chest pain due to coronary vasospasm that is relieved by rest/ NG

usually occurs during exercise or erertion

reduction in blood flow through a coronary artery via a spasm which leads to ischemia of the heart. This can lead to an STEMI or NSTEMI very quickly- hence its predictability is unknown

unstable is not made better vua rest or NG usually and can happen via rest, exercise or exertion. 

most important cardiac enzyme in determining an MI elevated and shows damage to the heart itself

UA 2/2 vaso spasm

pearls

• early Am
• vasospasm
• st elevation
• releived by NG

changes in pts BP from rgt to left arm

if pt is having an MI DO NOT GOVE THROMBOLYTIC therapy 

pressure on the heart muscle when the pericardial space fills up with fluid faster than the sac can stretch

sx:

dyspnea

pulselessness paradoxus- decrease pulse with inspriation

electrical alternans on the ECG 

paradoxial s2 split, heard at the base of the heart, radiates to the caraotid, increase with experiation, this is a systolic heart murmur

and does not increase with isometric handgrip exercises

increase with isometric and pt leans forward and increase inspiration

diastolic murmur

axilla to apex increase isometric and experation

systolic murmur

opening snap at s1 (diastole preload) 

heard as a low diastolic murmur

left ventricle is non compliant via beccoming too thick and the elecctrical pulse to get the ventricle to contract cant move through and therefore blood will sit and sit and cause clots. which when blood sits wil cause stroke

increase in squat to stand and valsalva

sx

pleural friction rub and chest pain, decrease breath sounds crackles

ecg findings

V5- st elevation pr decrease

avr- st depression pr increase

tachycardic

control excess fluids

furosomide- diurectics

it is released from the Left Ventricle

It is tested when a patient SOB to determine if the cause is pulmonary or CHF, if BNP elevated the cause is cardiac.

If BNP levels are still elevated after CHF therapy then the patient has a bad prognosis 

requires permenant pacemaker

p-p and r-r arent sychronized

adenosine

vagal manuevers

procanamide (good for wpw syndrome)