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EM > Cardio > Flashcards

Cardio Flashcards

0
Q

ST segment

A

Segment in between the QRS complex and the next T wave

To detect ST elevations measure against end of T to next P wave

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1
Q

How to diagnose STEMI?

A

at least 1 mm ST elevation in 2 or more contiguous leads
must be at least 2 mm in leads v1-v3
Or a new LBBB

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2
Q

STEMI: EKG mimics

A

Pericarditis/myocarditis - recent rad tx, fever
Benign early depolarization - young healthy male
Left ventricular hypertrophy - hypertension
Pacemaker - paced
HyperK - renal failure
Coronary vasospasm - cocaine and oth stimulants
Aneurysm - prior MI, usually assoc with q waves

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3
Q

Define ACS

A

Umbrella term encompasses
Unstable angina and
Acute MI

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4
Q

What percentage of pts presenting to adult ED with chest pain have ACS?

A

15%

One third of those will have an acute MI and the remainder unstable angina

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5
Q

Angina: duration of symptoms

A

typically <10 mins
occasionally lasting 10 - 20 mins
usually improves w/in 2 - 5 mins after REST or NITROglycerin

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6
Q

What % of pts experiencing an acute MI have NO pain?

A
  1. 4% men
  2. 5% women

Up to half of pts w/ unstable angina present with atypical symptoms

Prognosis is worse at time of infarction in pts with atypical symptoms (fatigue, malaise, vague discomfort)

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7
Q

Bradycardia in acute MI

A

May occur in inferior MI

Poor prognostic indicator in anterior MI (heart block is also a poor prognostic indicator)

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8
Q

EKG w/in _____ mins of pt w/ CP presenting to ED

A

10 mins

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9
Q

J point

A

H

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10
Q

Goal hospital to balloon time

A

90 mins

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11
Q

Risk of intracranial hemorrhage with fibrinolytic tx in acute MI

A

0.5-1%

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12
Q

Goal hospital to needle time (fibrinolytic tx) in acute MI

A

30 mins

To administer thrombocytes if no cath lab available

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14
Q

Clopidogrel in acute MI

A

Plavix

The addition of clopidogrel to aspirin and antithrombin therapy improves cardiovascular outcomes in patients receiving FIBRINOLYSIS for STEMI

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14
Q

Cocaine induced CP

A

6% will have an MI
Normal CP work-up

  1. ASA, NTG, O2
  2. Benzos
    - Consider Phentolamine or CCB (in benzo non responders)
  3. Consider NaHOC3 for Ventricular Arrhythmias immediately following cocaine use
    - reverses cocaine induced QRS prolongation by Na channel blockade

Labetalol?
Theoretical contra-indication B-blocker 2nd to unopposed alpha

May discharge after: 9-12 hour period of ECG’s and serial troponins, if both are negative.
NEJM 2/03; n=334; outcome of zero events at 30 days if no more cocaine

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15
Q

Diltiazem

A

CCB

A fib,

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16
Q

Commotio cordis

A

Primary electrical event resulting in induction of Vfib
Due to blow occurring 10-30ms before peak of T wave

Often results from innocent-appearing chest wall blow
Usually insufficient to cause damage to ribs, sternum, or heart

Second most common cause of death in young athletes

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17
Q

MCC of death in young athletes?

A

HOCM

18
Q

Cocaine induced CP

A

6% will have an MI
Normal CP work-up

  1. ASA, NTG, O2
  2. Benzos
    - Consider Phentolamine or CCB (in benzo non responders)
  3. Consider NaHCO3 for Ventricular Arrhythmias immediately following cocaine use
    - reverses cocaine induced QRS prolongation by Na channel blockade

Labetalol?
Theoretical contra-indication B-blocker 2nd to unopposed alpha

May discharge after: 9-12 hour period of ECG’s and serial troponins, if both are negative.
NEJM 2/03; n=334; outcome of zero events at 30 days if no more cocaine

19
Q

Cocaine induced CP

A

6% will have an MI
Normal CP work-up

  1. ASA, NTG, O2
  2. Benzos
    - Consider Phentolamine or CCB (in benzo non responders)
  3. Consider NaHOC3 for Ventricular Arrhythmias immediately following cocaine use
    - reverses cocaine induced QRS prolongation by Na channel blockade

Labetalol?
Theoretical contra-indication B-blocker 2nd to unopposed alpha

May discharge after: 9-12 hour period of ECG’s and serial troponins, if both are negative.
NEJM 2/03; n=334; outcome of zero events at 30 days if no more cocaine

20
Q

Commotio cordis

A

Primary electrical event resulting in induction of V Fib
occurs after a blunt blow to the chest in a pt who does not have any structural heart disease

must occur at the upstroke of the T to cause V Fib

Often results from innocent-appearing chest wall blow
Usually insufficient to cause damage to ribs, sternum, or heart

Second most common cause of death in young athletes

21
Q

EKG finding highly specific for pericarditis

A

PR depression

Will also see ST elevations

22
Q

Parkland burn formula

A

4% x BSA x wt in kg = L in 24 hours

Give 1/2 over first 8 hrs
Next 1/2 over next 16 hours

Maintain UOP of 50cc/hr?

23
Q

Burns

A

1st deg - sensation intact, red, swollen, epidermis? intact - no blisters

2nd deg - blistering, exudate, sensation intact

3rd deg - charred, leathery, dermal injury, sensation not intact

4th degree charred to bone

24
Q

Torsades: tx?

A

IV MgSO4

25
Q

8 classic findings on CXR in Ao dissection

A 
Widened mediastinum
Blurred Ao knob
Ao calcifications
Deviation of trachea to the right
Apical cap?
Pleural effusion
26
Q

Ao outflow track on US

A

<4 cm

27
Q

What med to start first in dissection

A

Esmolol

28
Q

How much blood to remove on pericardioscentesis to relieve tamponade?

A

? mls

29
Q

asymptomatic HTN

A

start oral antihypertensive if bp >200/120

PCP f/u in 1 week

30
Q

HTN in pregnancy

A

ACEI contraindicated

start labetalol or hydralazine

31
Q

HTN emergency

A

administer parenteral agents, with goal of therapy to decrease the MAP by 25% w/in 1 hour

then to 160/110 within the next 6 hours

32
Q

low molecular weight heparins

A

lovenox

safe in pregnancy, but

*unfracionated heparin is the preferred anticoagulant during the third trimester; its infusion can be stopped quickly and it has a more predictable reversal response to protamine sulfate if labor begins

33
Q

brugada syndrome

A

autosomal dominant

90% males
30s-40s yo

syncope or sudden death

need tele admission for defibrillator placement

incomplete RBBB with j-point and st-segment elevations in leads V1-V3

34
Q

sgarbossa criteria

A

st segment elevation measuring > or equal to 1 mm concordant with the QRS in any lead

st segment depression measuring > or equal to 1 mm in any of the V1 through V3 leads

Discordant ST segment elevation measuring > or equal to 5 mm

only needs to occur in one lead

35
Q

EKG predictors of reperfusion in acute MI

A

early T wave inversions can be highly specific markers for reperfusion

an accelerated idioventricular rhythm 60-120 beats per min is also highly specific for reperfusion - benign don’t supress it

36
Q

ekg in true posterior infarct

A

R>S waves in V1 and V2 with upright T waves

ST depression in V1-V2

37
Q

occluded vessel in inferior MI

A

ST elevations II, III, aVF

80% right coronary
20% circumflex

38
Q

occluded vessel in right ventricular infarct

A

ST elevation in V1 and II, III and aVT

always right coronary

39
Q

occluded vessel in anterior MI

A

ST elevation V1, V2 and V3

left anterior descending (LAD) coronary artery

40
Q

dressler’s syndrome

A

pericarditis 2-8 weeks post-MI - probably a continuum with earlier pericarditis (pericarditis can be seen 1-7 days post transmural MI)

fever, leukocytosis, friction rub, pericardial and pleural effusions

tx NSAIDS and steroids

41
Q

examples of high output heart failure

A 
thyrotoxicosis
anemia
av fistula
beriberi
paget's disease of the bone
42
Q

what happens withen a pt with EBV is treated with ampicillin or amoxicillin

A

maculopapular rash

EM (15 decks)

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