Clinical Presentation
What are:
-MI, GERD, angina, Pneumothorax, Pleuritic chest pain, Costochondritis, Pneumonia, PE.
One of the first things you should obtain on a patient complaining of chest pain is:
What is: EKG?
This OTC medication should be taken as soon as a patient thinks they may be having an MI.
ST segment elevations in leads V2-V6 represent an MI to which region?
Anterior MI.
These medications are used to decrease cholesterol and reduce the impact of atherosclerosis in the coronary arteries.
Bonus: What is the mechanism of action?
-Statins
-HMG co-reductase inhibitors.
Other symptoms that often accompany chest pain include:
What are:
-SOB, Left arm pain, Jaw pain, Pain that radiates to the back, nausea/vomiting, diaphoresis.
This enzyme is found to be elevated in the setting of an MI for approximately 1-2 days:
What is CK-MB I/II?
This medication is a vasodilator used to relieve symptoms of angina.
What is Nitroglycerin?
ST segment elevations in leads II, III and aVF represent an MI to which region?
Inferior MI.
Moderate-intensity statins have been shown to reduce LDL by ___ % to ___%.
Bonus- moderate-intensity statins include ____
-30% to 50%
-Pravastatin (40-80mg)
-Simvastatin (20-40mg)
-Lovastatin (40mg)
-Atorvastatin (10-20mg)
The 3 characteristics of typical chest pain include:
-Substernal pain/pressure
-Exacerbated by exertion/stress
-Relieved by nitroglycerin
This enzyme is found to be elevated in the setting of MI for approximately 1-2 weeks:
This class of medications can help control heart rate and aid in prevention of cardiac remodeling after an MI.
What are beta-blockers?
ST segment depressions in V1-V4 represent an MI to which region?
Posterior MI.
High intensity statins reduce LDL by >___% and include medications like ___.
-50%
-Atorvastatin 40-80mg
-Rosuvastatin 20-40mg
Risk factors/Co-morbidities that predispose someone to having chest pain/discomfort include:
-DM, HLD, HTN, Tobacco/nicotine use, obesity, GERD, PUD, Hypercoagulable states.
This enzyme is the earliest (1-4 hours after onset of pain) to become elevated in the setting of an MI and is found in the urine:
What is: Myoglobin. (Non-specific marker)
Morphine, Nitrates and diuretics are absolutely contraindicated in which specific type of MI? Why?
-These patients are preload-dependent and all of these agents will reduce preload.
ST segment elevations in leads I and aVL represent an MI in which region?
-Lateral MI
Patients who receive cardiac stents are typically put on a treatment regimen called _____ (3 words). This regimen typically includes medications like ____.
Dual anti-platelet therapy.
Plavix, Xarelto, Elliquis + ASA.
Some differences in the way men and women may present with chest pain include:
Studies have shown that women tend to report more pain in the back, stomach, neck or chin; whereas men will typically report more pain in the chest or left arm.
What is the minimum value of IUHP high sensitivity troponin that requires admission and Cardiology consult?
>100 or change of >5 in 1 hr
A procedure where an interventional cardiologist opens a coronary artery with a balloon and/or places a stent to restore perfusion.
Bonus: How soon after patient arrival should this be performed for best outcomes?
What is PCI?
Bonus: 90 minutes
ST segment elevations in leads V5 and V6 represent an MI to which region?
-An apical MI
Which classes of drugs have been shown to decrease both morbidity and mortality after an MI?
-B-Blockers
-ACEi/ARB
*Spironolactone for individuals post-MI with EF < 40%.