Initial Assessment
What is the first step when a patient comes in with chest pain?
Obtain a 12-lead ECG
Why do you give aspirin as an initial intervention?
To prevent further thrombus
Which arteries can you obtain access?
Femoral or radial artery
MONA is appropriate in what setting?
First responders (Basic Life Support)
What will unstable angina show vs NSTEMI?
BOTH will show ST depression and/or T wave inversion
What is a test that you would do after completing and ECG and have suspicion of an ACS?
Cardiac Biomarkers/enzymes: troponin and CK-MB
What is an alternative procedure from a PCI?
Fibrinolysis- Ex: tPA clot busting agent
What is the main long term management?
lifestyle change
What will a STEMI show?
ST elevation
What is the mechanism of nitroglycerin and why do you give it?
Nitroglycerin is a vasodilator and you give this to decrease oxygen demand on heart by allowing more blood flow
Briefly describe the process of PCI
A balloon angioplasty catheter is positioned into the stenosis over a guidewire under fluoroscopic guidance.
The balloon is inflated, temporarily occluding the vessel.
The lumen is enlarged primarily by stretching the vessel.
A stent mounted on a deflated balloon is placed into the lesion and pressed against the vessel wall with balloon inflation. The balloon is deflated and removed, leaving the stent permanently against the wall acting as a scaffold to hold the dissections against the wall and prevent vessel recoil.
What is the acute management of a STEMI?
aspirin
heparin
clopidogrel
high intestity statin
NG
beta blocker
How often do you do an ECG if first ECG is nondiagnostic?
Every 10-15 minutes
Why give a statin in patients before a PCI?
reduces periprocedural myocardial infarction in patients with stable angina and prevents myocardial damage in patients with acute coronary syndromes
A 60-year-old man is brought to the emergency department because of crushing substernal chest pain for the past 45 minutes. He received 325 mg of aspirin en route. Nitroglycerin does not relieve his pain. He has a history of diabetes and hypertension. Medications include carvedilol and sildenafil. His temperature is 36.8°C (98°F), pulse is 99/min, respirations are 18/min, and blood pressure is 192/88 mm Hg. He appears diaphoretic. ECG shows ST-segment elevation in leads V1, V2, and V3. Which of the following is the most appropriate next step in management?
PCI
Why would you not give NG?
When you are hypotensive and have bradycardia