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CRRAB 1 > Adams Week 4 > Flashcards

Adams Week 4 Flashcards

1
Q

What is on the differential for Chest Pain?

A

anxiety, aortic stenosis, asthma, cardiomyopathy, esophagitis, gastroenteritis, hypertensive emergency, myocarditis, pericarditis, cardiac tamponade, aortic dissection, pulmonary emboli

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2
Q

What can Acute Coronary Syndrom break into?

A

non-cardiac ds, stable angina, unstable angina, definite ischemic event (stemi or nstemi)

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3
Q

What ages count for family history of coronary disease?

A

Father

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4
Q

If patient has stroke symptoms and EKG demonstrating MI what is possible dx?

A

aortic dissection dt ischemia cutting off the carotid

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5
Q

What are alternative presentations of chest pain in women, the young and the old?

A

no ‘pain’ just: SOB, sweaty, syncope, stroke, palpitation, indigestion, weakness

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6
Q

What are adjectives that people use to describe alternative presentation of chest pain?

A

heartburn, indigestion, sharp squeezing, burning, numbness

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7
Q

What heart sound has decreased left ventricular compliance (cannot occur in atrial fibrillation since it is caused by atria contraction driving blood into the ventricle and against an abnormal ventricular wall)

A

S4

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8
Q

What heart sound do you hear with left ventricular dysfunction?

A

S3

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9
Q

What do you note in CHF?

A

crackles, hepatojugular reflux, leg edema

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10
Q

What EKGs look the same initially?

A

unstable angina and NSTEMI

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11
Q

Can a q wave differentiate stemi or non-stemi?

A

No

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12
Q

How long do sx last in Angina?

A

less than 30 minutes

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13
Q

what has increasing duration, frequency, or intensity; new associated sx and occurs with increasingly less activity or at rest?

A

Unstable Angina

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14
Q

10% with unstable angina will have an MI within what time frame?

A

7 days

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15
Q

What is Angina grade 1? grade 4?

A
  1. ordinary physical activity does NOT cause Angina, but do have it with exertion prolonged
  2. inability to carry out any physical activity; angina at rest
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16
Q

What criteria defines an MI?

A

elevation of tropinin and at least 1: sx of ischemia, Q wave development, new ST/T wave change or new LBBB, intracoronary thrombus, loss of cardiac wall

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17
Q

What should you get if you have an inferior MI?

A

right side leads EKG looking for right ventricle infarct

18
Q

STEMI

A

STE> 1mm in two contiguous leads but in leads V2-V3 at least 2 contiguous leads with >2 mm in men or >1.5 mm in women

19
Q

New left bundle branch block

A

difficult to dx STE because LBBB have STE normally (may not be an MI)

20
Q

EKG of Posterior MI

A

back of heart so infarct STE will appear as ST depressions

21
Q

NSTEMI and EKGs

A

horizontal or downward sloping ST depression >.05 in contiguous leads AND/OR T wave inversion >.1 mV with prominent R wave R/S ratio >1 in 2 contiguous leads

22
Q

Troponin: sensitivity vs specificity

A

higher sensistivity at the price of lower specificity, false + in anything that stresses the heart (AFib, Sepsis, CKD)

23
Q

Can you have a normal troponin with unstable angina?

A

Yes

24
Q

What to do with pt. with a heart score of 0-3?

A

Discharge

25
Q

What to do with pt. with a heart score of 4-6?

A

X-ECG

26
Q

What to do with pt. with a heart score of 7-10?

A

CAG

27
Q

How to tx low risk ACS?

A

ASA, conservative observation with repeat troponin in 6-12 hours

28
Q

How to tx moderate to high risk ACS?

A

nitroglycerin, heparin, repeat troponin in 6-12 hours

29
Q

How to manage UA/NSTEMI?

A

PCI (percutaneous coronary intervention), medications

30
Q

How to manage a STEMI (ST elevations or new LBBB)?

A

Fibrinolytics (only in STEMI), PCI with dilation and stinting, CABG, meds (heparin, aspirin, ticegralor)

31
Q

When do you NOT give nitroglycerin? why?

A

right ventricular infarct (50% of inferior MI’s); reduces preload and caused BP to drop

32
Q

What do you give in an MI if the patient is unable to take aspirin?

A

Clopidogel in pts less than 75

33
Q

What is the MOA of clopidogel?

A

inhibits adenosine 5’-diphosphate (ADP)-dependent activation of the glycoprotein IIb/IIIa complex to stop platelet aggregation

34
Q

When do you use a Glycoprotein IIb/IIIa inhibitor? name some

A

in conjunction with PCI, inhibits platelet aggregation (Abciximab, Eptifibatide, tirofiban)

35
Q

What to give in the first 24 hours after MI?

A

ACE inhibitors and B Blockers

36
Q

When to give an ACE inhbitior?

A

in pt with CHF or LV ejection fraction less than 40% and no hypotension

37
Q

What to use if contraindications of B Blocker?

A

Ca channel blocker

38
Q

What is Takotsubo cardiomyopathy?

A

stress cardiomyopathy dt surge of stress hormones; non-ischemic cardiomyopathy with sudden temporary weakening of the myocardium

39
Q

What can cause the EKG to look like and anterior and posterior MI same time?

A

Myocarditis

40
Q

What is usual USA cause of myocarditis?

A

Parovirus B19

41
Q

What is the worldwide usual cause of Myocarditis?

A

Chagas ds from protozoan Trypanosoma cruzi

CRRAB 1 (9 decks)

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