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ED > Cardio ER > Flashcards

Cardio ER Flashcards

1
Q

What is the most common cause of ischemic heart dz

A

Atherosclerosis of coronary arteries

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2
Q

Risk factors of CAD

A

Age >50, Family Hx, Male, smoker, Htn, Hyperlipidemia, DM

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3
Q

Presentation of stable angina

A

CP lasting 5-10 mins

Relieved by rest and SL nitro

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4
Q

Treat a stable angina in ER

A

1) Cardiac work up
2) ASA
3) O2
4) Nitrates if needed
5) Follow up in office

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5
Q

EKG, Troponin, and CXR findings in Stable angina

A

EKG-unchanged
Troponin- neg
CXR- neg

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6
Q

Presentation of unstable angina

A

1) New exertional CP

2) Someone with previous stale CAD that now has angina a rest and no relief with nitro

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7
Q

Work up unstable angina

A

Cardiac work up, ASA, O2, nitrates, Admit to tele to have angiogram scheduled, Cardiac consult, BB, Heparin drip, CCB

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8
Q

What does a cardiac work up consist of

A 
Troponin
EKG
CXR
CBC
CMP
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9
Q

What do my EKG, Troponin and CXR show in unstable angina?

A

1) EKG- ST depressions at time of pain, and normal with no pain
2) Troponin- sligh elevation
3) CXR- normal

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10
Q

What is unstable angina a precursor for?

A

MI

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11
Q

What is variant angina

A

Coronary artery vasospasm

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12
Q

What will EKG show in variant angina at the time of pain

A

ST elevations

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13
Q

What will the troponin show in variant angina

A

Negative

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14
Q

Treat my variant angina

A

Go home

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15
Q

I have cp while waling up the stairs at school. By the time I have sat down in my seat for a few minutes the pain subsides . If I were in your ED would you admit me?

A

No- Stable angina

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16
Q

I woke up last night at 2am with intense CP, I rushed to the ED and the pain had subsided when I got there and my EKG and biomarkers are negative. What should you do for me

A

Refer to cardiology - Variant angina

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17
Q

I am having severe substernal crushing CP. My EKG shows ST elevations in II and III. Help Me!!

A

Straight to Cath lab in <90 mins-STEMI

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18
Q

I have had CP in the past, but it has always resolved. This time I have taken my nitro and rested, but the pain has not been relieved. My EKG shows ST depressions, but my serial troponins are negative. What is my most likely diagnosis

A

Unstable Angina

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19
Q

How long does typical CP last for an MI

A

15-30 mins

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20
Q

In an MI do I respond to nitro

A

Nope

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21
Q

Describe typical CP in an MI

A

severe, crushing substernal pain

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22
Q

Associated symptoms with MI

A

SOB, Diaphoresis, N/V

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23
Q

Elderly presentation of MI

A

Weakness and CP

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24
Q

DM presentation of MI

A

Diaphoretic, holding chest, but no CP

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25
Q

Women presentation of CP

A

SOB, easy fatigability

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26
Q

How many patients will die of V. Fib arrest due to MI in ED

A

1 in 5

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27
Q

What is a Q wave

A

Old, transmural infarction

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28
Q

What do ST elevations mean?

A

Transmural ischemia

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29
Q

What do T wave inversions mean

A

Ischemia

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30
Q

What do ST depressions mean?

A

Ischemia

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31
Q

How long does it take to see a rise in troponin

A

3-6 hours

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32
Q

Can you have an elevated troponin without an MI?

A

Of course. Renal dz is the most common

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33
Q

I have typical CP that is not relieved with nitro or rest. My EKG is normal, but my troponin is elevated? Help me!!

A

1) Oxygen
2) Aspirin 325 chewed
3) Nitro
4) Morphine
5) Anticoagulation
6) BB/rate control

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34
Q

What is cardiogenic shock characterized by

A

depression of myocardial contractility, decreased Cardiac output

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35
Q

What are risk factors for cardiogenic shock

A

Elderly, female, impaired EF, Extensive infarct

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36
Q

How to patients with Cardiogenic shock present

A

Ill, Tachy, lethargic, hypotensive, JVD, crackles or rales

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37
Q

Drug you give me for Cardiogenic shock

A

PRESSORS- dopamine

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38
Q

What should you not give me if I am hypotensive in cardiogenic shock

A

beta blockers

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39
Q

If I am having cardiogenic shock due to AMI what do you do for me

A

PCI or balloon pump until you can get to PCI

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40
Q

I did some coke what drug is contraindicated in me

A

beta blockers

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41
Q

What does dresslers syndrome consist of

A

Pericarditis, Fever, leukocytosis, pericardial or pleural effusion (Friction rub)

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42
Q

How long after a heart attack can you get dresslers syndrome

A

1-6 weeks

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43
Q

How do you manage my dresslers syndrome

A

Supportive care- admit

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44
Q

What is contraindicated if I have dresslers syndrome

A

Anticoagulant- can cause hemorrhage or tamponade

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45
Q

I have JVD, Pitting edema, and clear lungs - what do I have

A

Isolated Right heart failure

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46
Q

I have crackles, rales and orthopnea, but no JVD or pitting edema- what do I have

A

Isolated LEft heart failure

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47
Q

I have JVD, piting edema, orthopnea, crackes and rales- what do I have

A

Combined right and left HF

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48
Q

Causes of Right heart failure

A

Acute:MI or PE
Chronic: pulm stenosis, COPD, pulm Htn, Left sided

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49
Q

Causes of Left heart failure

A

Infarct

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50
Q

Most common symptoms of CHF

A

SOB, DOE

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51
Q

On exam of left CHF what heart sound can be heard

A

S3

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52
Q

What are the CXR findings seen in CHF

A

Interstitial pulmonary edema

Kerly B lines

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53
Q

Treat my CHF exacerbation in the ER

A

1) IVLasix
2) Bipap
3) Vasodilators (nitro)
4) Positive inotropes
5) Morphine

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54
Q

I am hypertensive in a CHF exacerbation treat me

A

Nitropureside

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55
Q

I am hypotensive in a CHF exacerbation treat me

A

Pressors

Cannot give lasix or nitro

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56
Q

How many patients with infective endocarditis will have a murmur

A

90%

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57
Q

MCC and valve of acute endocarditis

A

Staph tricuspid

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58
Q

MCC in IVDA

A

Staph

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59
Q

MCC in normal people

A

Strep viridians

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60
Q

MCC valves infected in subacute

A

Aortic +Mitral

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61
Q

Major criteria of Jones criteria

A

1) Positive blood culture

2) Evidence of endocardial involvment

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62
Q

Minor criteria of Jones criteria

A

1) Predisposition
2) Fever >38
3) Vascular phenomena
4) Immunologic phenomena
5) Microbiological evidence
6) Echo

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63
Q

Endocarditis is diagnosed by what

A

need 2 major or 1 major and 3 minor from jones criteria

64
Q

How many blood cx do you need for an endocarditis patient

A

3

65
Q

Emperic tx of endocarditis

A

IV Pen G or ceftriaxone

IF MRSA-vanco

66
Q

What is myocarditis

A

Inflammation of the heart muscle

67
Q

MCC of myocarditis

A

Viral

68
Q

I am febrile, with tachycardia out of proportion to fever with a pleural rub,– what lab value of mine will be elevated?

A

CK-MB

ESR

69
Q

I have ST elevations in V1-V6

A

Pericarditis

70
Q

I have CP that is better with leaning forward

A

Pericarditis

71
Q

MCC of pericarditis

A

Idiopathic

72
Q

Tx of pericarditis

A

3 weeks of NSAIDS, get echo

73
Q

Becks triad

A

Hypotension, Kussmals sign, pulsus paradoxis

74
Q

What is Kussmals sign

A

JVD with inspiration

75
Q

What is pulsus paradoxis

A

drop on pulse with inspiration

76
Q

I have muffled heart sounds and hypotension treat me

A

Emergent pericardiocentesis

77
Q

I have breast cancer and I just took a long plane ride to see my new grandchild. Now I am presenting to your ER with sudden onset SOB- Work up for me

A

High risk- CTA

78
Q

I am a healthy 23 year old male with sudden onset cp – work me up for PE

A

Low risk- D dimer

79
Q

What percentage of people diagnosed with PE have a predisposing factor

A

90%

80
Q

Most common finding on EKG for PE

A

Tachycardia

81
Q

Most specific finding on EKG for PE

A

S1Q3T3

82
Q

What is the “Gold standard” for PE diagnosis

A

pulmonary angiography

83
Q

What is the “gold standard” for DVT diagnosis

A

Venogram

84
Q

When do you do a V/Q scan

A

Allergic to dye

Elevated Bun/Cr

85
Q

Treat my stable PE

A

Heparin bolus then drip
Admit
Convert to coumadin

86
Q

What must you do before starting anticoagulation

A

guaiac

87
Q

Therapeutic INR for coumadin

A

2.5

88
Q

PT is used to monitor what

A

Heparin

89
Q

Treat my unstable PE

A

Embolectomy or TPA

90
Q

Does Lovenox work for PE…what about DVT

A

No, Yes

91
Q

What is a hypertensive Urgency

A

BP >115 diastolic

92
Q

What is a hypertensive Emergency

A

BP>115 with signs of end organ damage

93
Q

What is end organ damage?

A

Blurred vision, elevated troponin, HA, renal problems, CP

94
Q

What is malignant hypertension

A

Htn emergency +papilledema

95
Q

Treat my Htn emergency

A

Nitropresside

96
Q

How fast should you lower my bp?

A

Not more than 25-30% in the first hour, return to baseline within 24-48 hrs

97
Q

I have sharp tearing pain that radiates up into my shoulder blades– what will my CXR look like and what other imaging should you get

A

1) Mediastinum widening

2) CTA of chest, abdomen and pelvis with IV contrast

98
Q

What is the “gold standard” for Aortic aneurysms

A

Aortography

99
Q

My aortic aneurysm involves the ascending aorta- do i need surgery

A

Yes- I have type A in stanford classification

100
Q

My aortic aneurysm does not involve the ascending aorta- do i need surgery

A

No- mange me medically - I have type B in stanford classifications

101
Q

I have a pulsiile abdominal mass and right hip pain- what should you do

A

Call vascular NOW

102
Q

Manage my dissecting aneurysm

A

IV Esmolol (lower BP)
Prep for OR
2 large Bore IV

103
Q

Name 2 signs of retroperitoneal bleeding

A

Cullen, grey turners

104
Q

What is another cause of retroperitoneal bleeding

A

Coumadin

105
Q

I am 85 and experiencing abdominal pain after eating with a syncopal event- what diagnostic test will you get, and which is the “gold standard”

A

1) CT of the abdomen with IV contrast

2) Arteriography

106
Q

Treat my messinteric ischemia if the CT detected a thrombus

A

Heparin drip

107
Q

Treat my messinteric ischemia if no thrombus

A

Admit, NPO and bowel rest

108
Q

What are the 6 P’s

A

pain, pallor, paralysis, pulselessness, paresthesias, and polar (for cold).

109
Q

What is the work up for extremity ischemia

A

1) Bedside doppler

2) CT with run off

110
Q

What is the treatment for confirmed extremity ischemia

A

1) Heparin drip

2) Call vascular

111
Q

What is virchows triad

A

1) stasis of blood flow
2) endothelial injury
3) hypercoagulability

112
Q

I just had an IV in and now I have redness, tenderness along that vein. what test do I need. and if that test is negative what do you do with me

A

Doppler- warmth, elevation, NSAIDS

113
Q

If I have a positive doppler of a superficial thrombophlebitis what do you do with me

A

Out patient follow up- can communicate with outside

114
Q

What is the Sign of pain with dorsiflexion of the foot, and what does it indicate

A

Homans sign- DVT

115
Q

I have unilateral pain and edema of my right leg- what test should you do

A

Doppler

116
Q

I have a positive doppler fir a DVT with no PE symptoms- treat me!

A

Lovenox with bridging to coumadin

117
Q

I have elevated venous pressure in my upper body –why?

A

Malignancy- Lung cancer (70%)

118
Q

Management of SVC

A

Supportive- O2, Diuretics, steroids, head elevation

119
Q

Syncope with a prodrome

A

Psychogenic or neurogenic

120
Q

Syncope without prodrome

A

Cardiac

121
Q

Work up of syncope

A

Work up what you think it is

121
Q

Work up of syncope

A

Work up what you think it is

121
Q

Work up of syncope

A

Work up what you think it is

122
Q

What can cause High output CHF

A

Anemia or thyroxicosis

122
Q

What can cause High output CHF

A

Anemia or thyroxicosis

122
Q

What can cause High output CHF

A

Anemia or thyroxicosis

123
Q

I have unilateral sharp stabbing pain in the temporal region of my head- what do you do with me?

A

Temporal arteritis-> High dose prednisone 60mg

Biopsy to temporal artery

123
Q

I have unilateral sharp stabbing pain in the temporal region of my head- what do you do with me?

A

Temporal arteritis-> High dose prednisone 60mg

Biopsy to temporal artery

123
Q

I have unilateral sharp stabbing pain in the temporal region of my head- what do you do with me?

A

Temporal arteritis-> High dose prednisone 60mg

Biopsy to temporal artery

124
Q

What test is elevated in temporal arteritis

A

ESR>50

124
Q

What test is elevated in temporal arteritis

A

ESR>50

124
Q

What test is elevated in temporal arteritis

A

ESR>50

125
Q

I have sinus bradycardia treat me

A

1) IV atropine (Up to 2 doses)
2) If Atropine doesn’t work - pace
3) Call cardio- may have pacer placed

125
Q

I have sinus bradycardia treat me

A

1) IV atropine (Up to 2 doses)
2) If Atropine doesn’t work - pace
3) Call cardio- may have pacer placed

125
Q

I have sinus bradycardia treat me

A

1) IV atropine (Up to 2 doses)
2) If Atropine doesn’t work - pace
3) Call cardio- may have pacer placed

126
Q

I have A fib treat me

A

1) IV Cadizem

2) Cardiovert

126
Q

I have A fib treat me

A

1) IV Cadizem

2) Cardiovert

126
Q

I have A fib treat me

A

1) IV Cadizem

2) Cardiovert

127
Q

Before you cardiovert what test must you have

A

TEE

127
Q

Before you cardiovert what test must you have

A

TEE

127
Q

Before you cardiovert what test must you have

A

TEE

128
Q

If you have new onset A fib can you cardiovert

A

yes if less than 48 hours

128
Q

If you have new onset A fib can you cardiovert

A

yes if less than 48 hours

128
Q

If you have new onset A fib can you cardiovert

A

yes if less than 48 hours

129
Q

Treat my SVT

A

1) Increase vagal tone
2) Adenosine (up to 3 doses)
3) IV vardizem or BB

129
Q

Treat my SVT

A

1) Increase vagal tone
2) Adenosine (up to 3 doses)
3) IV vardizem or BB

129
Q

Treat my SVT

A

1) Increase vagal tone
2) Adenosine (up to 3 doses)
3) IV vardizem or BB

130
Q

Treat my unstable V tac

A

cardiovert

130
Q

Treat my unstable V tac

A

cardiovert

130
Q

Treat my unstable V tac

A

cardiovert

131
Q

Treat my stable V tac

A

IV antiarrhythmic

131
Q

Treat my stable V tac

A

IV antiarrhythmic

131
Q

Treat my stable V tac

A

IV antiarrhythmic

132
Q

Treat my V fib

A

1) CPR
2) Shock
3) CPR
4) Rhythm/pulse chek
5) Shock
6) Epi
7) CPR
8) Rhythm/pulse check
9)

132
Q

Treat my V fib

A

1) CPR
2) Shock
3) CPR
4) Rhythm/pulse chek
5) Shock
6) Epi
7) CPR
8) Rhythm/pulse check
9)

132
Q

Treat my V fib

A

1) CPR
2) Shock
3) CPR
4) Rhythm/pulse chek
5) Shock
6) Epi
7) CPR
8) Rhythm/pulse check
9)

ED (7 decks)

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