CARDIAC Flashcards
What 3 diagnoses would kill a patient who presents with chest pain?
ACS (acute coronary syndrome), Aortic dissection, Pulmonary embolism
Who are the 3 people that experience atypical sxs for ACS?
Women, elderly, diabetics (nausea)
What do we see on an EKH with a STEMI?
Greater than 1mm ST elevation in 2 contiguous leads
New LBBB (can suggest STEMI too)
What are some questions we should ask to rule out acute coronary syndrome?
History/Symptoms (OPQRST)
Discomfort with exertion is more concerning for ACS
Radiation to arm, neck, jaw/teeth
Severity has nothing to do with ACS
What do we look for immediately in the patient’s appearance (sign’s) that may suggest ACS?
Distress, Diaphoresis, and Levign sign
What are some EKG signs for acute coronary syndrome?
ST elevation, T wave inversion, ST depression, or new LBBB
When would we get false positive with troponins?
Renal disease, myocarditis, cardiac contusion, and recent cardiac surgery/cath
How do we know if it’s a thrombus or an embolus causing an NSTEMI?
Thrombotic event (narrowing) → causing a supply/demand issue
If a patient has chest pain and they have any of the following: ST elevation, new LBBB, ST depression, T wave inversion, they’re hemodynamically unstable, have dynamic EKG changes, known CAD (reminiscent of prior events), or positive troponins – what level of risk stratification are they?
High Risk
If a patient has atypical CP with CAD and normal or unchanged EKG; CP with nonspecific ST depression; Low risk with a normal EKG but + troponins; or Anginal pain with spontaneous resolution promptly after NTG – are all examples of what level of risk stratification?
Moderate Risk
If a patient with atypical CP with negative troponins – what level of risk stratification?
Low risk
If we are concerned about someone where in the hospital do we put them?
Observation
What acronym can we use for initial cardiac treatment when the diagnosis is uncertain? What does it stand for?
MONA
Morphine, Oxygen; Nitro; Aspirin
What should we always check for prior to administering nitro?
Phosphodiesterase inhibitors!
What labs should you check for your uncertain cardiac issues?
CBC (anemia?), electrolytes (Potassium & Magnesium), and Troponins (serial)
If you rule out ACS – can you send them home?
No!
If you’ve ruled out ACS and watched them overnight, what does the risk stratification involve to discharge them?
Ability to exercise, prior to workup, prior episodes Echo or Stress Echo Stress nuclear imaging ETT (exercise treadmill test) Cardiac Cath
If we have rules in ACS, how do we treat NSTEMI or UAP?
Aspirin & Plavix (P2Y12 receptor blocker)
Beta Blocker
Heparin
Possible Statin?
If a patient has heart failure + NSTEMI – what should we add to treatment?
Diuretics and NTG IV (to help reduce afterload)
When do we use the TIMI score?
For pretest possibility for ACS
What is the TIMI score?
Age greater than 65
3+ risk factors for CHD
Prior coronary stenosis (greater than 50%)
ST Segment deviation via EKG
2+ Anginal episodes in prior 24 hours
Elevated cardiac biomarkers
Use of aspirin in prior 7 days (just that people who use aspirin are usually at higher risk)
Afib, what 4 things must we identify ASAP?
Verify rhythm, hemodynamic stability, ventricular rate control, BP management
What are the management goals for Afib>
Minimize symptoms, prevent thromboembolic complications (especially stroke); minimize side effects or adverse reactions; minimize risk of bleeding; decrease mortality
: If a patient with Afib is hemodynamically unstable, angina, or prexcitation (WPW) – what do we do?
May require cardioversion
BUUUUTTT risk of embolus must be considered