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Emed 1 > Cardiac > Flashcards

Cardiac Flashcards

1
Q

unstable angina

A

Ischemic Cardiac chest pain WITHOUT myocardial damage

Occurs suddenly, often at rest or with minimal exertion

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2
Q

cardiac ischemia without myocardial damage

A

NSTEMI

Chest Pain, WITHOUT classic EKG findings, +Cardiac Enzymes

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3
Q

cardiac ischemia with myocardial damage

A

STEMI

Chest pain, WITH classic ST elevation Pattern on EKG, +Cardiac Enzymes

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4
Q

these pts present with atypical symptoms of chest pain

A
  • diabetes
  • advanced age
  • AMS
  • women
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5
Q

initial workup for chest pain

A

Labs:
CBC (check for anemia/bleeds), Chem (baseline BUN/Cr for cath lab), Coags, Cardiac Enzymes

Chest XR

EKG

Coronary CT-good for people that don’t have preexisting cardiac disease

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6
Q

best lab test for MI

A

-troponins, released within 4-6 hours of onset of MI
-repeat every 4-6 hours
CK-MB peaks at 12 hours

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7
Q

common EKG findings for acute coronary syndrome

A
  • peaked T waves, occur early
  • ST elevations, Indicates transmural injury & diagnostic of acute infarct
  • Q waves, indicate necrosis from previous damage
  • new LBBB
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8
Q

Non invasive test
Good test for low risk patients
Limitations: not useful in patients w/ areas of old, calcified (hardened) plaque

A

CT coronary angiogram

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9
Q

how to treat ACS?

A
  • immediate IV, O2, cardiac monitor, and EKG
  • ASA
  • clopidogrel
  • nitro
  • heparin
  • BB
  • Morphine
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10
Q

main and second line treatment of a STEMI?

A

main-percutaneous coronary intervention (door to balloon time <90 min)
second-fibrinolytics (door to needle time <30 min)

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11
Q

main tx for NSTEMI or unstable angina?

A

antiplatelet-ASA or plavix
anticoag-LMWH
stress test

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12
Q

Chest pain at rest associated w/ transient ST segment elevation

Normal exercise tolerance

Cyclical pain pattern, most episodes in early morning

Due to focal coronary artery vasospasm

Associated w/ acute myocardial infarction, ventricular arrhythmias, and sudden death

A

variant/prinzmetal angina

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13
Q

how to treat prinzmetal angina?

A
  • nitro
  • CCB
  • BB contraindicated
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14
Q

S/S pericarditis

A

Varies w/ respiration (Pleuritic)
Worsens w/ Lying down
Relieved by leaning forward
may follow a viral illness

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15
Q

best diagnostic test for pericarditis

A

echo

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16
Q

how to treat pericarditis?

A

-outpatient NSAIDs

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17
Q

acute endocarditis vs

subacute

A

acute MCC staph aureus, fatal <6 weeks

subacute caused by less virulent Streptococcus viridans & enterococcus

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18
Q

pt presents with new heart murmur and unexplained fever, think…

A

endocarditis

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19
Q

dukes major criteria

A 
2  POSITIVE BLOOD CULTURES
Of an organism that typically causes IE
Or, persistent bacteremia
EVIDENCE ON ECHO
DEVELOPMENT OF NEW REGURGE MURMUR
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20
Q

dukes minor criteria

A

Fever > 38 C
Predisposition, predisposing heart condition, IV drug use.
Vascular phenomena
Immunologic phenomena
Serologic evidence of an active infection

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21
Q

positive dukes criteria

A 
Two Major Criteria
                 Or
One Major Three Minor
                 Or
Five Minor Criteria
22
Q

anbx prophylaxis is required for

A

anbx prophylaxis is required for

23
Q

beck’s triad is associated with

A 
cardiac tamponade
-JVD
-hypotension
-muffled heart sounds
Other symptoms: tachycardia, narrow pulses pressure, pulsus paradoxus (dropped beats in the peripheral pulse during inspiration)
24
Q

test of choice for cardiac tamponade

25
cardiac tamponade tx
pericariocentesis
26
s/s aortic dissection
Classically sudden onset SEVERE RIPPING or TEARING Radiation to the BACK
27
PE findings for aortic dissection
Pulse or BP asymmetry btw limbs | >30 is bad
28
how to dx aortic dissection
- CXR shows widened mediastinum call CT sx stat (>8mm) - CT is the test of choice in acute setting!!!! - angiography is the gold standard
29
how to tx aortic dissection
- beta blockers are first line (CCB if BB are C/I) | - Nicardipine/Nitroprusside (vasodilators) started after BB to achieve BP reduction
30
type A vs | type B aortic dissection mgmt
- surgical tx | - medical tx (BP/HR) doesn't involve ascending aorta
31
how to dx CHF?
- BNP (normal range 10-100) | - CXR (cardiomegaly, Kerley B line)
32
how to treat CHF?
- O2 - intubate if needed - nitro - diuretics (double pts normal dose) - dopamine/dobutamine if hypotensive
33
how to treat stable pts with a-flutter/fib >48 hours?
CCBs Anticoagulation w/ heparin TEE to r/o atrial thrombus prior to cardioversion
34
how to treat stable pts with a-flutter/fib <48 hours?
electric cardioversion
35
how to treat stable vs unstable SVT
stable-vagal maneuver, valsavla, carotid massage unstable-synchronized cardioversion adenosine can be used short term
36
how to treat pulseless V-tach
defibrillation w/ unsynchronized cardioversion
37
how to treat unstable vtach pts with a pulse
synchronized cardioversion
38
how to treat hemodynamically stable pt w/normal cardiac function presenting with vtach
procainamide
39
how to treat hemodynamically stable pt w/impaired cardiac function with tach
amio is first line | lido
40
how to treat vfib?
- defibrillation | - if unsuccessful, CPR and intubate and give epi and vasopressin
41
how to treat heart blocks
- atropine | - external pacing if that doesn't work
42
hypertensive emergency
-elevated BP associated with target end organ damage
43
hypertensive urgency
elevated bp associated w/ risk of imminent target organ dysfunction
44
acute hypertensive episode
Systolic BP > 180 & Diastolic BP >110 w/out evolving or impending target organ dysfunction
45
initial tx for hypertensive emergency
O2 supplementation, cardiac monitoring, IV access
46
how to tx HTN emergency w/CVA
Labetalol | Subarachnoid Hemorrhage: Nimodipine
47
how to tx HTN emergency with hypertensive encephalopathy
Characterized by severe headaches, nausea, vomiting and AMS) Sodium Nitroprusside (avoid rapid correction to prevent hypo-perfusion) Labetalol is 2nd line
48
how to tx acute sympathetic crisis?
benzos followed by nitro or phentolamine
49
how to tx acute renal failure
nitroprusside
50
how to tx preeclampsia
labetalol | hydralazine
51
beck's triad is associated with
``` cardiac tamponade -JVD -hypotension -muffled heart sounds Other symptoms: tachycardia, narrow pulses pressure, pulsus paradoxus (dropped beats in the peripheral pulse during inspiration) ```

Emed 1 (8 decks)

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