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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
Q

Management of aortic dissection?

A
  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
Q

Describe extreme tachycardia?

A
  • 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
Q

Clinical features of extreme tachycardia?

A
  1. Chest pains
  2. Low SBP
  3. Hypoxia
  4. Excessive sweating
28
Q

Management of extreme tachycardia?

A
  1. If unstable, do electrical cardioversion
  2. Medically
    * Vagal maneuvers
    * Beta blockers
    * calcium channel blockers
    * Amiodarone
29
Q

Amiodarone dose in tachycardia treatment?

A
  1. 150mg iv over 10min then
  2. 1mg/Kg iv over 6 hrs then
  3. 0.5mg/Kg iv over 18hrs
30
Q

Cardiopulmonary resuscitation?

A

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
Q

Chest compressions?

A

30 chest compressions and then 2 breaths

32
Q

When do we stop compressions?

A

only hands off time is for defibrillation and rhythm analysis

33
Q

When to shock the patient?

A

Attach defribrillator and assess rhythm and if a shockable rhythm, please provide shock

34
Q

When to apply definitive airway?

A

delay definitive airway management until after return of spontaneous circulation
NB : DO NOT stop compressions for airway

35
Q

What to do when airway is secure?

A

provide adequate breaths after each compression

36
Q

What to do when breathing is adequate?

A

give high- concentration oxygen by nonrebreather

37
Q

What to do if breathing is inadequate?

A

ventilate with high-concentration oxygen

38
Q

Compressions if patient is intubated?

A

continuous

39
Q

Compressions if patient is not intubated?

A

rotate every 2 minutes at which point a resuscitation cycle is said to have been completed

40
Q

Medication in CPR?

A
  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
Q

How to establish underlying cause for cardiac arrest?

A

arterial blood gas

42
Q

When to admit to ICU?

A

ICU for post resuscitation care once return of spontaneous circulation is achieved

MBBS 3: Internal Medicine (72 decks)

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