Acute Cardiac Diseases

Question 1

CK-MB

Answer 1

cardiac specific
but may not rise for up to 4 hours after onset
test for myocardial injury
normal <4-6%

Question 2

troponin

Answer 2

cardiac and skeletal muscle
can be seen as early as within 1 hour of symptoms
<0.1

Question 3

CRP

Answer 3

can speak to risk of heart disease and atherosclerosis
Helps identify acute MI, acute inflammation, may help identify risk of cardiac disease
low risk- <1
mod risk- 1-3
high risk >3

Question 4

BNP

Answer 4

indicative of HF, unreliable alone
<100, over 100 can indicate HF

Question 5

Lipids

Answer 5

high levels in blood correlate with high risk for CAD
HDL: Men >45, female3 >55
LDL <130, high risk >160

Question 6

EPS is done for

Answer 6

cardiac arrhythmia’s

Question 7

invasive diagnostic tests for cardiac

Answer 7

TEE (transesophageal Echo)
Cardiac Cath
EPS

Question 8

class 1 of heart failure

Answer 8

symptoms on excretion, able to maintain ADL’s

Question 9

class 2 of heart failure

Answer 9

symptoms with ADL’s, able to start day, can walk to around the store but are tired afterwards

Question 10

class 3 HF

Answer 10

symptoms with normal daily activities such as preparing meals, feeding animals, must sit periodically, transition activities and living to 1 level of house cannot climb stairs

Question 11

class 4 HF

Answer 11

symptoms with rest
walking from bed to bathroom can be to much, need chairs and periods of rest between
oxygen and assistive devices
often feel isolated and depressed

Question 12

cardiomyopathy

Answer 12

big fat floppy heart
can produce HF
caused by CAD and HTN

Question 13

common symptoms of heart failure

Answer 13

orthopnea
paroxysmal nocturnal dyspnea
fatigue
JVD
dependent edema (legs, lower body)

Question 14

most useful diagnostic test for HF

Answer 14

Echo, then CXR and BNP (
remember that BNP can be elevated for inflammatory process)

Question 15

treatment of HF

Answer 15

treat risk factors of HF
therapies to slow progression
ACE inhibitors, Beta Blockers, Diuretics

Question 16

Hypertensive urgency

Answer 16

BP> 180/110m without evidence of acute organ damage
slowly lower BP
most common symptoms HA, nose bleeds, dyspnea
140 systolic is ideal

Question 17

hypertensive crisis

Answer 17

BP >180/110 with evidence of acute organ damage
admit to ICU aggressive IV antihypertensives and Drip therapy

Question 18

Aortic Rupture

Answer 18

balloon popping b/c its too big
50% die before reaching the hospital
AAA triad of symptoms- syncope, Acute onset of SEVERE abdominal pain
hypotension
surgical emergency, time is of the essence
fluid resuscitation with large bore IV’s, rapid blood transfusion, pain control, airway protection

Question 19

aortic dissection

Answer 19

ripping away from artery wall
most common symptom is migrating pain (ripping, tearing, stabbing, burning)
IF hypotension is present on admission mortality is likely

Question 20

treatment of aortic dissection

Answer 20

IV fluids for circulatory support
aggressive antihypertensive for reduced stress and pressure on vessel
pain control
emergency surgery

Question 21

unstable angina is caused when

Answer 21

thrombi partially occludes arteries
EKG will show ischemic changes
T wave inversion and ST depression are 2 hallmark indicators of ischemia

Question 22

MI occurs when

Answer 22

total occlusion of artery resulting in cell necrosis and release of cardiac markers
EKG may or may not have ST elevation (NSTEMI VS STEMI)

Question 23

Rapid assessment of ACS

Answer 23

EKG
cardiac enzymes
common presenting signs CP lasting longer than 20 min but less than 12 hours
crushing, gripping, smothering pain
feelings of impending doom
atypical presentation is common especially in elderly

Question 24

how is mortality decreased and myocardium preserved with STEMI

Answer 24

if reperfusion is started within 30 minutes of presentation, reperfusion therapy includes thrombolytic therapy, percutaneous coronary intervention, and CABG

Question 25

goal of thrombolytic therapy

Answer 25

to dissolve the blood clots causing the MI and reduce the area of infarction
used if onset of symptoms less than 12 hours

Question 26

contraindications for thrombolytic therapy

Answer 26

active internal bleeding
previous hemorrhagic stroke
pregnancy
recent surgery

Question 27

PCI

Answer 27

useful in elderly and those that cannot have thrombolytic therapy or have had a complication with thrombolytic therapy.
coronary stents or balloon angioplasty
monitor for retroperitoneal bleeding post rupture repair

Question 28

CABG

Answer 28

used in severe left main coronary artery compromise
triple vessel disease
acute re-stenosis
coronary artery rupture

Question 29

cardiac tamponade

Answer 29

life threatening post op complication
bleeding into pericardium
monitor for becks triad (elevated RAP, hypotension, muffled heart sounds)
treatment is pericardiocentesis or pericardial drainage in the OR