040815 chest pain Flashcards
pathogenesis of aneurysms
inadequate collagen
excessive connec tissue degrad
loss of sm musc cells (thickening of intima in atherosclerosis, systemic HTN)
common cause of abdominal aorta aneurysm
atherosclerosis
common cause of ascending aorta aneurysm
HTN
causes of aortic dissection
HTN (media-loss of sm musc cells)
connec tissue abnormality
signs of aortic dissec
sharp pain, can radiate to back
uneven pulses
widened mediastinum
STEMI
ST segment elevation in two or more contiguous leads
NSTEMI
EKG may be normal
ST depression
T wave inversion
pericarditis EKG
ST elevation in all leads
how to be more sure it’s a STEMI if you see ST elevation in leads
look for ST depression in opposite leads
lateral wall MI, ST depression can be seen reciprocally in?
II, III, avF (inferior leads)
anterior wall MI (V1-V4) can have reciprocal ST depression where
inferior leads
initial management when suspecting MI
O2
IV access
pads (in case need to shock)
consider meds: aspirin, nitroglycerin, beta blockers, morphine, heparin, clopidogrel
thicker fibrous cap in plaque is more stable or vulnerable plaque?
stable
troponins are more specific and sensitive than CK-MB for MI: true or false
true
troponins can be elevated how long post-MI
10 days
when does troponin begin to rise after MI?
2-3 hrs after
pt presents w chest pain-what tests do you want to get?
EKG
labs
CXR
pt presents w chest pain-what do you want to do before giving heparin?
look at CXR because want to rule out aortic dissec
chest pain in hypotensive pt-differential?
- acute MI
- PE
- percardial tamponade
- tension pneumothorax
- Boerhave’s (esophageal rupture)
- aortic dissection w/ involvement of coronary arteries or pericardium
- pneumonia w sepsis
acute inferior myocardial infarction can have what complication
conduction abnormalities secondary to ischemia of AV node (can get complete heart block)
can give atropine, but be prepared for transcutnaeous pacing
what do you NOT give to pts w RV infarction
nitroglycerin
type A aortic aneurysm-what meds do you start?
beta blocker-esmolol
then if BP still over 110, add second agent: vasodilator-nitroprusside, nicardipine, nitroglycerine
needs surgery (whereas type B-maybe just meds)
