cardiac exam 2
myocardial infarction ANS: lack of O2 to heart muscle causing death to the heart muscle
acute coronary syndrome (ACS) ANS: develops when ischemia is prolonged and not immediately
reversible.
ACS is the umbrella term for what conditions? ANS: unstable angina, NSTEMI, STEMI
what diagnostics do you do right away if you suspect ACS? ANS: 12 ECG, cardiac biomarkers
Which biomarkers are drawn? ANS: troponin, and CK-MB
What leads are for lateral? ANS: 1, AVL, V5, V6
What leads are for inferior? ANS: 2, 3, AVF
what leads are for septal? ANS: V1,V2
what leads are for anterior? ANS: V3, V4
what artery is for the lateral leads? ANS: circumflex
what artery is for the inferior lead? ANS: right coronary artery
what artery is for the septal leads? ANS: LAD
,what artery is for the anterior leads? ANS: Left coronary artery
which leads will show changes if the whole anterior wall is blown out? ANS: All the V leads
which stemi is the worst? ANS: anterior because it destroys the whole myocardium thickness; anterior
is the biggest part of the left ventricle
which stemi is the best if you get to choose? ANS: inferior wall nstemi; because inferior wall is small
and not as much muscle damage
stemi ANS: entire thickness is necrosed, cardiac enzymes are elevated, pathologic Q wave develops
why would cardiac biomarkers be elevated? ANS: because when heart muscle is damaged, enzymes are
released into the blood
on an ecg for stemi what is shown? ANS: st elevation
on an ecg for nstemi what is shown? ANS: st depression and T wave inversion
what do you do first with a stemi? ANS: open artery right away; emergent reperfusion therapy
what do you do first in unstable angine or nstemi? ANS: meds first, maybe angiogram
anterior MI characteristics ANS: -LAD is blocked
-Changes in V2-V4
-Ventricular dysrhythmias
-Pulmonary edema, cardiogenic shock
,inferior MI characteristics ANS: -RCA blocked
-changes in 2,3, aVF leads
-right sided heart failure
lateral MI characteristics ANS: -LAD or circumflex artery blocked
-1, avl, V5, V6 lead changes
septal MI characteristics ANS: -LAD blocked
-V1, V2 lead changes
posterior MI characteristics ANS: -circumflex blocked
-no lead changes because the leads are not on the back
what is the gold standard cardiac biomarker? ANS: troponin
what is the most common complication of MI? ANS: dysrhythmias
what is the first cardiac biomarker? ANS: myoglobin- within two hours
what biomarker last the longest in blood? ANS: troponin- 4-6 hours after MI they start to rise, peak at
10-24 hours, return to baseline 10-14 days
what are the cardiac biomarkers ANS: troponin, CK-MB, myoglobin
what do you do with the first sign of chest pain? ANS: call 911
, what management do you do for all ACS patients? ANS: 12 lead ECG, and continuous cardiac
monitoring, O2,
nitro, morphine, aspirin, beta blockers, ACE inhibitors or ARBs, high dose statins
what management for unstable/nstemi? ANS: NTG, antiplatelet, anticoagulation, cardiac
catheterization, possible PCI, possible CABG
what is the management for stemi? ANS: emergent reperfusion (PCI, CABG,
thrombolytics),anticoagulation and antiplatelets
what are thrombolytics? (alteplase and reteplase) ANS: they dissolve and get rid of clots
what do anticoagulants do? ANS: they thin the blood and do not let exsisting clots get bigger, they do
not get rid of clots
what are the three main emergent reperfusion therapies for a STEMI? ANS: PCI, CABG, Thrombolytics
what should you do before starting thrombolytics? ANS: start at least two preferably three IV site, do
anything invasive before starting to decrease risk of bleeding.
How long does the pain usually last for a pt with chronic stable angina? ANS: Only a few minutes
How long does the pain last for a pt with unstable angina? ANS: 10 minutes or more
If you run cardiac biomarker labs on a pt with chronic stable angina, what are the results going to look
like? ANS: WNL - there is no significant to myocardial muscle yet
myocardial infarction ANS: lack of O2 to heart muscle causing death to the heart muscle
acute coronary syndrome (ACS) ANS: develops when ischemia is prolonged and not immediately
reversible.
ACS is the umbrella term for what conditions? ANS: unstable angina, NSTEMI, STEMI
what diagnostics do you do right away if you suspect ACS? ANS: 12 ECG, cardiac biomarkers
Which biomarkers are drawn? ANS: troponin, and CK-MB
What leads are for lateral? ANS: 1, AVL, V5, V6
What leads are for inferior? ANS: 2, 3, AVF
what leads are for septal? ANS: V1,V2
what leads are for anterior? ANS: V3, V4
what artery is for the lateral leads? ANS: circumflex
what artery is for the inferior lead? ANS: right coronary artery
what artery is for the septal leads? ANS: LAD
,what artery is for the anterior leads? ANS: Left coronary artery
which leads will show changes if the whole anterior wall is blown out? ANS: All the V leads
which stemi is the worst? ANS: anterior because it destroys the whole myocardium thickness; anterior
is the biggest part of the left ventricle
which stemi is the best if you get to choose? ANS: inferior wall nstemi; because inferior wall is small
and not as much muscle damage
stemi ANS: entire thickness is necrosed, cardiac enzymes are elevated, pathologic Q wave develops
why would cardiac biomarkers be elevated? ANS: because when heart muscle is damaged, enzymes are
released into the blood
on an ecg for stemi what is shown? ANS: st elevation
on an ecg for nstemi what is shown? ANS: st depression and T wave inversion
what do you do first with a stemi? ANS: open artery right away; emergent reperfusion therapy
what do you do first in unstable angine or nstemi? ANS: meds first, maybe angiogram
anterior MI characteristics ANS: -LAD is blocked
-Changes in V2-V4
-Ventricular dysrhythmias
-Pulmonary edema, cardiogenic shock
,inferior MI characteristics ANS: -RCA blocked
-changes in 2,3, aVF leads
-right sided heart failure
lateral MI characteristics ANS: -LAD or circumflex artery blocked
-1, avl, V5, V6 lead changes
septal MI characteristics ANS: -LAD blocked
-V1, V2 lead changes
posterior MI characteristics ANS: -circumflex blocked
-no lead changes because the leads are not on the back
what is the gold standard cardiac biomarker? ANS: troponin
what is the most common complication of MI? ANS: dysrhythmias
what is the first cardiac biomarker? ANS: myoglobin- within two hours
what biomarker last the longest in blood? ANS: troponin- 4-6 hours after MI they start to rise, peak at
10-24 hours, return to baseline 10-14 days
what are the cardiac biomarkers ANS: troponin, CK-MB, myoglobin
what do you do with the first sign of chest pain? ANS: call 911
, what management do you do for all ACS patients? ANS: 12 lead ECG, and continuous cardiac
monitoring, O2,
nitro, morphine, aspirin, beta blockers, ACE inhibitors or ARBs, high dose statins
what management for unstable/nstemi? ANS: NTG, antiplatelet, anticoagulation, cardiac
catheterization, possible PCI, possible CABG
what is the management for stemi? ANS: emergent reperfusion (PCI, CABG,
thrombolytics),anticoagulation and antiplatelets
what are thrombolytics? (alteplase and reteplase) ANS: they dissolve and get rid of clots
what do anticoagulants do? ANS: they thin the blood and do not let exsisting clots get bigger, they do
not get rid of clots
what are the three main emergent reperfusion therapies for a STEMI? ANS: PCI, CABG, Thrombolytics
what should you do before starting thrombolytics? ANS: start at least two preferably three IV site, do
anything invasive before starting to decrease risk of bleeding.
How long does the pain usually last for a pt with chronic stable angina? ANS: Only a few minutes
How long does the pain last for a pt with unstable angina? ANS: 10 minutes or more
If you run cardiac biomarker labs on a pt with chronic stable angina, what are the results going to look
like? ANS: WNL - there is no significant to myocardial muscle yet
