Term
| What type of chest pain occurs without the usual precipitating factors and is caused by vasospasm, or constriction of the coronary art.? |
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Definition
| Prinzmetal's (variant angina) |
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Term
| Which art. is typ. involved in Prinzmetal's angina? |
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Definition
|
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Term
| Are there any EKG changes in Prinzmetal's angina? |
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Definition
| Yes - ST elevation rather than depression. Only occurs during the attack. |
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Term
| What is the tx for Prinzmetal's angina? |
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Definition
|
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Term
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Definition
| Provocation of an attack with ergonovine (vasocontrictor) |
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Term
| How is unstable angina distinguished from NSTEMI? |
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Definition
| Absent elevation of cardiac enzymes in unstable angina |
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Term
| What type of pts w/ MI may have no CP? What is their prognosis? |
|
Definition
| Older, women, DM. They have a higher chance of death |
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Term
| Who is Prinzmetal's angina more common in? |
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Definition
|
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Term
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Definition
| Onset w/ exertion, goes away w/ rest, only lasts a few minutes |
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Term
| What distinguishes stable from unstable angina pathophysiologically? |
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Definition
| In stable angina the atherosclerotic plaque is covered by a fibrous cap that may rupture in unstable allowing blood clots to precipitate decreasing the art. lumen |
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Term
| Name the 3 features that unstable angina must have at least one of. |
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Definition
| 1) At rest lasting >10min 2) Severe and new onst 3) Crescendo pattern |
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Term
| What are 3 sx commonly associated with stable angina? |
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Definition
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Term
| Name 4 ways to det. of CP is not ACS. |
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Definition
| 1) Radiates to legs 2) If CC is not CP 3) Relived w/ NTG 4) Pleuritic or reproducible |
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Term
| What is primary prevention of ACS? (5) |
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Definition
| Modify RF 1) DM control 2) Tobacco cessation 3) Control HTN 4) Exercise 5) Low fat/salt diet |
|
|
Term
| what is secondary prevention? |
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Definition
| Identifying and tx people w/ established dz or very high risk for dev. CVD |
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Term
| What meds are used to prevent ACS? |
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Definition
| Asprin and lipid lowering meds |
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|
Term
| Sudden death is the first sx of CHD in what % of people? |
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Definition
|
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Term
| What tx should be avoided in pts /s ST elevation? |
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Definition
|
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Term
| What 2 meds are considered first line tx for pts w/ ACS presenting w/ CP? |
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Definition
|
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Term
| Which pts should receive asprin? What can be given to pts w/ an asprin allergy? |
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Definition
| All pts/ w/ suspected or definite MI regardless of thrombolytics or previous asprin use. Clopidogrel. |
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Term
| When should pts w/ STEMI be tx w/ reperfusion tx? What are the 2 types? |
|
Definition
| w/i 12 hrs of the onset of sx. Primary percutaneous coronary intervention (PCI) or thrombolytics |
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|
Term
| Which is considered the preferred reperfusion tx? |
|
Definition
| PCI if w/i 90 minutes otherwise thrombolytics |
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|
Term
| What meds are used during PCI? Name 3. |
|
Definition
| Glycoprotein IIb/IIIa inhibitors (Abciximab, Eptifibitide, Tirofiban) |
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|
Term
| Which glycoprotein IIb/IIIa inhibitor is safer in pts w/ renal dysfxn? |
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Definition
|
|
Term
| What do glycoprotein IIb/IIIa inhibitors do? |
|
Definition
| prevent platelet aggregation |
|
|
Term
| Name 4 immediate tx indicated in a pt presenting w/ CP suggestive of ischemia. |
|
Definition
| 1) O2 2) Asprin 3) Nitro 4) Morphine |
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|
Term
| Name 7 absolute contraindications for Thrombolytics. |
|
Definition
| 1) h/o ICH 2) Cerebral vascular lesion 3) Malignant IC neoplasm 4) Ischemic CVA w/i 3m 5) Suspect aortic dissection 6) Active bleeding 7) CHI or facial trauma w/i 3m |
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Term
|
Definition
| 1) >65 yo 2) Wt <70kg 3) HTN (>180/110) 4) Clot-specific thrombolytics |
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|
Term
| Explain the effect of unfractionated heparin physiologically. |
|
Definition
| Accelerates action of circulating antithrombin (inhibits factors IIa, IXa, and Xa to prevent thrombus propagation) but not clot blound thrombin |
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|
Term
| Name LMWH and explain its benefit over UFH. |
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Definition
| Enoxaparin - better inhibitor of factor Xa, more predictable, longer half-life, superior in prevention of death and MI |
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Term
| In which pts should Enoxaprin not be used or be used cautiously? |
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Definition
|
|
Term
| What is Bivalirudin? When is it indicated? |
|
Definition
| Direct thrombin inhibitor, indicated for pts undergoing angioplasty or stent |
|
|
Term
| Name 5 DDX for c/o CP that are more urgent? |
|
Definition
| 1) Ischemic HD 2) Severe aortic stenosis 3) Aortic dissection 4) PE 5) Spon. pneumo |
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|
Term
| How is CP described in ACS? |
|
Definition
| Pressure, tightness, squeezing |
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