Download Acute Coronary Syndromes: A Comprehensive Guide for Medical Professionals and more Exams Advanced Education in PDF only on Docsity!
Cardiovascular - Acute Coronary Syndromes
PDB CEN Exam
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)
- cyclical pain at rest
- vasospasm is precipitated by stress ST elevation resolves and pain relief when vasospasm resolves*** BB may exacerbate vasospasm d/t unopposed alpha stimulation
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
- proximal RCA
- S/S - JVD hypotension, shock, STE at V4R
- TX - caution with preload reducing agents (NTG and Morphine), NS bolus and dobutamine to increase contractility Lateral STEMI I and aVL high lateral, V5, V
- LAD, Circumflex
- see reciprocal changes (ST depression in II, II, aVF for high) Posterior STEMI ST segment elevation in V7-V0 or depression in V1,V Standard STEMI Treatment
- Oxygen at 4L NC if SpO2 <94% or respiratory distress
- NTG: **** contraindicated if SBP<90 HR <50, phosphodiesterase inhibitor
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
