cardiac emergencies Flashcards
60 year old male presents to A&E with 4hr history of central crushing pain radiating to his left shoulder
differentials?
MI - NSTEMI
Unstable angina
Pericarditis
Gastroenteritis
investigations
bedside - ECG
bloods - troponin, fbc
imaging - cxr
special tests - coronary angiogram
non-modifiable risk factors for acs
age over 65
male
genetics
early menopause
immediate management of MI
MONA
morphine (with antiemetic, metoclopramide)
oxygen (only if sats <94%)
nitrates (sublingual glyceryl trinitrate)
aspirin, clopidogrel (dual antiplatelets)
percutaneous coronary intervention
symptom onset within 12 hours
PCI available within 120 mins
2nd line
thrombolysis (fibrinolysis)
iV alteplase
secondary prevention
lifestyle
medication
A-aspirin 75mg for life, ACE inhibitor (rampiril), atorvastatin (80mg)
B-beta blocker (bisoprolol)
C-clopidogrel
post MI complications
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
patient collapses, severely breathless, on auscultation you hear a pan systolic murmur
ventricular septal defect -> acute heart failure
elevated JVP but struggling to hear any heart sounds
cardiac tamponade
ventricular free wall, cardiac tamponade, results in acute heart failure
patient presents feeling hot and breathless, with pain worse when he breaths in or lies down
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)
gold standard investigation for heart failure
echo cardiogram
management of heart failure
- diuretics (IV
O - oxygen
M - morphine (with metoclopramide)
F - iv furosemide
G - GTN
Sit-up
consider stopping beta blockers
most important medications long term in heart failure
- diuretics
- beta blockers
- aldosterone antagonist
- ACE inhibitor
37 y/o female, presented with 4 day history of chest pain with rashes. pain is sharp and central and relieved by leaning forwards
pericarditis