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What is high sensitivity troponin and when to use? - 🧠 ANSWER ✔✔first
line test for cardiac cell damage
used for initial injury
What is CKMB - 🧠 ANSWER ✔✔CK isoenzyme specific to cardiac muscle
tissue (MI)
When should CKMB be used? - 🧠 ANSWER ✔✔for suspicion of secondary
ischemia after an initial infarct
normal level for Troponin I - 🧠 ANSWER ✔✔<0.04
,normal level for CKMB - 🧠 ANSWER ✔✔3-5% of total CK
What is BNP - 🧠 ANSWER ✔✔B-type natriuretic peptide
Normal BNP levels - 🧠 ANSWER ✔✔<100 pg/mL
Differential for chest pain - 🧠 ANSWER ✔✔Consider:
Myocardium- angina, MI, myocarditis, heart failure
Pericardium- pericarditis
Aorta- dissecting aortic aneurysm
Trachea and bronchi- bronchitis
Parietal pleura- pericarditis, pneumonia, pneumothorax, pleural effusion,
pulmonary embolus
Chest wall- costochondritis, herpes zoster
Esophagus- reflux, esophageal spasm, esophageal tear
Referred pain from elsewhere- cervical arthritis, biliary colic, gastritis
Psych: anxiety attacks
Revascularization in under ____ minutes - 🧠 ANSWER ✔✔90
Initial diagnostics for chest pain - 🧠 ANSWER ✔✔12-lead EKG
,Troponin q3h x3 at least
BNP - HF
CBC - baseline H&H and Plts
PTT, PT/INR - baseline coagulation status
BMP - renal function and lytes
TSH, Mg, and Phos
ECHO
Cath
Requirements for STEMI dx - 🧠 ANSWER ✔✔new ST elevation in 2
contiguous leads of >0.1 mV except V2&V3
elevated troponin
STEMI findings in V2-V3 - 🧠 ANSWER ✔✔>0.2mV in >40yo M
>0.25 mV in <40 yo M
>0.15 mV in women
Difference between NSTEMI and unstable angina - 🧠 ANSWER
✔✔NSTEMI involves Elevated Cardiac Bio markers (cell death)
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, NSTEMI & unstable angina tx - 🧠 ANSWER ✔✔Dual antiplatelet therapy
Full-dose AC
High-intensity statin
BB
Nitrates
oxygen
pain medication
Dual antiplatelet therapy - 🧠 ANSWER ✔✔DAPT
Aspirin (325 x1 = daily 81mg)
AND
P2Y2 inhibitor
clopidogrel or ticagrelor
full dose AC - 🧠 ANSWER ✔✔SQ lovenox 1mg/kg BID
if PCI planned of low GFR use heparin gtt
50-70 units/kg bolus plus 12units/kg/hr titrated to PTT 1.5-2.5 x baseline