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A detailed overview of acute coronary syndromes (acs), including stable angina pectoris, nstemi, stemi, and prinzmetal's angina. It covers the pathophysiology, clinical presentation, diagnostic workup, and management of these conditions. The document also includes a comprehensive discussion of electrocardiogram (ecg) interpretation, focusing on the identification of st segment elevation myocardial infarction (stemi) in various leads. It further outlines the standard treatment protocol for stemi, emphasizing the importance of timely reperfusion therapy and the use of various medications.
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Stable Angina Pectoris CP that occurs w/ physical exertion, short duration **relieved by rest or NTG
NSTEMI Plaque rupture, absent ST elevation
STEMI ST elevation d/t obstruction of vessels w/ thrombosis
Prinzmetal's Angina AKA variant angina - ischemia d/t coronary vasospasms (usually stimulants)
S/S of Acute coronary syndromes Chest Tightness Jaw/neck/left arm/epigastric pain
scapular discomfort N/V S/sx of schock dysrhythmias diaphoresis dizziness **Women - increased fatigue, scapular, RUQ pain **DM more likely to have silent MI
Labs A/w ACS Troponin - elevation in 3-12 hours, peaks 10- CK-MB (myoglobin) - rises earlier but not specific
Signifant history for those in ACS emergency Use of Phosphodiesterase inhibitors (sildenafil/viagra) w/in last 24 hrs Cocaine - leaves unopposed alpha stimulation if given beta blockers
What is unopposed alpha stimulation acute elevation in blood pressure and/or worsening coronary artery vasoconstriction following the administration of a β-blocker
Limb Leads Leads I, II, III, aVR, aVL, aVF are all derived using 3 electrodes - Right arm, left arm, left leg
Contiguous Leads Leads that view geographically similar areas of the myocardium; useful for localizing areas of ischemia.
**Get posterior ECT when you see ST depression in V1 and V
Precordial Leads V1-V
Inferior contiguous leads II, III, aVF
Anterior Contiguous Leads V1-V4 (Septal V1-V2)
Lateral Contiguous Leads I, aVL (High lateral), V5, V
Reciprocal Leads Leads that oppose contiguous leads
STEMI of the right ventricular vasculature Get right sided EKG
SL tablet 0.3-0.4 or spray initially 1 tab q 5 min up to 3
IV infusion as needed
Aspirin 162-325mg in chewable form to prevent platelet aggregation
PCI ****catheterization**** expect reperfusion dysrhythmias like accelerated IVR or VT - good sign of reperfusion
→ goal <90 min, fibrinolytic if unavailable within 90-
BB early for hypertensive STEMI patients
ACE/ARBs to decrease infarct size and improve ventricular remodeling
Antiplatelets-aspirin, clopidogrel/Plavix, prasugrel/Effient, ticagrelor/Brilinta-prevention of aggregation of blood clots
Anticoagulants