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18 Cards in this Set
- Front
- Back
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Unstable Angina Pectoris and Acute Coronary Syndromes:
The diagnosis of unstable angina is based on the .... Unstable angina occurs at ..., usually lasts longer than ... minutes, is ... in nature, and demonstrates a ... pattern. |
clinical history
rest 10 severe crescendo (getting worse) |
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Unstable Angina Pectoris and Acute Coronary Syndromes:
The diagnosis of NSTEMI is established from the presenting ... combined with ... in a patient with unstable angina pectoris symptoms. The pathophysiology of UA/NSTEMI involves decreased oxygen supply and/or increased myocardial demand superimposed on atherosclerotic coronary plaque. |
ECG
cardiac biomarkers |
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Four pathophysiologic processes contribute to the development of UA/NSTEMI:
1. Plaque ... with superimposed non-occlusive ... (most common cause). An acute event 2. Dynamic obstruction (coronary artery ...). MC in young women < 50 y/o 3. Progressive coronary obstruction with atherosclerosis. 4. Increased myocardial oxygen demand or decreased myocardial oxygen supply. |
rupture
thrombus spasm |
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Unstable Angina Pectoris and Acute Coronary Syndromes:
There are usually multiple coronary ... obstructions present. They are all vulnerable to disruption and rupture. This occurs on the endothelial lining of the coronary .... |
plaque
intima |
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Unstable angina pectoris and acute coronary syndromes:
Clinical Presentation -Clinical hallmark is .... -Typically, pain is central chest with radiation to the neck and/or down the arms. -At times, pain can radiate to the ... area of the back. -There is usually associated ... and epigastric distress with nausea. -Other symptoms may include sweating and sensation of being “cold”. |
chest pain
interscapular dyspnea |
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With an acute MI, what should be done ASAP?
Physical examination may include a rapid pulse, S3 gallop, basal rales. The blood pressure may be elevated or decreased. An apical systolic murmur may be heard. Generally when inferior posterior wall is involved. Mitral regurge developed acutely |
EKG
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... are cardiac enzymes which are normally intracellular. When there is tissue necrosis then these enzymes are released into the blood circulation. This indicates that an infarct has occured.
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cardiac biomarkers
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what are the important cardiac enzymes?
The presence of these enzymes in the circulation is what distinguishes ... (which has the presence of biomarkers) from ... |
Troponin I or T, and CK-MB
NSTEMI unstable angina |
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There is a direct relationship between the amount of enzyme elevation and mortality.
If the cardiac enzymes remain negative in the patient with typical chest pain this represents .... |
unstable angina without infarction
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Diagnosis
Approximately ... million persons per year present with chest pain suggestive of acute coronary syndrome (ACS). Approximately 20% prove to have ACS. |
7
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NSTEMI:
Diagnostic guidelines established by the ACC and the AHA include: -Typical ... pain. -Patient’s age and gender. -Prior history of .... -... ECG changes. -... cardiac biomarkers. Other clinical risk factors include age > 70, diabetes, peripheral arterial disease, or cerebrovascular disease. |
chest
coronary artery disease Abnormal Abnormal elevated |
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What are the 4 diagnostic tools used to diagnose UA/NSTEMI in the ED?
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Clinical history
EKG cardiac biomarkers stress testing |
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The goals with these studies are to:
-exclude ... -evaluate for ... myocardial ischemia -evaluate for significant .... We must remember to determine the ... likelihood (TIMI 7 – if their score is low, it’s probably not an acute MI) for myocardial ischemia. Treatment is then determined by the findings of these studies. |
acute myocardial infarction
rest CAD pretest |
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should you do a stress test if the biomarkers are normal?
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no
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look at slide 21
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ok
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Risk Stratification and Prognosis:
-Patients with documented UA/NSTEMI exhibit a wide spectrum of early risk of death and new or recurrent infarction. -The early mortality rate may be as high as 10%. -The global risk can be determined by the ... risk scoring system. (if high, cath em!) |
TIMI
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Risk Stratification and Prognosis:
-TIMI risk scoring system includes ... independent risk factors. -The risk scoring system plus the EKG and cardiac biomarkers help to determine ... of the chest pain. -As was documented in the TIMI 18 clinical study, early invasive therapy ... death and recurrent MI by 40%. |
7
early treatment reduced |
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Class I Recommendations for Use of an Early Invasive Strategy: (High risk)
-... angina at rest/low-level activity despite Rx. -... TnT or TnI -... ST-segment depression. -Recurrent angina/ ischemia with CHF sxs, rales, mitral regurgitation. -... stress test. -EF < ...%. -... BP. -Sustained ventricular tachycardia. -PCI < ... months or Prior ... |
Recurrent
Elevated New Positive 40 Decreased 6 CABG |
