST elevation (cardiogenic shock) or it has been 3 hours since initial symptoms presented?
PTCA
(Percutaneous Transluminal Coronary Angioplasty)
which throbolytic is highly immunogenic and cannot be used in the same patient twice in a 6 month period?
streptokinase
what should be given 48 hours post infarct if tPA was used?
heparin
drug class that is excellent for late and long-term therapy for acute MI to decrease afterload and prevent remodeling?
ACEi
58-yo man discharged from hospital after MI 2 weeks ago presents w/ fever, chest pain and malaise. EKG shows diffuse ST-T wave changes.
What is Dx?
What is Tx?
(2 possible meds)
Dressler's syndrome

Tx:
1. NSAIDs
or
2. Corticosteroids
Medication orders w/ discharge of an ACS (post-MI) patient? (5)
easy AS ABC:
- Aspirin (indefinitely)
- Statin to lower LDL < 100
- ACE-inh (if EF <40%)
- Beta-blocker (indefinitely)
- Clopidogrel for 1 - 12 mo depending on stent placement
Dx:
fever, pericarditis and possible pericardial or pleural effusions post cardiac surgery
Dressler's syndrome