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RCSI EMERGENCIES > CARDIO > Flashcards

CARDIO Flashcards

1
Q

criteria for ECG in STEMI

A 
1. ST elevation in 2 consecutive leads at J point 
all leads (except 2,3) >0.1mv 
2,3 Female - >0.15
2,3 Males < 40 - >2.0 
2,3 Males >40 - >2.5
  1. New LBBB
  2. Posterior MI
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2
Q

treatment of STEMI

A 
MONA 
morphine 0.1mg/kg 
Oxygen - maintain O2 stats at 93% 
Nitrates - 2 spray GTN 
Aspirin 300mg PO chewed STAT
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3
Q

Emergency acute and unstable tx STEMI

A 
Emergency revascularization 
- ACLS protocol 
Thrombolysis - 30 minutes 
PCI - w/i 90 min 
PCI 
CABG

Adjunctive
- inotropic support
intra-airotic ballon pump

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4
Q

Acute and HD stable STEMI TX

A

Early revascularization

  • PCI
  • thrombolysis

Anticoagulant
- Heparin
LMWH - enoxaparin 1mg/kg
G2b/3a (Abiximab)

Anitplatlet
- Aspirin
ADP inhibitor (ticragrelor, prasugrel clopidogrel

Others
Bblocks
stain

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5
Q

ongoing treatment post STEMI

A

DUAL Antiplatlet (aspirin, ADP inhibitor )
- NO stent - 12 months
Bare mental sent - 12 months
dual eluting stent - 12 month

Ace inhibitor
B blocker
Statin
Lifestyle

CARDIAC REHABILITATION

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6
Q

ECG criteria for Non SSTEMI

A
  • ST depression

+ / - T wave inversion

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7
Q

Risk stratification NSTEMI

A

ACA/ AHA guidelines
TIMI score
Fillip classification
Grace score

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8
Q

TIMI Score

A 
Age > 65 
CAD R.F > 3 
Stenosis > 50% 
ST segment deviation 
elevated cardiac enzymes 
Angina like episodes >2 in 24 hours 
aspirin use in past 7 days

HIGH RISK TIMI SCORE > 5-7

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9
Q

ACC/AHA

A

think the up down risk stratification

Ge >75
Pain at rest
New or worsening murmur or heart sounds

DOWN:
 - ST in initial ECG 
- BP 
UP:
- troponin 
UP / DOWN 
- HR

> 1 = high risk

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10
Q

Killip risk score

A

LOOKING AT LV FAILURE

Class 1: no evidence 
Class 2: 
- s3 gallop 
- raised JVP 
- basal rales and crackles 
Class 3: 
- pull edema 
Class 4: 
- cariogenic shock
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11
Q

treatment NSTEMI

A

MONA-C

- asses both invasive or conservative approach

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12
Q

NETEMI Invasive approach - NOT PLANNED

A

Anti-coagulate - LMWH or UFH

MONA

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13
Q

invasive approach planned NSTEMI

A

MONA
anticogulate - enoxaparin 1mg/kg every 12 hours
PCI

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14
Q

Post PCI / secondar y perversione

A

DUAL Antiplatlet (aspirin, ADP inhibitor )
- NO stent - 12 months
Bare mental sent - 12 months
dual eluting stent - 12 month

Ace inhibitor
B blocker
Statin
Lifestyle

CARDIAC REHABILITATION

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15
Q

Definition for pull edema

A
  • fluid accumulation in the lungs (air spaces and parenchyma) which impairs gas exchange and MAY lead to respiratory distress and failure, hypoxia, cardiac arrest and health
  • can be cariogenic (LV failure) § or NON cariogenic (ARDS, barotrauma)
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16
Q

CXR of palm edema

A 
Alveolar edema 
B - kerly B lines *fluid accumulation in interstium lower L 
Cardiomegaly (>0.5 on PA 
Diversion in upper lobes 
E pleural effusion
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17
Q

PE ECG findings

A

S1Q3T3 (prominent S wave in lead I, Q wave and inverted T wave in lead III)

Sinus tachycardia
Right axis deviation
RBBB complete or incomplete
T wave inversions in reciprocal leads

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18
Q

treatment of palm edema

A

LMNPO
Furosemide 40-160mg
Morphine sulphate 2-10mg every 2-6 hours
Nitrates - PO or IV isosorbide denigrate
Position - sit up
Oxygen - ventilate CPAP - 5mmH2O to begin with

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19
Q

if LMNPO does not work for pulm edema

A
  1. for diuretics
    - non loop diuretic (METOLAZONE)
    ultra filtrate with dialysis - if poor urine output
  2. for refractory HYPOTENSION
    - ionotrope (DIGOXIN, AMIODARON) +/- vasoactive agents
    - IABP
    - KV assisted device
  3. Ongoing schema - coronary revascularization
  4. Valvuloplasty (post STEMI MV tendon rupture
20
Q

how often do u check cardiac enzymes post chest pain

A

0,6,12 hours post event

21
Q

symptoms of unstable a.fib

A

Neuro (agitated, anxious, aggressive, decrease consciousness, confusion, drowsiness, syncope)

Cardio (chest pian, fast irregular pulse)
Resp (SOB)
Other (hot and sweaty)

22
Q

Signs of A.fib

A 
Neuro - decrease GCS 
CARDIAC
- hypotensive
- COLD peripheries 
- Cap refil 
- skin mottling 
- pulm edema evidence 
- murmurs

Resp - tachypnoea
Others - oliguria

23
Q

2 indication for Enoxaparin

A
  1. prior to electrical cardioversion

2. TE prophylaxis

24
Q

ECG criteria for A. fib

A
  1. irregular heart rhythm
  2. no P wave
  3. absence ventricular isoelectric baseline
  4. variable ventricular rate
  5. QRS < 129 ULESS
    - BBB
    - accessory pathways
    - rate related aberrant conduction
  6. Fibrillary waves (fine < 0.5 or coarse > 0.5)
  7. fibrillary waves may mimic P wave
25
Q

treatment of cariogenic shock

A 
ABC
O2 
Morphine 
CORRECT 
- arrhythmia 
- electrolytes 
acid base balance 
PRESSOR SUPPORT 
NORADRENALINE and DOBUTAMINE
26
Q

definition treatment for chardiogenic shock

A

PCI
CABAG
thormbolysis
IABP

27
Q

S/E IABP

A 
- occlusion of renal artery 
central embolism 
infection 
dissection 
perforation 
heamoorrage 
may cause a. flutter ]
28
Q

definition of cardiogeneic shock

A
  • cardiac pump failure usual from MI, valvular failure or pericardial condition
29
Q

HTNsive Crisis

A

SEVERE HTN - > 180/ 120
Hypertensive urgency- severe HTN with NO EOD
Hypertensive emergency - Severe HTN w/ EOD

30
Q

Causes of HTNsive Crisis

A
  1. uncontrolled longstanding HTN
  2. Renal steonisis
  3. non compliance to HTNsive agents
31
Q

HTnsive crisis cardio signs

A 
Heart sound
 LVH 
strain 
murmur 
pulm medema
32
Q

what two test can demonstrate long standing HTN

A

LVH - seen on either ECG or ECHO

33
Q

goals treating HTNsive Crisis

A
  1. decrease diastolic 100-105mmHG
    initial bP - NOT exceed 25 %
    aim to lower over 2-4 hours
    switch to oral and aim diastolic 85/90 *over 203 months)
34
Q

treatment HTNsive Crisis

A
  1. sodium nitropurside
  2. Labetolol
  3. Others - glycemic titrate, hydrazine
35
Q

SVT treatment in stable

A
  1. Call for help
  2. Vagal
    - blow in a 10ml syringe to advance plunder with holdings in 1 dose
    - carotid message
    - cold H2o on hand and face
  3. Adenosine - 6mg, rapid push ± 12 mg X 2 doses
  4. BB - metoprolol
  5. CBB - Verapamil
36
Q

SVT long term tretment

A

pill in a pocket - BB or verapamil

37
Q

Unstable SVT

A

symmetrical CV

analgesic and sedation

38
Q

2 situations where u use Unsynchronized cardioversion

A

PVT

V. fib

39
Q

v. fib definition

A

rapid rate and chaotic rhythm irregular and no p wave

40
Q

treatment

v. fib

A 
check pulse 
call help 
CPR 
early defibrillation (US) 
- 120-200 J biphasic
41
Q

V.tach treatment stable

A

IV amiodarone
IV lignocaine
electrical cardioversion if unsuccessful

42
Q

V.tach treatment unstable

A

Synchronized cardioversion

analgesi

43
Q

WPW

A

Procanamide

Cather ablation

44
Q

pericarditis

A

NSAID PPI and cholchicine

45
Q

treatment of bradycardia

A 
1. call for her 
2, ATROPINE - 0.5mg bols max 3mg , repeat 3-5 minutes 
3. pacing or bridging inotrope 
pacing - TC or TV 
Ionotrop - dopamine, Adrenaline
46
Q

Definite bradycardia treatment

A

except

permanent pacemaker

47
Q

treatment of bradycardia in young adolescent

A

probably due to physiological therefore leave it

RCSI EMERGENCIES (5 decks)

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