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Test1_Chapter 26C
Perfusion/ACS-Chapter 26
| Question | Answer |
|---|---|
| Acute Coronary Syndromes | NSTEM or STEM |
| Non-ST-segment Elevation ACS | Unstable Angina or NTE acute MI |
| ST segment elevation ACS | STE Acute MI |
| Systoms of ACS | Anginal chest pain at rest, new onset, may radiate or increasing angina. May be associated with diaphoresis, dyspnea, N/V |
| EKG STE-ACS | Must have 2 or more ST elevations in 2 contigous leads AND either >0.2mV (mm) in leads V1, V2, V3 or >0.1mV in other leads |
| EKG NSTE-ACS | ST segment depression>0.1mV in 2 or more contiguous leads or T-wave inversion> 0.1mV |
| EKG Anterior Infarct | Q in V1, V2, V3, or V4 |
| EKG Posterior Infarct | Large R in V1, V2, Maybe Q in V6 |
| EKG Laterial Infarct | Q in I, AVL |
| EKG Inferior Infarct | Q in II, III, AVF |
| Troponin I and T | Draw lab after 6 hours (then every 8) and need only 1 value within 24 hrs to confirm DX |
| CK-MB | Draw lab after 6 hours (then every 8) and need 2 values above upper limit wiithin 24 hrs to confirm DX |
| AGE65-74 -TIMI RISK for STEMI ACS | 2 points |
| Age > 75y/o TIMI RISK for STEMI ACS | 3 points |
| SBP,100mmHgTIMI RISK for STEMI ACS | 3 points |
| HR>100 bpm TIMI RISK for STEMI ACS | 2 points |
| HF class II-IV TIMI RISK for STEMI ACS | 2 points |
| Anterior ST segment or Left ventricular bundle branch block TIMI RISK for STEMI ACS | 1points |
| DM or HTN or Angina TIMI RISK for STEMI ACS | 1 points |
| Time to TX > 4hrs TIMI RISK for STEMI ACS | 1 points |
| Weight <67 kg TIMI RISK for STEMI ACS | 1 point |
| Age >65 y/o TIMI RISK for NSTEMI ACS | 1 point |
| > 3 or more risk for CAD TIMI RISK for NSTEMI ACS | 1 point |
| Prior Hx of CAD TIMI RISK for NSTEMI ACS | 1 point |
| ASA within the past 7 days TIMI RISK for NSTEMI ACS | 1 point |
| > 2 anginal events w/in last 24 hrs TIMI RISK for NSTEMI ACS | 1 point |
| St-segment deviation TIMI RISK for NSTEMI ACS | 1 point |
| Elevation of Biochemical markers TIMI RISK for NSTEMI ACS | 1 point |
| Non-STEMI High risk | 5-7 points |
| Non-STEMI medium risk | 3-4 points |
| Non-STEMI low risk | 0-2 points |
| STEMI mortality Risk 2% vs points | 0 points |
| STEMI mortality Risk 7% vs points | 7 points |
| STEMI mortality Risk 35% vs points | >8 points |
| EKG STEMI treatment-All | IV Line, O2, ASA, Plavix, SL NTG, IV NTG, BB, Statin, ACE if anterior, previous MI Heparin, PCI or fibrinlysis |
| STEMI or NSTEMI ASA dose acute | 162-325mg PO chew or 300mg PR(only STEMI) |
| Plavix dose acute | 300mg PO |
| IV NTG dose STEMI or NSTEMI | 5-10mcg/kg/min titrate up 5mcg/kg/min to max 200 mcg/Kg/min |
| Metoprolol dose acute | 5mg IV push over two minutes, 3 doses, then 50mg PO Q6-8hr |
| Statin dose | high dose Atorvostatin 80mg QD |
| ACE dose | lisinopril 2.5-5.0 then 10-200mg if anterior infarction, or previous MI |
| Aldosterone Antagonist | Use if LVEF<40%, HF, or DM within the first 24 hours |
| Aldalactone | 25-100 mg PO QD |
| Inspra | 25-50 mg PO QD |
| Heparin dose acute STEMI | 60U/kg bolus then 12U/Kg/Hr check aPTT 1.5-2.5 above normal (50-70) |
| enoxaparin STEMI | 30mg IV bolus then 1mg/kg/ SC |
| STEMI <12 hours Reprofusion therapy | PCI (stent) ,Abciximab,ASA, Heparin, Plavix |
| Abciximab dose STEMI (PCI) | 0.25mg/kg bolus 10-60min before PCI then 0.125mcg/kg/min for 12 hours |
| ASA dose acute STEMI (PCI) | 300-325mg 2-24 hours before procedure |
| Heparin dose STEMI (PCI) | 70-100U/Kg |
| Plavis dose acute STEMI (PCI) | 300-600mg PO at least 6 hours prior to PCI and/or IIb/IIIa inhibitor |
| ASA chronic dose | 75-162mg PO indefintely |
| Plavix chronic dose | 75 mg PO indefintely |
| Within 30 minutes of presenting to Hospital | Abciximab + plavix |
| STEMI Within 90 minutes of presenting to the hospital | PCI |
| STEMI >12 hours | Stress test, PCI, or CABG, or fibrinlysis |
| Primary PCI-STEMI | 90% of occluded infarct opened |
| Fibrinlysisis-STEMI | 60% occulded infarct opened |
| NSTEMI acute | IV line, O2, ASA, PLavix, SL, NTG, IV NTG, IV BB, Statin, UFH or enoxaparin |
| NSTEMI NO PCI | no further treatment |
| NSTEMI <12 hours PCI | ASA, Abiciximab, plavix |
| Bare metal stent | Can lead ro restenosis (scab) 1 month325mg ASA, , 75mg Paxil |
| Drug eluting stent | 3 month 325 mg ASA, 75 mg paxil |
| Brachytherapy | 6 months 325 mg ASA, 75 mg paxil |
| Canidates for fibrinolytic Therapy Contraindications: | Prior ICH, cerebral vascular lesions, malignant intracranial neoplasm, ischemic stroke w/in 3 months, severe facial trauma w/in 3 months, active bleed |
| Fibrinolysis Prefereed if | Early presentation (<3 hrs), invasive strategy not an option(Operater ,75 per y, or team ,36 per y), Delay to invasive strategy |
| Highest risk of bleed | Age, female, low body weight |
| ISIS-2 | value of ASA, 160mg acute (chew) |
| ISG | Alteplace (more stroke) and stroptokinase (more bleed) |
| ISIS-3 | Duteplace (more stroke) Heparin (more bleed) |
| Gusto | Flawed study, Combination Alteplace + strepotkinase (more stroke) |
| Gusto III | No different between Alteplace (tPA) and Recteplace (rPA) for stroke |
| Assent -2 | Tecnecteplace (TNK) fewer bleed, less specificity, more intracrainal and stroke |
| Gusto V | Retecplace (rPA) +abciximab +heparin had higher risk of bleeding complications |
| Asscent 3 | Tececteplace and enoxaparin increased benefit less reinfarct, refractory ischemia with combination product |
| EPIC | Abciximab 13% reduction at 3 years, overall 60% reduction in mortality |
| EPILOG | Abciximab +low dose weight heparin Decrease bleed |
| PRISM | Combo of Heparin, Tirofibran reduced death, But Tirofibran alone increased mortality |
| PURSUIT | Eptifibatide better than placebo |
| EPSIRIT | Eptifibatide + IIb/IIIa inhibitor reduced mortality 47% |
| Gusto IV | Abciximab infusion 24hr highest decrease in death or reinfaction |
Created by:
jhrobins99
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