Podcast
Questions and Answers
Which of the following is a non-modifiable risk factor for Coronary Artery Disease?
Which of the following is a non-modifiable risk factor for Coronary Artery Disease?
- Atherogenic diet
- Physical inactivity
- Smoking
- Family history (correct)
A patient presents with chest pain at rest, which is unpredictable. An ECG shows ST depression. The troponin level is negative. This is most likely:
A patient presents with chest pain at rest, which is unpredictable. An ECG shows ST depression. The troponin level is negative. This is most likely:
- ST-Elevation Myocardial Infarction (STEMI)
- Unstable Angina (correct)
- Variant Angina
- Non-ST-Elevation Myocardial Infarction (NSTEMI)
A patient experiences chest pain with ST elevation in two or more contiguous leads along with positive troponin levels. Which condition is MOST likely indicated?
A patient experiences chest pain with ST elevation in two or more contiguous leads along with positive troponin levels. Which condition is MOST likely indicated?
- Unstable angina
- Non-ST Elevation Myocardial Infarction (NSTEMI)
- ST Elevation Myocardial Infarction (STEMI) (correct)
- Variant Angina
Which of the following is characteristic of Variant or Prinzmetal’s Angina?
Which of the following is characteristic of Variant or Prinzmetal’s Angina?
During the management of acute chest pain, what is the recommended time frame for performing and reading an ECG?
During the management of acute chest pain, what is the recommended time frame for performing and reading an ECG?
Which medication should be administered as soon as possible for a patient experiencing an Acute Coronary Syndrome (ACS)?
Which medication should be administered as soon as possible for a patient experiencing an Acute Coronary Syndrome (ACS)?
What is the primary reason for avoiding non-cardioselective beta-blockers, such as propranolol, in the management of ACS?
What is the primary reason for avoiding non-cardioselective beta-blockers, such as propranolol, in the management of ACS?
Which ECG changes indicate a Right Coronary Artery occlusion affecting the inferior Left Ventricle?
Which ECG changes indicate a Right Coronary Artery occlusion affecting the inferior Left Ventricle?
Which of the following is NOT a typical finding associated with an Inferior Myocardial Infarction?
Which of the following is NOT a typical finding associated with an Inferior Myocardial Infarction?
A patient develops a systolic murmur secondary to papillary muscle rupture during an inferior MI. Which blood supply is most likely affected?
A patient develops a systolic murmur secondary to papillary muscle rupture during an inferior MI. Which blood supply is most likely affected?
What is a potential complication of an Anterior Myocardial Infarction regarding the bundle of His?
What is a potential complication of an Anterior Myocardial Infarction regarding the bundle of His?
What is indicated by ST elevation in leads V5 and V6?
What is indicated by ST elevation in leads V5 and V6?
For a patient experiencing a STEMI, when should reperfusion be the primary treatment goal following symptom onset?
For a patient experiencing a STEMI, when should reperfusion be the primary treatment goal following symptom onset?
Which of the following is an eligibility criteria for reperfusion therapy in STEMI?
Which of the following is an eligibility criteria for reperfusion therapy in STEMI?
Which of the following is a sign or symptom of a Right Ventricle Infarct?
Which of the following is a sign or symptom of a Right Ventricle Infarct?
Which of these modifiable risk factors for coronary artery disease is most directly associated with endothelial dysfunction and increased thrombotic potential?
Which of these modifiable risk factors for coronary artery disease is most directly associated with endothelial dysfunction and increased thrombotic potential?
A patient presents with chest pain described as predictable during physical exertion and relieved with rest. Which underlying pathological process is MOST likely contributing to these symptoms?
A patient presents with chest pain described as predictable during physical exertion and relieved with rest. Which underlying pathological process is MOST likely contributing to these symptoms?
An ECG of a patient with chest pain at rest shows ST depression and T-wave inversion, but cardiac biomarkers including troponin are negative. Which medical diagnosis is most consistent with these findings?
An ECG of a patient with chest pain at rest shows ST depression and T-wave inversion, but cardiac biomarkers including troponin are negative. Which medical diagnosis is most consistent with these findings?
Which characteristic is MOST specific to Variant or Prinzmetal's Angina compared to other types of unstable angina?
Which characteristic is MOST specific to Variant or Prinzmetal's Angina compared to other types of unstable angina?
Following a suspected acute coronary syndrome, a stat ECG identifies ST segment elevation, initiating the management process. What immediate next step is essential to improve outcomes based on established guidelines?
Following a suspected acute coronary syndrome, a stat ECG identifies ST segment elevation, initiating the management process. What immediate next step is essential to improve outcomes based on established guidelines?
Why is it important to avoid beta-blockers in patients with acute coronary syndrome due to cocaine use?
Why is it important to avoid beta-blockers in patients with acute coronary syndrome due to cocaine use?
A patient's ECG shows ST elevation in leads II, III, and aVF with reciprocal ST depression in leads I and aVL. What is the most likely location of the myocardial infarction and the artery affected?
A patient's ECG shows ST elevation in leads II, III, and aVF with reciprocal ST depression in leads I and aVL. What is the most likely location of the myocardial infarction and the artery affected?
An inferior myocardial infarction is associated with several complications. Which of the following is NOT typically associated with an inferior MI?
An inferior myocardial infarction is associated with several complications. Which of the following is NOT typically associated with an inferior MI?
A patient presenting with a Right Ventricle (RV) infarct is likely to exhibit which set of findings?
A patient presenting with a Right Ventricle (RV) infarct is likely to exhibit which set of findings?
A patient with a STEMI is being considered for reperfusion therapy. Which of the following criteria definitively qualifies a patient for this treatment method?
A patient with a STEMI is being considered for reperfusion therapy. Which of the following criteria definitively qualifies a patient for this treatment method?
A patient presents with chest pain at rest, which is unpredictable and relieved with nitroglycerin. The ECG shows ST depression and T-wave inversion. Troponin levels are negative. Which type of acute coronary syndrome is most likely?
A patient presents with chest pain at rest, which is unpredictable and relieved with nitroglycerin. The ECG shows ST depression and T-wave inversion. Troponin levels are negative. Which type of acute coronary syndrome is most likely?
Which of the following is a potential complication of an Anterior Myocardial Infarction (AMI)?
Which of the following is a potential complication of an Anterior Myocardial Infarction (AMI)?
A patient with a history of stable angina presents with chest pain at rest. The ECG shows ST elevation in leads V5 and V6. Which artery is most likely affected?
A patient with a history of stable angina presents with chest pain at rest. The ECG shows ST elevation in leads V5 and V6. Which artery is most likely affected?
A patient with an Inferior MI develops a systolic murmur. What is the most likely cause of the murmur?
A patient with an Inferior MI develops a systolic murmur. What is the most likely cause of the murmur?
Why is a right-sided ECG (V3R, V4R) recommended for a patient with suspected Right Ventricle Infarct?
Why is a right-sided ECG (V3R, V4R) recommended for a patient with suspected Right Ventricle Infarct?
A patient with a suspected STEMI is seen in the Emergency Department. What is the door-to-balloon time goal for percutaneous coronary intervention (PCI)?
A patient with a suspected STEMI is seen in the Emergency Department. What is the door-to-balloon time goal for percutaneous coronary intervention (PCI)?
A patient with chest pain has ECG changes consistent with an inferior MI. Which medication classes should be used with caution in this patient?
A patient with chest pain has ECG changes consistent with an inferior MI. Which medication classes should be used with caution in this patient?
Which of the following is a modifiable risk factor for Coronary Artery Disease (CAD)?
Which of the following is a modifiable risk factor for Coronary Artery Disease (CAD)?
Which medication is commonly used to relieve chest pain associated with variant angina?
Which medication is commonly used to relieve chest pain associated with variant angina?
Which of the following best describes the pathophysiology of acute coronary syndrome (ACS)?
Which of the following best describes the pathophysiology of acute coronary syndrome (ACS)?
A patient with an acute MI has new onset of ST elevation in leads I and aVL. Which area of the heart and associated artery are most likely affected?
A patient with an acute MI has new onset of ST elevation in leads I and aVL. Which area of the heart and associated artery are most likely affected?
A patient's ECG shows ST depression and T-wave inversion but cardiac biomarkers are negative. They report chest pain that is unpredictable and occurs at rest. Which type of acute coronary syndrome is MOST consistent with this presentation?
A patient's ECG shows ST depression and T-wave inversion but cardiac biomarkers are negative. They report chest pain that is unpredictable and occurs at rest. Which type of acute coronary syndrome is MOST consistent with this presentation?
A patient experiencing an acute myocardial infarction demonstrates ST elevation in leads II, III, and aVF. In addition to the immediate treatment of ACS, which other specific evaluation should be done?
A patient experiencing an acute myocardial infarction demonstrates ST elevation in leads II, III, and aVF. In addition to the immediate treatment of ACS, which other specific evaluation should be done?
A patient has just been diagnosed with an acute inferior MI. Which of the following is an expected ECG finding?
A patient has just been diagnosed with an acute inferior MI. Which of the following is an expected ECG finding?
Which of the following ECG changes would support a diagnosis of an anterior myocardial infarction?
Which of the following ECG changes would support a diagnosis of an anterior myocardial infarction?
A patient with an acute coronary syndrome has a contraindication to beta-blockers due to hypotension. Which of the following represents the most appropriate course of action regarding beta-blocker therapy in this patient?
A patient with an acute coronary syndrome has a contraindication to beta-blockers due to hypotension. Which of the following represents the most appropriate course of action regarding beta-blocker therapy in this patient?
A patient who had an inferior MI develops a new systolic murmur. Which of the following complications is most likely?
A patient who had an inferior MI develops a new systolic murmur. Which of the following complications is most likely?
A patient with an acute inferior myocardial infarction develops bradycardia and AV block. Which of the following is the most likely underlying mechanism?
A patient with an acute inferior myocardial infarction develops bradycardia and AV block. Which of the following is the most likely underlying mechanism?
Which statement best describes the goal of reperfusion therapy in the context of a STEMI (ST-Elevation Myocardial Infarction)?
Which statement best describes the goal of reperfusion therapy in the context of a STEMI (ST-Elevation Myocardial Infarction)?
What characterizes Non-ST Elevation Myocardial Infarction (NSTEMI)?
What characterizes Non-ST Elevation Myocardial Infarction (NSTEMI)?
Which of the following types of chest pain is associated with Variant or Prinzmetal’s Angina?
Which of the following types of chest pain is associated with Variant or Prinzmetal’s Angina?
In the context of acute coronary syndrome management, why is aspirin administered as quickly as possible?
In the context of acute coronary syndrome management, why is aspirin administered as quickly as possible?
What is the key distinguishing feature of an Anterior Myocardial Infarction?
What is the key distinguishing feature of an Anterior Myocardial Infarction?
In cases of inferior myocardial infarction, which complication is particularly associated with right coronary artery occlusion?
In cases of inferior myocardial infarction, which complication is particularly associated with right coronary artery occlusion?
Which medication is contraindicated in a patient with acute coronary syndrome who is suspected to have used cocaine?
Which medication is contraindicated in a patient with acute coronary syndrome who is suspected to have used cocaine?
What should be closely monitored in a patient undergoing management for a Right Ventricular Infarct?
What should be closely monitored in a patient undergoing management for a Right Ventricular Infarct?
Which of the following ECG changes indicate a Left Anterior Descending artery occlusion during an Anterior MI?
Which of the following ECG changes indicate a Left Anterior Descending artery occlusion during an Anterior MI?
What is the standard door-to-drug time for fibrinolytic therapy in managing STEMI?
What is the standard door-to-drug time for fibrinolytic therapy in managing STEMI?
Which of the following findings is associated with Non-ST Elevation Myocardial Infarction (NSTEMI)?
Which of the following findings is associated with Non-ST Elevation Myocardial Infarction (NSTEMI)?
Which of the following best describes the usual cause of an acute coronary syndrome?
Which of the following best describes the usual cause of an acute coronary syndrome?
A patient with a suspected acute MI shows ST elevation in V1-V4 and reciprocal ST depression in II, III, and aVF. Which type of infarct is suspected and what is the likely artery involved?
A patient with a suspected acute MI shows ST elevation in V1-V4 and reciprocal ST depression in II, III, and aVF. Which type of infarct is suspected and what is the likely artery involved?
A patient with chest pain has ECG results showing ST segment elevation in leads II, III, and aVF, and is experiencing bradycardia. What additional complication would strongly correlate with this presentation?
A patient with chest pain has ECG results showing ST segment elevation in leads II, III, and aVF, and is experiencing bradycardia. What additional complication would strongly correlate with this presentation?
What is the primary concern in administering beta-blockers to a patient experiencing an acute coronary syndrome with associated hypotension?
What is the primary concern in administering beta-blockers to a patient experiencing an acute coronary syndrome with associated hypotension?
A patient with chest pain at rest is diagnosed with variant angina. Which finding is MOST likely to be evident on their electrocardiogram during an episode of chest pain?
A patient with chest pain at rest is diagnosed with variant angina. Which finding is MOST likely to be evident on their electrocardiogram during an episode of chest pain?
A patient presents with acute chest pain, and the ECG shows ST elevation in leads V3R and V4R. Which of the following is the most appropriate acute treatment?
A patient presents with acute chest pain, and the ECG shows ST elevation in leads V3R and V4R. Which of the following is the most appropriate acute treatment?
A patient with a suspected STEMI developed a new RBBB. What is the clinical concern with this finding?
A patient with a suspected STEMI developed a new RBBB. What is the clinical concern with this finding?
A patient being treated for a STEMI is waiting for a percutaneous coronary intervention (PCI). What is the recommended time frame for this procedure from the point of hospital arrival?
A patient being treated for a STEMI is waiting for a percutaneous coronary intervention (PCI). What is the recommended time frame for this procedure from the point of hospital arrival?
A patient with a suspected acute coronary syndrome has severe bradycardia and a second-degree Type I AV block. Which type of MI is most likely underlying this presentation?
A patient with a suspected acute coronary syndrome has severe bradycardia and a second-degree Type I AV block. Which type of MI is most likely underlying this presentation?
A patient presents with acute chest pain, and their ECG shows ST elevation in leads V5 and V6. Which coronary artery is MOST likely involved and what location of the left ventricle is affected?
A patient presents with acute chest pain, and their ECG shows ST elevation in leads V5 and V6. Which coronary artery is MOST likely involved and what location of the left ventricle is affected?
A patient experiencing chest pain is found to have ST elevation in leads V1 through V4. Which location of the heart is most likely affected, and therefore what corresponding artery is likely the culprit?
A patient experiencing chest pain is found to have ST elevation in leads V1 through V4. Which location of the heart is most likely affected, and therefore what corresponding artery is likely the culprit?
A patient is being evaluated for a suspected acute coronary syndrome. Their ECG shows ST elevation in leads II, III, and aVF, along with reciprocal changes in leads I and aVL. Which area of the heart is MOST likely experiencing an infarction?
A patient is being evaluated for a suspected acute coronary syndrome. Their ECG shows ST elevation in leads II, III, and aVF, along with reciprocal changes in leads I and aVL. Which area of the heart is MOST likely experiencing an infarction?
An ECG reveals ST elevation in leads V3R and V4R. Which of the following conditions is MOST likely present?
An ECG reveals ST elevation in leads V3R and V4R. Which of the following conditions is MOST likely present?
A patient with an acute inferior MI develops a new systolic murmur. Which of the following is the MOST likely cause?
A patient with an acute inferior MI develops a new systolic murmur. Which of the following is the MOST likely cause?
A patient is admitted with chest pain and a STEMI. The recommended time goal for fibrinolytic drug therapy, from door-to-drug, is within:
A patient is admitted with chest pain and a STEMI. The recommended time goal for fibrinolytic drug therapy, from door-to-drug, is within:
A patient experiencing chest pain at rest has a stat ECG done showing ST-segment elevation. Based on the content, what should be the immediate next step?
A patient experiencing chest pain at rest has a stat ECG done showing ST-segment elevation. Based on the content, what should be the immediate next step?
A patient with a suspected inferior MI is experiencing bradycardia. Which of the following statements best explains why this is happening, according to the information provided?
A patient with a suspected inferior MI is experiencing bradycardia. Which of the following statements best explains why this is happening, according to the information provided?
A patient presents with symptoms suggesting acute coronary syndrome. Initial ECG shows ST depression and T wave inversion with negative troponins. Chest pain is reported to be unpredictable and at rest. Which of the following is the most likely diagnosis?
A patient presents with symptoms suggesting acute coronary syndrome. Initial ECG shows ST depression and T wave inversion with negative troponins. Chest pain is reported to be unpredictable and at rest. Which of the following is the most likely diagnosis?
Which of the following is a contraindication for the administration of beta-blockers for the treatment of acute coronary syndrome?
Which of the following is a contraindication for the administration of beta-blockers for the treatment of acute coronary syndrome?
A patient with an acute inferior MI is showing signs of right ventricular involvement. Which of the following hemodynamic changes is MOST consistent with right ventricular dysfunction?
A patient with an acute inferior MI is showing signs of right ventricular involvement. Which of the following hemodynamic changes is MOST consistent with right ventricular dysfunction?
Flashcards
Acute Coronary Syndrome (ACS)
Acute Coronary Syndrome (ACS)
A disorder that affects the heart due to reduced blood flow to the heart muscle, leading to symptoms like chest pain or discomfort, shortness of breath, and fatigue.
Risk Factors for Coronary Artery Disease
Risk Factors for Coronary Artery Disease
Factors that increase the risk of developing coronary artery disease. They can be categorized as modifiable, meaning they can be changed through lifestyle choices, and non-modifiable, meaning they are beyond an individual's control.
Modifiable Risk Factors
Modifiable Risk Factors
Factors that can be altered through lifestyle changes, such as diet, exercise, and smoking cessation. These factors can be influenced by an individual's choices and action.
Non-Modifiable Risk Factors
Non-Modifiable Risk Factors
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Spectrum of Ischemic Heart Disease
Spectrum of Ischemic Heart Disease
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Asymptomatic Coronary Artery Disease (CAD)
Asymptomatic Coronary Artery Disease (CAD)
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Stable Angina
Stable Angina
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Acute Coronary Syndrome (ACS)
Acute Coronary Syndrome (ACS)
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Unstable Angina
Unstable Angina
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Non-ST Elevation Myocardial Infarction (NSTEMI)
Non-ST Elevation Myocardial Infarction (NSTEMI)
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ST Elevation Myocardial Infarction (STEMI)
ST Elevation Myocardial Infarction (STEMI)
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Variant or Prinzmetal’s Angina
Variant or Prinzmetal’s Angina
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Stat ECG
Stat ECG
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Aspirin
Aspirin
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Anticoagulants
Anticoagulants
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Antiplatelet Agents
Antiplatelet Agents
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What is Acute Coronary Syndrome (ACS)?
What is Acute Coronary Syndrome (ACS)?
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What are modifiable risk factors for ACS?
What are modifiable risk factors for ACS?
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What are non-modifiable risk factors for ACS?
What are non-modifiable risk factors for ACS?
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What is Unstable Angina?
What is Unstable Angina?
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What is Non-ST Elevation Myocardial Infarction (NSTEMI)?
What is Non-ST Elevation Myocardial Infarction (NSTEMI)?
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What is ST Elevation Myocardial Infarction (STEMI)?
What is ST Elevation Myocardial Infarction (STEMI)?
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What is a Stat ECG?
What is a Stat ECG?
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What is Aspirin's role in ACS management??
What is Aspirin's role in ACS management??
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What are Anticoagulants?
What are Anticoagulants?
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What is Variant or Prinzmetal’s Angina?
What is Variant or Prinzmetal’s Angina?
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What are the ECG changes and symptoms of an Inferior MI?
What are the ECG changes and symptoms of an Inferior MI?
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What are the ECG changes and symptoms of an Anterior MI?
What are the ECG changes and symptoms of an Anterior MI?
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What are the ECG changes and symptoms of a Lateral MI?
What are the ECG changes and symptoms of a Lateral MI?
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Non-modifiable risk factors for ACS
Non-modifiable risk factors for ACS
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Modifiable risk factors for ACS
Modifiable risk factors for ACS
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Variant or Prinzmetal's Angina
Variant or Prinzmetal's Angina
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Acute Coronary Syndrome (ACS): What is it?
Acute Coronary Syndrome (ACS): What is it?
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Aspirin: What is it?
Aspirin: What is it?
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Inferior MI: What are the ECG changes?
Inferior MI: What are the ECG changes?
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Aspirin for ACS
Aspirin for ACS
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Anticoagulants for ACS
Anticoagulants for ACS
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Inferior MI
Inferior MI
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Study Notes
Acute Coronary Syndrome
- Risk Factors for Coronary Artery Disease:
- Non-modifiable: age, sex, family history, genetics
- Modifiable: smoking, diet, alcohol, physical activity, dyslipidemias, hypertension, obesity, diabetes, metabolic syndrome
- Spectrum of Ischemic Heart Disease:
- Asymptomatic coronary artery disease (CAD)
- Stable angina (predictable chest pain with activity)
- Acute Coronary Syndrome (due to platelet-mediated thrombosis, sudden cardiac death)
- Types of Acute Coronary Syndrome:
- Unstable angina
- Chest pain at rest, unpredictable, may be relieved by nitroglycerin, troponin negative, ST depression, or T-wave inversion on ECG
- Non-ST Elevation Myocardial Infarction (NSTEMI)
- Troponin positive, ST depression, T-wave inversion on ECG, unrelenting chest pain
- ST Elevation Myocardial Infarction (STEMI)
- Troponin positive, ST elevation in 2 or more contiguous leads, unrelenting chest pain
- Variant/Prinzmetal's Angina
- Type of unstable angina associated with transient ST segment elevation, due to spasm with or without atherosclerosis
- Unstable angina
- Management of Acute Chest Pain:
- Stat ECG, read within 10 minutes for categorization (STEMI, NSTEMI/unstable angina, no acute change)
- Risk stratification (high, medium, low)
- Aspirin (chewed ASAP, improves morbidity and mortality)
- Anticoagulants (heparin or enoxaparin)
Additional Treatments and Diagnostics
- Antiplatelet Agents: heparin/enoxaparin, clopidogrel, abciximab, eptifibatide, tirofiban
- Beta Blockers: cardioselective (metoprolol) preferred; avoid non-selective (propranolol) in certain cases
- Pain Treatment: nitroglycerin, morphine
- Lab Assessment: cardiac biomarkers, lipid profiles, CBC, electrolytes, BUN, creatinine, magnesium, PT, PTT
- ECG Lead Changes: associated changes reflecting different coronary artery involvement (e.g., changes in II, III, aVF indicate right coronary artery; changes in V1-V4 indicate left anterior descending)
- Differentiation of MI Types: inferior MI, lateral MI, anterior MI (based on ECG changes, associated symptoms, etc.)
Further Details of MI types and Treatment
- Inferior MI: ST elevation in II, III, aVF; associated with right coronary artery occlusion; may have symptoms of JVD, high CVP, hypotension, clear lungs, bradyarrhythmias; may have right ventricular involvement
- Anterior MI: ST elevation in V1-V4; associated with left anterior descending occlusion; may have systolic murmur (mitral valve regurgitation or ventricular septal defect); higher mortality than inferior MI
- Lateral MI: ST elevation in V5, V6, I, aVL; associated with left circumflex occlusion
- Reperfusion Strategy: PCI (within 90 minutes of symptom onset) for STEMI; fibrinolytic therapy (within 30 minutes) in appropriate cases for STEMI.
- Complications: arrhythmias (ventricular tachycardia/fibrillation), heart failure, cardiogenic shock, reinfarction, thromboembolic events, pericarditis, ventricular aneurysm, ventricular septal defect, papillary muscle rupture, cardiac wall rupture.
- Nursing Management: assess for major and minor bleeding, changes in LOC, brain bleed, institute bleeding precautions, assess for repurfusion, assess for reocclusion as evidenced by recurring chest pain and ST deviation for STEMI and NSTEMI patients; monitor for possible vasovagal reactions, hypotension, and bradycardia.
- Treatment of NSTEMI: similar medications as STEMI, high-risk patients/continued chest pain warrants diagnostic cardiac catheterization; use of GP IIb/IIIa inhibitors as appropriate.
- Additional NSTEMI Notes: possibility of high risk score or continued chest pain prompting diagnostic cardiac catheterization if patient is considered at high risk.
- Monitoring for Bleeding: Hemostasis (pressure applied for at least 20 minutes, 30 if GP IIb/IIIa inhibitors administered) after procedure. Possible monitoring for retroperitoneal bleeding (fluid or blood products should be given as needed).
Additional Notes (Page 4 and 5)
- Chest Pain Management: nitroglycerin, PCI, possible need for vasovagal reaction management (fluids, atropine), monitor for bleeding, specific details like door-to-balloon (PCI) < 90 minutes for STEMI are included, monitoring for bleeding (manual pressure on puncture site for 20-30 minutes); avoiding preload reducers (like nitrates, diuretics) in anterior MI due to potential hypotension; potentially using inotropic support.
- Absolute Contraindications for Fibrinolytic Therapy: prior intracranial hemorrhage, structural cerebral vascular lesion, known malignant intracranial neoplasm, stroke within 3 months (except acute ischemic stroke within 3 hours), suspected aortic dissection, active bleeding, bleeding diathesis (excluding menses); careful consideration required for patients with ischemic stroke within 3 months (except acute ischemic stroke).
- Repurfusion Arrhythmias: ventricular tachycardia (VT), ventricular fibrillation (VF), and Accelerated Idioventricular Rhythm.
- Nursing Management (Reperfusion): assess for major and minor bleeding, changes in LOC, brain bleed, institute bleeding precautions, assess for repurfusion, assess for reocclusion as evidenced by recurring chest pain and ST deviation; need to assess for potential repurfusion arrhythmias.
- Additional Considerations for Nursing Care: Monitor for signs of reocclusion (chest pain, ST elevation), vasovagal reactions (requiring fluids or atropine), hypotension(<90 systolic), bradycardia, or absence of compensatory tachycardia.
- Specific details included: Door-to-Balloon (PCI) < 90 minutes for STEMI, Monitoring for bleeding (manual pressure on puncture site for 20-30 minutes).
- Additional possible complications: Bradycardia, heart blocks, sick sinus syndrome, higher risk of mortality if return to NSR is complicated by arrhythmias. Potential for thromboembolic events, pericarditis, ventricular aneurysm, ventricular septal defect, papillary muscle rupture, cardiac wall rupture, reinfarction.
- Additional Notes: Use of beta blockers needs careful consideration in anterior MIs due to potential for hypotension (consider inotropic support). Possible 2nd degree Type II AV block or RBBB development. May develop ventricular septal defect.
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