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31 Cards in this Set
- Front
- Back
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What is the target goal for hyperlipidemic pt with coronary artery disease?
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LDL: <100
HDL: > 40 Trig: < 150 |
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What pt are best tx with coronary bypass grafting?
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-Left main coronary disease
-three vessel disease -left ventricular dysfunction |
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How is STEMI defined?
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-persistent ST- segment elevation of > 1 mm in two contiguous limb leads
-ST-segment elevation of > 2 mm in two continguous chest leads -New LBBB pattern |
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What are the modifiable risk factors for Ischemic heart disease?
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Cholesterol levels
Tobacco hypertension physical inactivity obesity DM (IHD equivalent) |
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What are the uncontrollable risk factors for IHD?
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-Age:
-Sex -Heredity |
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What are some of the symptoms ass. with stable angina?
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-substernal pressure lasting 5-15 min
-radiation to jaw, neck, shoulders, arms -pain mostly after exertion |
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What are some diagnostic studies in stable angina?
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ECG: ST segment depression
Exercise stress test (most useful) Dobutamine or adenosine stress test Stress Echo (wall motion abnormalities) |
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What is the long term tx of stable angina?
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-long acting nitrates
-beta blockers -ASA -statins -reduce modifiable risk factors -evaluate disease w/ stress test and if needed angiography |
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Thrombolytic therpay can be used in pt with UA and NSTEMI
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---FALSO----
They can actually be harmful!!! |
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What is the definition of unstable angina?
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-angina of increasing intensity, frequency, duration
-increase resistance to nitrates -angina at rest -new onset angina |
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What are the ECG readings consistent with NSTEMI?
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- ST segment depression
-new T wave inversion (> 2mm) |
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What is the long term medical management of UA and NSTEMI
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- ASA + clopidogrel
- unfractionated heparin (48-72hrs) -Glycoprotein IIb/IIIa inbitors -beta blockers - IV nitroglcerin |
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What are the invasive management in pt with NSTEMI?
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-early coronary angiography (within 48 hrs)
-revascularization |
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In addition to the symptoms of substernal pain, neck or jaw shoulder or arm pain? What other symptoms are in STEMI?
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-Additional symptoms
-dizziness -nausea -vomiting -diaphoresis -dyspnea **longer than 20 min*** |
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What pts are ass. with atypical symptoms in STEMI and what are those symptoms?
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-women, elderly, diabetics
-symptoms: nausea or dyspnea |
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Describe the ECG features of STEMI...
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- Persistent ST seg elevation of > 1mm in two contiguous limb leads
-ST seg elevation of > 2mm in 2 contiguous leads -New LBBB pattern |
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What is the initial management in a pt who presents with possible MI?
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N: nitroglycerin
A: ASA O: Oxygen M: morphine I: IV access |
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Pt with STEMI must present within ___ hrs to be considered fro reperfusion therapy?
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12 hrs
*remember NSTEM does not need reperfusion therapy |
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Which is a better treatment for STEMI PCI or thrombolytics?
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PCI (percutaneous coronary intervention)
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How long do you have to initiate tx in PCI?
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90 min!!
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What are the thrombolytics commonly used?
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streptokinase
TPA |
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In which pt can thrombolytic agents be used as an alternative to primary PCI?
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in ST elevation MI (>1mm
New LBBB |
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What pt are need to be considered for cardiac surgery after an STEMI?
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- failed PCI with persistent pain
- persistent or recurrent ischemia refactory to medical therapy |
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What are the recommended discharge meds after ACS?
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1. Aspirin (75-325mg)
2. Clopidogrel 3. Beta blackers (metoprolol and carvedilol in HF) 4. ACE inhibitors (those CHF) 5. Statins (everyone) 6. Nitrates 7. Warfarin (only those at risk for thrombus formation) |
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What drugs have been show in pt with ischmic heart disease to decrease mortality?
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-Statins
-ASA -beta blockers -Cabg in triple vessel disease |
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What are the bacteria associated with acute endocarditis?
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S. aureus
gram negative |
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What are the bacteria associated with subacute endocarditis?
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Strep viridans
Enterococcus Staph epidermdis Strep bovis (ass with GI malignancy) |
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What pt are considered to be high risk for endocarditis?
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ALL prosthetic valves
previous endocarditis surgical pulmonary stenosis |
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What is the empirical tx for suspected endocarditis?
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Vanc or
ceftraxone + gentimicin |
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what antibiotic is used for oral dental procedures to cover for endocarditis?
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amoxicillin
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What is dukes criteria for endocarditis?
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Major: + blood cultures, evidence of endocardial involvement
Minor: risk factors fever vascular phenomena immunological: GN, oslers nodes, roths spots Microbiological evidence |
