cardiac emergencies Flashcards
CAD risk factors (6)
- over 40 yo, male or postmenopause
- hypercholesterolemia
- DM, obesity, HTN, sedentary
- fam hx
- tobacco, cocaine
- HIV infection
use of CXR in chest pain
to r/o other causes like pneumonia, pneumothorax
aortic dissection, PE would be seen best on what kind of imaging
CT angiography
what kind of radiography would be good for low risk ACS
coronary CTA
D-dimer is gotten to r/o what?
PE
4 HEART risk fx:
- HTN, hypercholesterolemia
- DM, obesity (BMI >30 kg/m²)
- smoking (current, or smoking cessation ≤3 mo)
- positive family history (1st deg. with CVD before age 65)
HEART risk score (low vs intermediate vs high)
- low is 0-3
- intermediate is 4-6
- high is 7+
leading cause of adult mortality in the US
ACS
chest pain w/ no clear alternative cause, and no clear evidence of cardiac injury or stress on ECG and biomarker tests
low probability ACS
chest discomfort lasting short amount of time; provoked with exertion/stress
stable angina
rest angina, prolonged >20 mins
new onset angina w/ significant physical limitation
previously diagnosed angina becoming longer or more often
unstable angina
what med should be avoided with stable angina
NSAIDs
you do not use nitroglycerin for what type of MI
inferior wal MI
2 tx options for STEMI less than 12 hrs
- PCI
- fibrinolytics
IABP is used for ____ or ____
acute MR or RV infarct
nitroglycerin, nitroprusside, loop diuretics are used for afterload reduction in ____tensive HF
HYPER
- Airway, ventilation, oxygenation
- noninvasive ventilation early, and sit patient upright!
- Nitroglycerin (BP > 150/100) - Reduce BP by 20%–30%
acute pulmonary edema management
when do you use nitroprusside in acute pulmonary edema
If elevated BP, persistent sx despite Max IV Nitro
Dx– endocardial biopsy is gold standard, ECG changes, troponin elevation, cardiac MRI
myocarditis dx
classic ECG findings of
* PR segment depression
* Diffuse ST elevations
* low voltage QRS
* Electrical alternans– think tamponade
pericarditis
which imaging is diagnostic for pericarditis
echo
which HEART score gets admitted with low probability ACS
- 4-6
which HEART score gets early revascularization with low probability ACS
7+
you should avoid what med class in AR unless its from an aortic dissection
BB
sudden onset of 6 Ps, normal contralateral limb
embolic acute limb ischemia
6Ps of acute limb ischemia
pain
pallor
paralysis
pulseless
paresthesia
polar
4 chronic risk factors of occlusive PAD
- Age, smoking, diabetes, hyperlipidemia
ABI values for chronic vs life threatening occlusive PAD
- chonic < 0.9
- life threatening < 0.25
ways to manage occlusive PAD
- Vascular surgery consult
- Unfractionated heparin
- Aspirin 325 mg
- Pain control
- Environment protection
- Vascular surgery
what does this describe:
intima violation, blood into media and dissects btwn intima and adventitia, creating false lumen
aortic dissection
what does this describe:
intima violation, blood into media and dissects btwn intima and adventitia, creating false lumen
aortic dissection
Sudden onset severe, sharp or ripping/tearing chest pain radiating to back b/w scapulae
this is the general descriptor for what?
aortic dissection
can have sx of stroke, anterior cord syndrome, Horner’s syndrome
____ tension is more common in aortic dissection while ____ tension is more common in AAA
- hyper— dissection
- hypo— AAA
if hypo in dissection, thats a bad prognosis
____ tension is more common in aortic dissection while ____ tension is more common in AAA
- hyper— dissection
- hypo— AAA
if hypo in dissection or new AR, thats a bad prognosis
two imaging in evaluating aortic dissection and what are their findings
CXR: widened mediastinum
CTA: evaluate anatomy
Severe abrupt onset back pain, abdominal pain, flank pain, +/- syncope, shock, ischemic limb
AAA
HR and SBP goals when reducing shear force in aortic dissection
HR under 60
BP under 160 (ideally 100-120)
first 2 med to give in aortic dissection
- esmolol bolus + drip
- labetolol bolus + PRN
they are negative inotropes/BB
2nd two meds to give in aortic dissection that can be given first to avoid reflex tachycardia?
- Nitroprusside
- Nicardipine
vasodilators given PRN
which type of aortic dissecton is tx with medical management unless refractory
type B
which type of aortic dissection is tx emergently
type A or complicated B
