Chest pains

STEMI vs. NSTEMI vs. Unstable Angina

PQRST

NSTEMI not full thickness

Broken Heart Syndrome

*Nitrates given up to 3 times every 15 minutes

Angina

Unstable Angina some sort of severity; but no cardiac

markers.

Printzmetals Variant Angina (vasospasm)

o Supply Angina
Chronic Stable Angina (fixed stenosis)
o Demand Ischemia
Unstable Angina (thrombus)
o Supply Ischemia

Cardiac Markers
Troponin
CK
o CK-MB

Ischemia, Injury, Infarction Waveforms

Angioplasty

Typical progression of MI

CABG (Coronary Artery Bypass Graft)

1. Insufficient oxygen flow (Ischemia), high degree that

the heart already felt it.
2. Because of decreased oxygen, the heart becomes
injured. There is breakdown and release of different
cardiac markers
3. Irreversible damage to the heart; pathologic u wave is
an indicator of lifetime myocardial infarct?

Etiology

Preload
Heart Heart Rate, Contractility
Afterload
Oxygenation

Pharmacologic Management

O2
Nitrates
Aspirin
Morphine

CASE STUDY:
Miss maya Valdez complains of easy fatigability. The
housemaid Maya, goes to hopsital to visit the boss. You
realize that Maya has fever 3 months ago. Then when you
assess, you realize that it is cardiac, there is murmur. Why do
you think this patient,... do you think... where did she incur
that case... infection... from? The usual cause is that they

oinly have tonsilitis or pharyngitis, based on streptococcus

and then the heart got infused, they attacked. So when you
assess, you realize murmur, so later Ill ask which position.
The murmur of Mitral Valve Prolapse
(Between left atrium and left ventricle.)

Tachycardia, Restlessness, Confusion, Orthopnea, Exertional

Dyspnea, Fatigue, Cyanosis
COR PULMONALE (RIGHT SIDED HEART FAILURE)
Right heart failure if systemic.
The returning of blood, there is difficulty in that.

Hows the flow? Because if you dont know the flow, you
cant answer the valve.

So how can it accept more fluid if it cant function.

Insufficiency vs. Stenosis

You could auscultate more fluid and stuff, ascites, edema and
many more.

Insufficieny The valve does not fully close

Stenosis THe valve does not fully open

In most cases, they would progress into both side.

Maraming nangyayari sa right.

Management:
Damaged valve is removed.
Mechanical or tissue valve is placed.

Treating Congestive HF: Pnemonics

STUDY MORE.

UNLOAD FAST

Structure

Upright position, Nitrates, Lasix, Oxygen, Aminophylline,

Digoxin

Flow stenotic, regurgitating, prolapse

Pressure normal pressure, MAP

Fluids, (Decrease), Afterload (Decrease), Sodium restriction,

Test (Dig level, ABGs, ___)

MANANG FE LOURDES
Heart Failure

Don Robert Tensive complains of Headache

Swollen Feet Right HF

Hypertensive Crisis:

Cyanotic Pwedeng Both

LEFT SIDED HEART FAILURE

Systolic 180
Diastolic 120