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19 Cards in this Set
- Front
- Back
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Approximately 25% of people presenting with NSTEMI will have no ____ ____.
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chest pain.
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Of those that do have chest pain, describe it.
Other NSTEMI manifesting Sx? (2 categories) Does chest pain have to be cardiac? Of the chest pain that *is* cardiac, what are the three possible sources? |
New or Changing Pain
no pleuritic or positional cmpt. Symp effects (sweating, SOB, Palpitations) & parasympathetic effects (nausea vomit weakness) No, and the other stuff can kill you too (pulm emb, pneumothrx, esophageal disaster) Aortic dz, myocardial/pericardial dz, coronary artery |
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Dx, Risk stratification, and evidence/data are the....
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...3 key principles of therapeutics.
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What are the two coronary etiologies of chest pain? Breakdown of CAD?
If you have + biomarkers for an MI, but w/o a Q wave/ST elevation... what should you think? |
Coronary spasm and CAD
Stable angina, NSTEMI, STEMI NSTEMI |
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What is the initial Dx of ACS based on?
Does a normal ECG rule out ACS? what biomarker starts to rise 3-8hrs after infarction onset, peaks at 24hrs, and returns to baseline 48-72hrs later? 3-4, 18-36 peak, 10-14d return base? |
Clincal, based on the history.
No, dammit. No! CK-MB TnI and TnT |
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What are the 7 things that give you a point on the TIMI score?
What are the risk lvls the scores stratify into? Can we just Dx & Tx with TIMI? |
Age >65; Known CAD; >/=3rf's for CAD; >/=2angina eps i/last 24h; ASA use in last 7d; ST-seg changes; +biomarkers
0-2=low 3-4=intermediate 5-7=high No, remember Dick Cheney vs marathon runner example (5vs2). Marathon runner is the one who's havin' an MI. |
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For Tx of NSTEMI, the emphasis is on ______.
Morphine, in addition to relieving pain, also... |
platelets
....decreases oxygen demand. |
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Based on ECG and biomarkers, what are the 3 risk stratifications for NSTEMI?
What are the 3 stages of Tx? |
STchange & + bioM = high
either = intermediate none = low risk initial therapy, assessment of coronary arteries, prevention |
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What is involved w/ initial therapy of NSTEMI? (6)
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O2, Pain control, B-blockade, Nitrates, Anti-platelets, antiCoag
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______ should be used in all ACS pts w/ a reasonable HR and BP that have no evidence of heart failure.
____ should be used in the same situations, but is ALSO ok to use in the case of heart failure. |
B-blockers
Nitroglycerine. |
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What inhibits cycoloxygenase, preventing thromboxane synth from arachidonic acid, and should be used in all ACS pts w/o an ASA allergy?
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ASA.
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What are the 3 options for anti-platelet therapy in NSTEMI?
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Oral: ASA & Thienopyridines
IV: Glycoprotein IIb/IIIa inhibitors |
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When are Thienopyridines used in ACS? What do they do?
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They're used alone in pts w/ ASA allergy, but are ideal in conjuction with ASA.
inhibit ADP-mediated actvation of platelets. |
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Ticlopidine and Clopidogrel are what?
What is a concern (and a famous example) of using Clopidogrel upfront in ACS? |
Thienopyridines.
can cause bleeding, and delay operation if the pt needs it (Bill Clinton) |
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Abciximab, Tirofiban, and Eptifibatide are all what? What do they do?
- used in conjuction with? - downside? - when used w/ greatest benefit? |
Glycoprotein IIb/IIIa inhibitors
Block the final common pathW of platelet aggregation Used w/ heparin Can really increase risk of bleeding. In high-risk pts undergoing PCI. |
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all pts with suspected ACS should be ....
does this Tx improve cardiac outcomes? How about influence the progression to STEMI? downside? |
anticoaged with heparin (LMW seems to be better, with more predictable kinetics)
improves, and decreases this progression Unfractioned Heparin can have v. variable kinetics... LMW seems to be better (has a longer half life, which can be a great thing or a complicating thing, depending on the situation) |
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All NSTEMI ACS pts must have some assessment of ____ ______ prior to discharge.
2 main categories? Examples? What is the Dx standard? - upside is, it can be converted from a ____ to a ______ strategy. - downside? |
coronary anatomy.
invasive (Coronary Angiography) non-invasive (stress test w/ imaging (echo or nuclear); CT-Angiography) CT angiography Dx to a therapeutic strategy invasive nature carries risk |
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Early angiography (first 12 to 48hrs) in NSTEMI is _____ by the literature.
Benefit of Invasive strategy is greatest in which stratifications of pts? What can be done w/ the remaining strata? |
supported.
intermediate and high risk low risk pts --> angiography or stress testing w/ imaging |
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Does stinting prevent future ACS/MI events? What is the most important therapeutic maneuver that makes pts live longer and better?
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No.
Prevention, both w/ meds and lifestyle changes. |
