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MBBS 3: Internal Medicine > Cardiac Emergencies > Flashcards

Cardiac Emergencies Flashcards

1
Q

Name the common cardiac emergencies?

A
  1. acute coronary syndrome
  2. cardiac tamponade
  3. aortic dissection
  4. severe arrhythmias
  5. cardiac arrest
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2
Q

What is acute coronary syndrome?

A

encompasses a spectrum of unstable coronary artery disease

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3
Q

Mechanism of ACS?

A

is a rupture or erosion of a fibrous cap of a coronary artery atheromatous plaque

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4
Q

Disease spectrum of ACS ranges from?

A
  1. Unstable angina
  2. Myocardial infarction
    - NSTEMI
    - STEMI
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5
Q

Criteria for unstable angina?

A
  1. troponin - negative
  2. ECG - normal
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6
Q

Criteria for non ST segment myocardial infarction?

A
  1. troponin - >x10 ULM
  2. ECG - ST segment depression
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7
Q

Criteria for ST segment elevation myocardial infarction?

A
  1. troponin - >x10 ULM
  2. ECG - ST elevation
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8
Q

ACS clinical features?

A
  1. Patient has a history of angina or presents with worsening chest pain on minimal exertion
  2. chest pain- discomfort, tightness, pressure or burning like
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9
Q

Describe the chest pain of ACS?

A
  1. Central or left sided
  2. Dull , pressing, burning on nature
  3. Radiates to the left shoulder or the left jaw or the occipital
  4. Relieved by rest or nitrates
  5. Associated with autonomic symptoms
    - Nausea, heart palpitations or excessive sweating
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10
Q

Treatment options for ACS?

A
  1. Admit to HDU/ICU and put on continues cardiac monitor
  2. Pain relief
  3. antiplatelet
  4. anticoagulant
  5. thrombolysis
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11
Q

Pain relief treatment for ACS?

A
  1. Nitroglycerine o.5mg SL start
  2. Morphine 2.5-5mg iv start
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12
Q

Antipletelet treatment for ACS?

A
  1. Aspirin 300mg po chewed
  2. Clopidogrel 300mg po start
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13
Q

Anticoagulant treatment for ACS?

A

Low Molecular weight heparin - 1mg/kg sc q12hrly

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14
Q

Thrombolysis treatment for ACS?

A

If presented in less than 4hrs from onset of chest pains
1. Streptokinase 1.5MU in 100ml of N/S over 60minutes
2. Altepase

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15
Q

Describe altepase treatment for ACS?

A
  1. <67Kg
    15mg iv push over 2 minutes
    0.75mg/kg over 30minutes
    0.5mg/Kg iv over 60minutes
  2. > 67Kg
    15mg iv push over 2 minutes
    50mg iv over 30minutes
    35mg iv over 60minutes
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16
Q

What is cardiac tamponade?

What does it result in?

A
  • Rapid accumulation of pericardial fluid within the pericardial sac
  • Impairs ventricular filling and therefore cardiac output leading to cardiogenic shock
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17
Q

Clinical features of cardiac tamponade?

A
  1. Elevated JVP
  2. Kussmaul’s signs
  3. Tachycardia
  4. Tachypnea
  5. Apex beat may not be palpable
  6. Becks triad
18
Q

Becks triad?

A

clinical feature of cardiac tamponade
1. increased JVP
2. low systolic BP
3. diminished heart sounds

19
Q

Treatment for cardiac tamponade?

A
  1. Urgent drainage under ultrasound scan guidance
  2. Pericardial window if chronic or recurrent
20
Q

What is aortic dissection?

A
  1. Separation of layers of the aortic wall
  2. A tear within the intimal layer will propagate either distally or proximally
21
Q

What are the 3 types of aortic dissection?

A

Type I - originates in the ascending aorta and to at least the aortic arch
Type II - originates in and is limited to the ascending aorta
Type III - begins in the descending aorta and extends distally above the diaphragm (3a) or below the diaphragm (3b)

22
Q

Clinical features of dissecting aorta?

A
  1. sudden onset of sever chest pains
  2. Syncope
  3. Anxiety and prenomination of death
  4. Altered mental status
  5. Flank pain if the renal artery is involved
23
Q

Severe chest pain in aortic dissection?

A

Tearing and ripping in nature
1. May be anterior if associated with aortic arch or aortic root
2. Posterior or intrascapular pain may suggest descending aorta involvement
- 10% are chest pain free

24
Q

Diagnosis of aortic dissection?

A
  1. Inter-arm BP difference more than 20mmHg
  2. AR murmur
  3. Becks triad suggestive of possible cardiac tamponade
  4. CXR show a widened mediastinum
  5. Cardiac ECHO
25
Management of aortic dissection?
1. Surgical - Tear is repaired and replaced with a dacron graft 2. Medically - BP lowering to SBP<100mmHg > Beta blockers are the drug of choice - Pain relief > Morphine
26
Describe extreme tachycardia?
- Extreme tachycardia with heart rates of more than 150bpm impairs diastolic filling - Lead to reduced cardiac output and cardiogenic shock - Commonest arrhythmia is a supraventricular tachycardia, SVT
27
Clinical features of extreme tachycardia?
1. Chest pains 2. Low SBP 3. Hypoxia 4. Excessive sweating
28
Management of extreme tachycardia?
1. If unstable, do electrical cardioversion 2. Medically * Vagal maneuvers * Beta blockers * calcium channel blockers * Amiodarone
29
Amiodarone dose in tachycardia treatment?
1. 150mg iv over 10min then 2. 1mg/Kg iv over 6 hrs then 3. 0.5mg/Kg iv over 18hrs
30
Cardiopulmonary resuscitation?
Pay attention to ABCs 1. Airway 2. Breathing 3. Circulation - Current trend is to place more emphasis on Circulation - Check for pulse and if absent, start chest compression immediately
31
Chest compressions?
30 chest compressions and then 2 breaths
32
When do we stop compressions?
only hands off time is for defibrillation and rhythm analysis
33
When to shock the patient?
Attach defribrillator and assess rhythm and if a shockable rhythm, please provide shock
34
When to apply definitive airway?
delay definitive airway management until after return of spontaneous circulation NB : DO NOT stop compressions for airway
35
What to do when airway is secure?
provide adequate breaths after each compression
36
What to do when breathing is adequate?
give high- concentration oxygen by nonrebreather
37
What to do if breathing is inadequate?
ventilate with high-concentration oxygen
38
Compressions if patient is intubated?
continuous
39
Compressions if patient is not intubated?
rotate every 2 minutes at which point a resuscitation cycle is said to have been completed
40
Medication in CPR?
1. adrenaline as bolus in between each cycle 2. Establish venous access - Put up two iv lines if possible - One for fluids and the other for special drugs
41
How to establish underlying cause for cardiac arrest?
arterial blood gas
42
When to admit to ICU?
ICU for post resuscitation care once return of spontaneous circulation is achieved

MBBS 3: Internal Medicine (72 decks)

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