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ER > 1) Cardio > Flashcards

1) Cardio Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Area of infarct/Artery if Changes in: II, III, AVF

A

Inferior Infarct/Right Coronary Artery

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2
Q

Area of infarct/Artery if Changes in: V1-V3

A

Anteroseptal Infarct/Left Anterior Descending

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3
Q

Area of infarct/Artery if Changes in: V2-V4

A

Anterior Infarct/Left Anterior Descending

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4
Q

Area of infarct/Artery if Changes in: I, AVL, V4, V5, V6

A

Lateral Infarct/ Left Circumflex Artery

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5
Q

Area of infarct/Artery if Changes in: V1, V2

A

Posterior/Right Posterior descending artery

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6
Q

Dx of AMI =

A

ST elevations of at least `1mm in 2 contiguous leads

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7
Q

Tx of chest pain =

A

Oxygen, Aspirin, Nitroglycerin unless systolic BP <90 and IV morphine if not relieved by 3 sublingual nitros

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8
Q

Tx of unstable angina, NSTEMI and STEMI should recieve

A
  • Beta-blockers IV (metoprolol, atenolol = selective beta1)
  • Heparin IV
  • Nitroglycerin IV drip (caution if inferior or posterior MI because may precipitate hypotension)
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9
Q

Goals for PCI

A

It is superior to primary thrombolysis

  • thrombolytics should begin w/in 30 minutes of arrival to arrival
  • if PCI is unavailable to patients within 60 minutes of arrival to ED then treatment should begin with thrombollytic agents such as tissue plasminogen activator and streptokinase
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10
Q

BNP levels

A

<100 in a patient w/ acute dyspnea makes the diagnosis of CHF unlikely

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11
Q

Tx of CHF

A

1) Oxygen (high flow/CPAP/intubation)
2) Nitroglycerin
3) loop diuretics (IV q 30 min, double dose each time if no response)
4) Morphine (IV q5-10min)
5) Pressors (dopamine IV if systolic 100 and in need of inotropic support)

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12
Q

What is a hypertensive emergency?

A

Elevated BP w/ signs of end organ damage (brain, heart, kidney, eyes)
-typically occurs when Diastolic is >115-130

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13
Q

Tx of hypertensive emergency

A

Don’t lower too quickly, want to lower by 25%
-diastolic to 100-115 over hours
(if you lower it too quickly = cerebral or coronary insufficiency)
-Nitroprusside is usually the drug of choice (contraindicated in pregnancy)
-Labetolol (alpha and beta effects)
Others:
-Phentolamine (excess catecholamine states/cocaine, MAOI) etc
-Hydralazine (for eclampsia)
-Nitroglycerine (for ischemia or CHF)

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14
Q

Stanford Classification for Aortic Dissection

A

A: Involves the ascending Aorta
B: involves the descending aorta

(TEE: can be performed quickly at the bedside, determines type and valvular involvement; Aortography = gold standard)

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15
Q

Tx of Aortic Dissection

A

IV fluids, blood transfusions
-if unstable = vascular surgery consult
-goal is to maintain systolic BP 100-120mmHg to limit progression of dissection in hypertensive pts
(nitroprusside and beta-blockers or alternatively = labetolol)

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16
Q

AAA dx

A

Ultrasound

-but to as sensitive in determining if it has ruptured, for this abdominal Ct is better

17
Q

Tx of AAA

A

If unstable = immediate surgery and fluid resuscitation

18
Q

Tx of Occlusive arterial disease

A

This is a true emergency

  • Emergency vascular surgery consult
  • IV heparin to prevent further clot extension/further emboli

Treatment of choice is thrombolectomy; alternative = intra-arterial thrombolysis: streptokinase, urokinase, tissue plasminogen activator

19
Q

Cardiac Tamponade signs=

A

(Beck’s Triad)

  • Muffled heart sounds
  • Jugular venous distention
  • Hypotension

-Pulsus Paradoxus (fall in SBP >10mmHg w/ inspiration) may be present w/ large pericardial infusion or tamponade

20
Q

Tx of Cardiac Tamponade

A

US guided pericardiocentesis

21
Q

Tx of Pericarditis

A
  • NSAIDS (if viral, idiopathic, rheumatologic, post traumatic)
  • IV abx & drainage (if bacterial)
22
Q

Most common cause of infective endocarditis

A

HIV and IV drug use now > rheumatic fever

23
Q

Roth spots =

A

small white spots on the retina surrounded by hemorrhage

infective endocarditis

24
Q

Osler nodes=

A

small tender lesions that form on the fat pads of the finger or toes and represent immune complex deposition
(infective endocarditis)

25
Q

Janeway lesions=

A

painless, reddish, macular lesions on the hands or feet

infective endocarditis

26
Q

Criteria for Dx of Infective Endocarditis

A

=Duke Criter
Major:
-Persistently + blood cultures
-Positive blood cultures for microorganism known to cause endocarditis
-Positive echogram for endocarditis
-New heart Murmur
Minor:
-Predisposing condition (IVD use, heart valve ban)
-Fever >38.0 on 2 occasions
-Vascular phenomena: stroke, janeway lesions, splinter hemorrhages, myocotic aneurysms, major arterial emboli
-Immunologic phenomena: roth spots, osier nodes, +RF, glomerulonephritis

27
Q

Microorganims known to cause endocarditis

A
  • strep viridians
  • strep bovis
  • HACEK group: haemophilus, actinobacillus, cardiobacterium, eikenella, kingella)
  • s. aureus or enterococci
28
Q

Tx of Infective endocarditis

A

Stabilize hemodynamic status & empiric abx
-Nafcillin and genatmicin = 1st line
(further tx depends on culture results and should go on for at least 4 weeks)

29
Q

What are the steps to reading an EKG

A

1) Rate
2) Rhythm
3) Axis
4) Hypertrophy/Morphology
5) Ischemia/Infarction

30
Q

How to determine rate?

A

If regular rhythm = 300, 150, 100, 75,60,50

If irregular = Count QRS per 6 sec (30big boxes) x 10

31
Q

How to determine axis?

A

Lead I if positive = right side of graph
Lead AVF if positive = bottom of graph
(or find isoelectric lead and know that axis is perpendicular to this)

32
Q

What are the designations of axis?

A

Normal = -30 to 90
RAD = 90 to 180
marked RAD = 180 to -90
LAD = -90 to -30

33
Q

R Atrial Hypertrophy =

A

Biphasic P wave with front part more positive than the second part is negative
(also has peaked p-waves in lead 2 (>2.5mm))

34
Q

L Atrial hypertrophy =

A

Biphasic p wave w/ front part less positive than the second part is negative
(also P wave is notched)

35
Q

R ventricular hypertrophy

A

Large R wave in V1

progressively smaller v1-v4

36
Q

L ventricular hypertrophy

A

Large S wave in V1
and
Large R in V5
If the sum of S in V1 or V2 + large R in V5 or V6 is >35

ER (11 decks)

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