CMC Certification - Section #1 (ACS, Cardiac Dysrhythmias, and Therapeutic Hypothermia) Latest

CMC Certification - Section #1 (ACS, Cardiac Dysrhythmias, and Therapeutic Hypothermia) What is included in Acute Coronary Syndrome (ACS)? - 1. Unstable Angina 2. NSTEMI 3. STEMI What is unstable angina? - Angina that occurs with diminished exercise (more resting state) - Myocardial oxygen demand supply **Partial occlusion by thrombi** - MI is total occlusion by thrombi! What are the 2 types of unstable angina? - 1. Unstable 2. Prinzmetal's Prizmetal's Angina is also known as? - Variant, Vasospastic, or Atypical Angina What is the pathophysiology of Prinzmetal's angina and when does this usually occur? - Influx of calcium ions into cell leading to vasospasm of the coronary artery **Not exercise induced** Usually happens in early AM and pt. are usually awaken from sleep Prinzmetal's Angina is often seen in which population? - Younger men (More in Japanese than Caucasion) Most important risk factor for Prinzmetal's Angina? - Cigarette Smoking Symptoms of Prinzmetal's Angina? How long do they last? Received by nitro? - Sub-sternal chest pain similar to MI that may radiate 5-30 minutes Yes! Relieved by nitro! EKG characteristics of Prinzmetal's Angina? - ST segment elevation over indicative leads only during angina Are cardiac enzymes elevated in Prinzmetal's Angina? - No! How is Prinzmetal's diagnosed? - 1. Coronary Angiography with provacative agent like ergonovine or methylergonovine (Produces coronary artery vasospasm) 2. 12-Lead EKG with and without angina Tx of Prinzmetal's angina? - 1. Nitrates - Activate nitric oxide in vessels and dilate coronary artery! 2. CCB - Most common are nifedipine (Procardia) and nicardopine (Cardene) - Prevent calcium influx! 4 most common risk factor for ACS? **All these cause development of atherosclerosis** - 1. Cigarette Smoking 2. HTN 3. Hyperlipidemia 4. Obesity **Other risk factors include sedimentary lifestyle, stress, diabetes, low serum folate (high serum homocysteine), and cocaine use! How does cocaine affect body? - 1. HTN 2. Coagulopathy - Platelets tend to clump more! Symptoms of Unstable Angina? - Same as vasospastic Symptoms of Angina in Woman? - N/V, GI upset, Radiate to jaw, low back pain, Fatigue, weakness EKG changes for unstable angina? - ST segment depression and T wave inversion during episode of pain - SIGN OF ISCHEMIA! Are cardiac enzymes elevated in Unstable Angina? - Yes (But not as much as NSTEMI or STEMI) Troponin 0.6 (0.8 is NSTEMI/STEMI level) CK-MB - 0-3 What does an echocardiogram determine? - 1. Ejection Fraction