040815 chest pain

Question 1

pathogenesis of aneurysms

Answer 1

inadequate collagen
excessive connec tissue degrad
loss of sm musc cells (thickening of intima in atherosclerosis, systemic HTN)

Question 2

common cause of abdominal aorta aneurysm

Answer 2

atherosclerosis

Question 3

common cause of ascending aorta aneurysm

Answer 3

HTN

Question 4

causes of aortic dissection

Answer 4

HTN (media-loss of sm musc cells)

connec tissue abnormality

Question 5

signs of aortic dissec

Answer 5

sharp pain, can radiate to back
uneven pulses
widened mediastinum

Question 6

STEMI

Answer 6

ST segment elevation in two or more contiguous leads

Question 7

NSTEMI

Answer 7

EKG may be normal
ST depression
T wave inversion

Question 8

pericarditis EKG

Answer 8

ST elevation in all leads

Question 9

how to be more sure it’s a STEMI if you see ST elevation in leads

Answer 9

look for ST depression in opposite leads

Question 10

lateral wall MI, ST depression can be seen reciprocally in?

Answer 10

II, III, avF (inferior leads)

Question 11

anterior wall MI (V1-V4) can have reciprocal ST depression where

Answer 11

inferior leads

Question 12

initial management when suspecting MI

Answer 12

O2
IV access
pads (in case need to shock)

consider meds: aspirin, nitroglycerin, beta blockers, morphine, heparin, clopidogrel

Question 13

thicker fibrous cap in plaque is more stable or vulnerable plaque?

Answer 13

stable

Question 14

troponins are more specific and sensitive than CK-MB for MI: true or false

Answer 14

true

Question 15

troponins can be elevated how long post-MI

Answer 15

10 days

Question 16

when does troponin begin to rise after MI?

Answer 16

2-3 hrs after

Question 17

pt presents w chest pain-what tests do you want to get?

Answer 17

EKG
labs
CXR

Question 18

pt presents w chest pain-what do you want to do before giving heparin?

Answer 18

look at CXR because want to rule out aortic dissec

Question 19

chest pain in hypotensive pt-differential?

Answer 19

• acute MI
• PE
• percardial tamponade
• tension pneumothorax
• Boerhave’s (esophageal rupture)
• aortic dissection w/ involvement of coronary arteries or pericardium
• pneumonia w sepsis

Question 20

acute inferior myocardial infarction can have what complication

Answer 20

conduction abnormalities secondary to ischemia of AV node (can get complete heart block)

can give atropine, but be prepared for transcutnaeous pacing

Question 21

what do you NOT give to pts w RV infarction

Answer 21

nitroglycerin

Question 22

type A aortic aneurysm-what meds do you start?

Answer 22

beta blocker-esmolol
then if BP still over 110, add second agent: vasodilator-nitroprusside, nicardipine, nitroglycerine

needs surgery (whereas type B-maybe just meds)