cardiac emergencies Flashcards

1
Q

60 year old male presents to A&E with 4hr history of central crushing pain radiating to his left shoulder

differentials?

A

MI - NSTEMI

Unstable angina

Pericarditis

Gastroenteritis

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2
Q

investigations

A

bedside - ECG

bloods - troponin, fbc

imaging - cxr

special tests - coronary angiogram

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3
Q

non-modifiable risk factors for acs

A

age over 65

male

genetics

early menopause

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4
Q

immediate management of MI

A

MONA

morphine (with antiemetic, metoclopramide)

oxygen (only if sats <94%)

nitrates (sublingual glyceryl trinitrate)

aspirin, clopidogrel (dual antiplatelets)

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5
Q

percutaneous coronary intervention

A

symptom onset within 12 hours

PCI available within 120 mins

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6
Q

2nd line

A

thrombolysis (fibrinolysis)

iV alteplase

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7
Q

secondary prevention

A

lifestyle

medication

A-aspirin 75mg for life, ACE inhibitor (rampiril), atorvastatin (80mg)

B-beta blocker (bisoprolol)

C-clopidogrel

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8
Q

post MI complications

A
D - death
A - arrhthymia 
R - rupture of ventricular wall, IVS 
T- tamponade 
H - heart failure
V- valve disease
A- aneurysm 
D- dresslers syndrome 
E- embolism 
R- recurrence
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9
Q

patient collapses, severely breathless, on auscultation you hear a pan systolic murmur

A

ventricular septal defect -> acute heart failure

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10
Q

elevated JVP but struggling to hear any heart sounds

A

cardiac tamponade

ventricular free wall, cardiac tamponade, results in acute heart failure

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11
Q

patient presents feeling hot and breathless, with pain worse when he breaths in or lies down

A

dressler’s syndrome

Dressler syndrome is a type of inflammation of the sac surrounding the heart (pericarditis).

Dressler syndrome is believed to be an immune system response after damage to heart tissue or to the sac surrounding the heart (pericardium)

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12
Q

gold standard investigation for heart failure

A

echo cardiogram

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13
Q

management of heart failure

A
  • diuretics (IV

O - oxygen

M - morphine (with metoclopramide)

F - iv furosemide

G - GTN

Sit-up

consider stopping beta blockers

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14
Q

most important medications long term in heart failure

A
  • diuretics
  • beta blockers
  • aldosterone antagonist
  • ACE inhibitor
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15
Q

37 y/o female, presented with 4 day history of chest pain with rashes. pain is sharp and central and relieved by leaning forwards

A

pericarditis

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16
Q

differentials

A

acute pericarditis

esophagitis

costochondritis

ACS

aortic dissection

pneumonia

mI

17
Q

causes of pericarditis

A

inflammation of pericardium

innervated by phrenic nerve

common cause: idiotpathic, viral (coxsackievirus)

18
Q

pr depression most specific change for pericarditis

A

more likely to see global ST elevation

transthoracic echo is gold standard.

19
Q

cardiac tamponade vs constrictive pericarditis

A

cardiac tamponade
- pulses paradoxus present

  • echo, large effusion, RA , and RV compression
  • JVP absent Y
  • treatment - urgent pericardiocentesis

constrictive pericarditis
- pulses paradoxus absent

  • echo , no effusion, pericardian thickening
  • JVP - X and Y present