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ACute Coronary Syndrome
PA CLin Med
26
Health Care
Graduate
10/17/2009

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Cards

Term
5 urgent differential Dx for chest pain
Definition
1. Ischemic heart dz
2. severe aortic stenosis
3. aortic dissection
4. PE
5. spontaneous pneumothorax
Term
5 less urgent diff Dx for chest pain:
Definition
1. GERD
2. Muskuloskeletal pain
3. pericarditis
4. emotional/psychiatric conditions
5. pleuritis
Term
HPI: what does PQRST stand for?
Definition
P - pallative/provocative factors
Q/A - quality/assoc Sx
R - radiation
S - severity
T - timing
Term
PQRST for ischemic heart dz:
Definition
P - exertion, cold, stress, or spontaneous/ relieved with rest, nitro or not at all
Q/A - pressure, tightness, squeezing, heavy/dyspnea, nausea, diaphoresis, syncope, palpitations
R - left arm/jaw
S - variable
T - important info?
Term
PQRST for aortic stenosis:
Definition
P - exertion,cold,stress,spontaneous/ rest,nitro,unrelieved
Q/A -ressure,tightness,squeezing,heavy /dyspnea,syncope,palpitations
R - left arm or jaw
S - variable
T - gradual
Term
PQRST for Aortic Dissection:
Definition
P - none
Q/A - tearing,ripping,knife-like/ dyspnea,nausea,diaphoresis,syncope, palpitations
R - back btwn shoulder blades
S - severe
T - sudden
Term
PQRST for PE:
Definition
P - none
Q/A - pleuritic/tachypnea
R - lateral to side of PE
S - severe
T - abrupt
Term
PQRST for spontaneous pneumothorax:
Definition
P - none
Q/A - pleuritic tachypnea
R - lateral to side of pneumothorax
S - severe
T - sudden
Term
5 risk factors for atherscleotic dz:
Definition
1. DM
2. HTN
3. hypercholesterolemia
4. Fam Hx
5. Tobacco use
Term
CC is CP what are you looking for on CXR?
Definition
1. pneumothorax
2. widened mediastinum
3. signs of CHF
Term
what are the antiplatelet/anticoagulant therapies for acute coronary syndrome?
Definition
ASA asap and indefinately + heparin.
if ASA not tolerated - Clopidogrel
platelet factor antogonists should be given to high risk pts
Term
3 subtypes of ACS:
Definition
1. unstable angina
2. non-ST elevation MI (NSTEMI)
3. ST elevation MI (STEMI)
Term
pt presenting w CP should have an EKG within:
Definition
10 minutes
Term
what are the two risk predicting scores?
Definition
TIMI & GRACE
Term
Pt w normal cardiac enzymes and abnormal EKG have which subtype of ACS?
Definition
unstable angina
Term
which of the ACS subtypes should receive immeddiate thrombolytics?
Definition
STEMI
Term
pathophysiology of ACS
Definition
All 3 of these disease processes involve disruption of vulnerable or high-risk plaques leading to platelet activation and myocardial ischemia
Term
Tx for unstable angina and NSTEMI
Definition
Treatment includes aspirin, beta blockers, and enoxaparin or heparin. Once the diagnosis of NSTEMI is confirmed, a glycioprotein IIb/IIIa inhibitor should also be started with percutaneous coronary intervention (PCI) and stenting within 48 hours in selected patients
Term
when the ischemia is predictable with activity and subsides with rest the pt is said to have:
Definition
chronic coronary syndrome; stable angina pectoris
Term
4 indications for Non-cardiac chest pain
Definition
1. pain radiates to legs
2. CC is something other than CP
3. Relief w NTG doesn;t = myocardial ischemia
4. pleuritic or reproducible isn't cardiac
Term
chest pain longer than __ _______ should be assoc w enzyme changes.
Definition
30 minutes
Term
ECG in ACS:
Definition
can have ST elevation or depression
can have T wave changes esp. biphasic T waves
can be present w LBBB
Term
Acute coronary syndrome algorithm:
Definition
ABCDEF
A- airway secure
B - breathing
C - circulation
D - drugs (O2,ASA,NO,Morphine)
E - EKG
F - fibrinolytic checklist

IV access
Labs; CMP,coag,cardiac enzymes
CXR (portable)
Term
3 indications for fibrinolytics:
Definition
1. Chest pain >15min <12hrs
2. STEMI or LBBB
3. Fibrinolytics NOT contraindicated
Term
contraindications for fibrinolytics: 9
Pneumonic:
Definition
DONT GIVEM
D- diff in BP >15mmHg btwn arms
O- old CNS dz
N- Noggin trauma <3mo
T- Trauma/surgery recent
G- Gestation (pregnancy)
I- Illness systemic (cancer)
V- Vitalization CPR >10min
E- Elevated BP
M- Medications (anticoags)
Term
Is patient at high risk for death? 4 indications:
Definition
1. HR>100bmp & BP<100
2. Pulmonary edema (rales)
3. shock (cool/clamy)
4. contraindications for fibrinolytics
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