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Emergency EOR > Cardiac > Flashcards

Cardiac Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Most common complications of endocarditis

A

CHF
CNS disorder
Peripheral embolization

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2
Q

Cutaneous embolic phenomena of endocarditis

A
  1. Splinter or subungual hemorrhages of finger/toenails
  2. Osler nodes - (small, tender subcutaneous nodules on the pads of the fingers or toes)
  3. Janeway lesions - (small hemorrhagic painless plaques on the palms or soles)
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3
Q

Admitting for endocarditis

A
  1. Febrile injection drug users

2. Admit all patients with a cardiac prosthetic valve and fever (or persistent malaise, vasculitis, or new murmur)

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4
Q

Abx for endocarditis

A
  1. Uncomplicated hx - Ceftriaxone, Oxcacillin, or Vancomycin PLUS Gentamicin or Tobramycin
  2. Injection drug users: Nafcillin + Gentamicin + Vancomycin
  3. Prosthetic heart valve: Rifampin + Gentamicin + Vancomycin
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5
Q

Iatrogenic causes of acute heart failure

A

Recent addition of negative inotropic drugs (e.g., calcium channel blocker, β-blocker)

Initiation of salt-retaining drugs (e.g., NSAID, steroids, thiazolidinediones- glitazones)

Inappropriate therapy reduction

New antiarrhythmic agents

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6
Q

Acute heart failure with hypotension, tx:

A

Ionotropic therapy:

norepinephrine, dopamine, or dobutamine

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7
Q

Hypertensive acute heart failure, tx:

A
  1. O2
  2. Nitroglycerin (venous and arterial dilator). Sublingual then IV if needed
  3. IV loops diuretics - Furosemide of Bumetanide for volume overload
  4. Admite or discharge after obs
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8
Q

Diuretics without vasodilators in acute hypertensive HF?

A

NO - vasodilators first
Diuretics (furosemide most commonly used) administered alone without vasodilators for hypertensive heart failure may increase mortality44 and worsen renal dysfunction.

successful management of blood pressure and cardiac filling pressure creates marked improvement in respiratory status long before any diuresis.

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9
Q

Contraindications to using vasodilators in acute HF

A

Signs of hypoperfusion or hypotension

Flow-limiting, preload-dependent states such as right ventricular infarction, aortic stenosis, hypertrophic obstructive cardiomyopathy, or volume depletion increase the risk of vasodilator-associated hypotension

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10
Q

Flow-limiting, preload-dependent states

A

Right ventricular infarction
Aortic stenosis
Hypertrophic obstructive cardiomyopathy
Volume depletion

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11
Q

Normotensive HF tx:

A

Diuresis first

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12
Q

Loop diuretic electrolyte complications

A

Hypokalemia - keep an eye out for increasing QT interval

also hypocalcemia, hypomagnesemia

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13
Q

Drugs to avoid in Heart Failure

A

Calcium Channel Blockers (verapamil, diltiazem, amlodipine,

NSAIDs

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14
Q

High-risk physiologic markers in ED patients with acute heart failure associated with morbidity and mortality

A

Renal dysfunction
Low BP
Low sodium
Elevated BNP or Troponin

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15
Q

Diagnosis of STEMI vs NSTEMI

A

STEMI = ECG changes in presence of suggestive sx

NSTEMI = depends on cardiac biomarkers, but may include ECG changes

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16
Q

Inferior wall AMIs on ECG

A

ST-segment elevations in II, III, and aVF

get V4 on right side to check for ST elevation there too!

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17
Q

ST-segment elevations in II, III, and aVF + V4 (right side)

A

Suggestive of right ventricular infarction = NO NITRO

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18
Q

Reciprocal ST-segment changes—those in leads away from or opposite the elevation area—

A

– are from subendocardial ischemia and denote a larger area of injury risk, an increased severity of underlying CAD, more severe pump failure, a higher likelihood of cardiovascular complications, and increased mortality.

In general, the more elevated the ST segments and the more ST segments that are elevated, the more extensive is the injury.

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19
Q

In the setting of an inferior wall AMI (II, III, aVF), ST-segment elevation in at least one lateral lead (V5, V6, or aVL) with an isoelectric or elevated ST segment in lead I is strongly suggestive of lesion i which artery

A

Left circumflex

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20
Q

The presence of ST-segment elevation in lead III greater than that in lead II predicts

A

a right coronary artery occlusion

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21
Q

ST seg elevation in lead III greater than lead II, accompanied by ST-segment elevation in V1 or a V4R, it predicts

A

a proximal right coronary artery lesion with accompanying right ventricular infarction

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22
Q

pattern of abnormal T waves in the precordial leads V2and V3 associated with critical stenosis of the left anterior descending artery

A

Wellen’s sign (deeply inverted T waves or biphasic)

V2, V3 especially

Present in 18% of unstable angina

23
Q

STEMI/NSTEMI/unstable angina initial tx:

A
  1. Aspirin
  2. Clopidogrel, Ticagrelor, Prasugrel
  3. Nitroglycerine
  4. Beta blockers
  5. Antithrombin > Enoxaparin, unfract heparin, or fondaparinux
24
Q

Antithrombin options for STEMI/NSTEMI tx

A

Enoxaparin (Lovenox, LMWH)
Unfractionated heparin
Fondaparinux

all bind antithrombin III, inhibit Xa and thrombin

25
Q

Anti-platelet options for STEMI/NSTEMI/unstabe angina

A

Aspirin +
Clopidogrel
Ticagrelor
Prasugrel

26
Q

Fibrinolytic therapy is indicated for patients with STEMI (as a reperfusion option) if

A

time to treatment is <6 to 12 hours from symptom onset and the ECG has at least 1 mm of ST-segment elevation in two or more contiguous leads

27
Q

Evidence of bundle branch block on EKG

A
  1. Widened QRS (> 120ms)
28
Q

Normal V1, V6

A

V1, little positive then big negative QRS

V6, little negative then big positive QRS

29
Q

LBBB V1, V6

A

V1, one big negative, “W”

V6, notched big positive, “M”

30
Q

RBBB V1, V6

A

V1 “terminal R”/peaked R wave, complex looks “M’

V6, “slurred S”, looks kinda “W’

31
Q

R BBB, L BBB pneumonic

A

WLM MRW

WILLIAM MARROW

32
Q

200-300 BPM
doesnt last long
can be SOB, dizzy, syncope, palpitations

A 
Supraventricular tachycardia (AVRT, AVNRT)
Ex. Wolf Parkinson White syndrome
33
Q

Supraventricular tachycardia on EKG

A

Buried p waves

34
Q

Common causes fo syncope

A
  1. Vasovagal
  2. Cardiac
  3. Orthostatic
  4. Medication related
  5. Neurologic
  6. Unknown
35
Q

Classic sypmtom constellation in aortic stenosis

A

Chest Pain
Dyspnea on exertion
Syncope

36
Q

stiff noncompliant left ventricle, diastolic dysfunction, and outflow tract obstruction

A

hypertrophic cardiomyopathy

37
Q

Hypomagnesemia on EKG

A

torsades de pointes

38
Q

1st degree AV block

A

PR interval > 200 ms

39
Q

2 types of 2nd degree AV block

A

Mobitz 1 (Wenchebach) : PR interval going, going, QRS dropped

Mobitz 2 - PR interval > 200ms, constant, doesn’t get longer - then QRS dropped

40
Q

Longer longer longer drop

A

that is a wenchebach

Mobitz 1, 2nd degree AV block
PR interval is > 200ms, gets longer, longer, then QRS dropped

41
Q

3rd degree AV block

A

Atria and ventricle conduct independently

Constant P-P intervals
Constant Q-Q intervals

42
Q

Symptoms of A blocks

A

bradycardia
dizziness
syncope

43
Q

patient is unstable, has a bradycardic dysrhythmia - most likely

A

3rd degree AV block

followed ( much less likely) by 2nd degree

44
Q

Indications for treating bradydysrhythmias

A

HR < 50 bpm + hypotension/perfusion

45
Q

Pharm tx for brady-dysrhythmia due to sinus and AV nodal diseas

A

Atropine

46
Q

Effective in terminating narrow QRS complex reentrant tachydysrhythmias involving the AV node

A

Adenosine

47
Q

Effective in terminating narrow QRS complex reentrant tachydysrhythmias involving the AV node

AND reducing ventricular rate in atrial fibrillation or flutter

A 
Adenosine
Verapamil
Diltiazem
Metropolol
Propanolol
48
Q

Tachycardias are categorized as

A

Supraventricular - “narrow complex tachycardia”

Ventricular - “wide complex tachycardia”

49
Q

Ventricular tachycardia tx

A

Amiodarone

Cardioversion

50
Q

Supraventricular tachycardia with aberrency tx

A

Adenosine

51
Q

Afib + WolffPrkWht tx

A

Amiodarone or procainamide

52
Q

Torsades de pointes tx

A

Magnesium sulfate 2g IV

53
Q

Polymorphic ventricular tachycardia tx

A

Cardioversion

54
Q

Tx for symptomatic SA node arrest

A

Atropine

cardiac pacing for recurrence

Emergency EOR (4 decks)

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