1
What is a printzmetal angina
no blockage but the coranaries are spasming and closing shut
what medication is used to induce stress when unable to perform on a treadmill
dobutamine
if my patient has chest pain unrelieved with nitrogylcerin and the ECG shows T wave inverted and/or ST dperession, and enzymes are positive what is this indicative of
NSTEMI
Additional**
Type One NSTEMI = plaque rupture
Type Two NSTEMI = no blockage, O2 supply/demand problem --> Anemia, GI bleed
what do we do to the body's temperature during a CABG
we cause hypothermia to cool the body which cools the heart to reduce oxygen demand
what medication may increase BNP in lab draw when first starting
ARNI - entresto (valsartan/sacubitril)
what happens with blood pressure in ACS
initially elevated BP due to the heart trying to compensate, then the BP drops due to a decrease in cardiac output
what does a positive ischemic change indicate during a stress test
area of heart during stress is not getting oxygen
what medication prevents ventricular remodeling and HF
decreased mortality
ACE-I
what do patients always have after chest surgery
atelectasis rt lungs not being inflated during the procedure
pulmonary rehab is extremely important to prevent pneumonia
ST depression and T wave inversion =
ST elevation =
Q wave =
ischemia
injury
infarction
what does a left heart cath determine vs a right heart cath
left heart cath determines location and severity of blockages - arterial puncture (wrist or groin)
right heart cath measures pressures in right side of heart and lungs - venous puncture (groin)
LAD - what is it
widow maker
most often have blockages here
supplies anterior 2/3 of septum, anterior and apical L ventricle
what are some complications of CABG
dysrhythmias - afib
cardiac tamponade (Beck's Triad and pulsus paradoxus)
pneumothorax (get chest tube)
stroke
ileus
how often are cardiac markers repeated after an MI
every 6-8hours over 24 hours
what test measures ejection fraction
ventriculogram
What is a PCI
it is used to open up vessels in the cath lab
angioplasty is done by using a balloon inflation of the artery, then vacuum extraction of thrombus, then removal of plaque, then a stent is placed
what is the timeframe to get a patient to PCI with a STEMI
90 minutes
when does troponin elevate, when does it peak and when does it return to baseline
2-4 hour elevates
10-12 hours peak
within 10 days return to baseline
what is an important thing to remember about CT angiograms
has to be timed exactly with respiratory cycle
requires just as much dye as a cardiac cath - not a great replacement
what is the post PCI care
neuro checks rt CVA risk
hemorrhage bleeding risk
distal circulation
watch for pseudoaneurysm - blood leaks from injured artery and collects in surrounding tissue, forming a pulsaitle lump
monitor for restenosis
bedrest for 4-8 hours with leg straight and HOB flat
pressure bands if radial site was used, no mobility restrictions
nitrates and DAPT is used after
a patient has acute and sharp chest pain worse on inspiration, relieved by leaning forward, we hear friction rub over the lungs, they also present with tachycardia, high WBC and sed rate, mild fever
ECG shows mild ST elevation in all leads
what is the patient presenting with
**Extra - pericarditis can cause cardiac tamponade (muffled heart sounds, hypotension, and JVD)
** we would do a pericardiocentesis, tylenol, NSAIDs, steroids