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Medicine (MD/DO)
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Ischemic Heart Disorders

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Pathology | Medicine (MD/DO) School Study Aid

Ischemic Heart Disorders
17 Picmonics to Learn | 30 mins
Stable Angina
Assessment
Chest Pain with Exertion
Relieved within 15 Minutes
ST Depression
Interventions
Nitroglycerin
Up to 3 Doses q 5 Minutes
Rest
Antiplatelet Medication
CABG
Angioplasty
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2 mins
Unstable Angina
Assessment
Chest Pain with Rest or Exertion
Limits ADLs
> 15 Minutes
Less Likely Relieved by Nitroglycerin
ST Depression
Fatigue
Considerations
Acute Coronary Syndrome (ACS) Treatment
Emergency Treatment
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2 mins
Myocardial Infarction Assessment
Assessment
Substernal Chest Pain
Crushing or Dull Sensation
Arm, Jaw, and Neck
> 20 Minutes
Unrelieved by Nitro
Palpitations
Diaphoresis
Fear of Impending Doom
Nausea and Vomiting
Shortness of Breath
Considerations
Monitor for Arrhythmias
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2 mins
Myocardial Infarction Diagnosis
Diagnosis
12 Lead ECG
ST Elevation
Q Wave
T Wave Inversion
Troponin T and I
CK-MB
Considerations
Early ECG
Cardiac Stress Test
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2 mins
Myocardial Infarction Interventions
MONA
Morphine
Oxygen
Nitrates
Aspirin
Thrombolytics (tPA)
Invasive Procedures
Cardiac Catheterization
Stent Placement
Angioplasty
Coronary Artery Bypass Grafting (CABG)
Considerations
Decrease Modifiable Risk Factors
Resuming Activity (Physical, Sexual)
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2 mins
Cardiac Catheterization
Considerations
Fluttering Sensation
Contrast Media
NPO 6-12 Hours
After Procedure
Bed Rest
Assess Circulation
Assess for Bleeding
Monitor Vital Signs
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2 mins
Cardiac Enzyme Evaluation: Troponin
Measures
Cardiac Muscle Injury
Time Ranges
Detection in Blood: 4 Hours
Peak: 24 - 36 Hours
Return to Normal: 5 - 14 Days
Considerations
Most Specific for Cardiac Muscle
Treat Aggressively
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2 mins
Cardiac Enzyme Evaluation: Creatine Kinase CK-MB
Measures
Skeletal or Cardiac Muscle Injury
Time Ranges
Onset: 4-8 Hours
Peak: 12-24 Hours
Return to Normal: 2-3 Days
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1 min
Cardiac Enzyme Evaluation: Myoglobin
Measures
Skeletal or Cardiac Muscle Injury
Time Ranges
Onset: 1 - 4 Hours
Peak: 12 Hours
Return to Normal: 24 Hours
Considerations
Elevation After 24 Hours: Reinfarction
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2 mins
TIMI Score (Thrombolysis In Myocardial Infarction)
Use
Mortality Predictor
Unstable Angina or NSTEMI
2 Week Risk of Death and Ischemic Events
AMERICA (Each is +1)
Age Greater or Equal to 65
Markers Elevated
EKG ST Changes (Greater or Equal to 0.5mm)
Risk Factors for CAD (Coronary Artery Disease)
Ischemia (2 Anginal Events in 24 Hours)
Coronary Artery Disease (CAD)
Aspirin Use in the Last 7 Days
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3 mins
Evolution of Myocardial Infarction and Complications
Hours to Days
Arrhythmia
Before 7 Days
Fibrinous Pericarditis
Papillary Muscle Rupture
Interventricular Septum Rupture
Before 14 Days
Ventricular Pseudoaneurysm
Ventricular Free Wall Rupture
After 14 Days
True Ventricular Aneurysm
Dressler Syndrome
Other
Left Ventricular Failure
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2 mins
12 Lead Contiguous Leads - Anterior Wall MI
Leads Elevated
Lead V3
Lead V4
Artery Affected
Left Anterior Descending (LAD)
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56 secs
12 Lead Contiguous Leads - Septal Wall MI
Elevated Leads
Lead V1
Lead V2
Artery Affected
Left Anterior Descending (LAD)
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48 secs
12 Lead Contiguous Leads - Inferior Wall MI
Leads Elevated
Lead II
Lead III
Lead aVF
Artery Affected
Right Coronary Artery (RCA)
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56 secs
12 Lead Contiguous Leads - Lateral Wall MI
Leads Elevated
Lead I
Lead aVL
Lead V5
Lead V6
Artery Affected
Circumflex
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1 min
Brugada Syndrome
Defective Myocardial Sodium Channels
Predominance in Asian Males
Autosomal Dominant
Pseudo-Right Bundle Branch Block Pattern
Persistent ST Elevations in Leads V1-V2
Risk of VTACH and Sudden Cardiac Death
Syncope
Management
ICD
Antiarrhythmics
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3 mins
Ischemia and Vulnerable Tissues
Brain
MCA-ACA and MCA-PCA Interface
Heart
Subendocardium of Left Ventricle
Kidney
Proximal Tubule
Thick Ascending Limbs of the Loop of Henle
Liver
Central Vein
Colon
Splenic Flexure
Rectosigmoid Junction
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2 mins

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