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Spring ER > Cardiovascular Part 1 > Flashcards

Cardiovascular Part 1 Flashcards

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1
Q

What is signs and symptoms from imbalance between myocardial oxygen supply and demand with no elevation of biomarkers and no pathologic ST segment elevation

A

Unstable Angina

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2
Q

Acute chest pain lasts

A

<24 hours

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3
Q

Visceral pain feels

A

poorly localized and dull, heavy or aching

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4
Q

Initial approach to chest pain includes

A

prompt triage

Visceral pain, abnormal vitals, significant risk factors, dyspnea => place in bed, cardiac monitor, IV, oxygen, ECG

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5
Q

What PE characteristic increases the likelihood of AMI greatest

A

radiation to right arm or shoulder

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6
Q

Factors that decrease the likelihood of AMI

A 
Pleuritic
Positional
Sharp
Reproducible with palpation
Inframammary location
Not exertional
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7
Q

Who commonly has atypical presentations of ACS?

A 
Women
Nonwhite minorities
Diabetics
Elderly
Psych pts/AMS
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8
Q

Cardiac risk factors include

A 
Age > 40
Male or postmenopausal female
HTN
Smoking
High cholesterol
Diabetes
Truncal obesity
 Family history
Sedentary lifestyle
Cocaine use
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9
Q

Does absence of chest pain rule out MI?

A

No

33% do not have CP

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10
Q

Does chest wall tenderness on palpation rule out MI?

A

No

15% have this

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11
Q

Chest pain that is sharp or dull and is worse with breathing should consider

A

costochondritis

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12
Q

What cardiac enzyme is most sensitive for MI?

A

Troponin

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13
Q

What cardiac enzyme is best to see reinfarction

A

CK-MB

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14
Q

Define hypoxia

A

Deficiency in oxygen supply or availability to tissues

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15
Q

Define ischemia

A

Oxygen deprivation with inadequate removal of metabolites due to reduced perfusion. Occurs when there is an imbalance between oxygen demand and supply

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16
Q

Hearing rales on PE Is suggestive of

A

LV dysfx

left sided CHF

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17
Q

JVD, peripheral edema, hepatojugular reflex on PE is suggestive of

A

right sided CHF

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18
Q

Changes in II, III, & aVF indicate what infarct area and occlusion to which vessel

A

Inferior Infarct

RCA

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19
Q

Changes in lateral leads (I, aVL, V5, V6) indicate what infarct area and occlusion to which vessel

A

Lateral Infarct

Left circumflex

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20
Q

Changes in V1-V6 indicate what infarct area and occlusion to which vessel

A

Anterior

LAD (left anterior descending)

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21
Q

V1 with tall R waves and ST depression indicate what infarct area and occlusion to which vessel

A

Posterior MI

Right Coronary Artery

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22
Q

Changes precordial leads + I & aVL indicate what infarct area and occlusion to which vessel

A

Anterolateral

Left Main Artery

23
Q

Changes in II, III, aVF, and V1 indicate what infarct area and occlusion to which vessel

A

Inferoposterior MI

Right Coronary Artery

24
Q

What type of angina can demonstrate ST elevation on ECG

A

Prinzmetal

25
Q

PCI should goals are within _____ of ED arrival OR fibrinolysis within _____ if PCI cannot be done

A

90min

or fibrinolysis within 30min

26
Q

ABSOLUTE contraindications to fibrinolytics

A

Any prior intracranial hemorrhage
Known structural cerebral vascular lesion (e.g., arteriovenous malformation)
Known intracranial neoplasm
Ischemic stroke within 3 mo
Active internal bleeding (excluding menses)
Suspected aortic dissection or pericarditis

27
Q

Is history of GI bleed a contraindication to ASA in unstable angina/MI?

A

No

Only withhold in case of true allergy

28
Q

If true allergy to ASA exists, what should be used instead?

A

Clopidogrel

29
Q

If Clopidogrel is given when can the patient receive a CABG

A

Hold clopidogrel for 5 days if possible

should still give in ED if appropriate

30
Q

What drugs are used in PCI but not in fibrinolytics

A

GP IIb/IIIa Inhibitors:

Abciximab, Eptifibatide, Tirofiban

31
Q

When using unfractionated heparin, you should monitor _____.

Try to d/c after _____ hours to reduce risk of _____

A

Unfractionated Heparin:
Monitor PTT
d/c after 48 hrs to reduce risk of thrombocytopenia

32
Q

LMWH monitored by

A

Do not need to monitor PTT

33
Q

Nitrates should be used with caution in what type of MI?

A

Inferior MI

nitrates reduce preload and may cause hypotension due to RV involvement

34
Q

When should BB be used in ACS?

A 
Start oral (not IV) in pts with STEMI or NSTEMI within 24 hrs unless:
Signs of heart failure
  Low cardiac output state
   Increased risk for cardiogenic shock
   Prolonged PR, 
    2nd or 3rd degree heart block,
    active asthma, 
   reactive airway disease
cocaine use!
35
Q

What roles do ACEI play in MI treatment

A

should be started orally within 24hrs MI

-reduced mortality

36
Q

When should ACEI not be used in MI treatment

A

HOTN, renal failure, hx angioedema, renal artery stenosis

37
Q

How should postprocedural chest pain be approached?

A

ACS symptoms shortly after PCI should be assumed to have vessel closure until proven otherwise. Treat aggressively for ACS. Could also be pericarditis.

38
Q

Are cardiac risk factors good predictors of risk for MI or ACS?

A

NO

39
Q

A change in troponins 2 hours apart of _____ is significant, and can be seen in AMI

A

0.05

40
Q

RF for Cardiogenic Shock

A 
Elderly
Female
Acute or prior ischemic event
Prior medical hx
Hx MI
CHF
Diabetes
41
Q

MCC of cardiogenic shock

A

Large MI

–>pump failure

42
Q

Tx changes if pt has cardiogenic shock and acute MI

A

No Nitroglycerin if SBP <90

No BB

43
Q

Tx cardiogenic shock hypotension if no improvement from small fluids or if pulmonary congestion present

A 
Use vasopressors (Dopamine)
and/or
inotropes (dobutamine)
  • Dobutamine DOC if SBP>90
  • SBP <70 then atleast use dopamine
44
Q

If dopamine is ineffective in the treatment of hypotension secondary to cardiogenic shock the next DOC is

A

norepinephrine

45
Q

Cardiogenic shock + acute MI

best treatment targeted for MI

A

PCI preferred to thrombolytic

Mortality decreased with revascularization

46
Q

Do CHF symptom severity predict outcome?

A

Yes

47
Q

MC non-cardiac causes acute of CHF

A

noncompliance to diet/meds

48
Q

Normal Eject Fraction is

A

60%

49
Q

Pattern of progression respiratory symptoms in CHF

A

Exertional dyspnea
Paroxysmal nocturnal dyspnea
Orthopnea
Dyspnea at rest

50
Q

(+) hepatojugular reflex with

A

right sided failure

51
Q

Kerley B Lines on CXR

A

CHF

52
Q

Obesity raises/lowers BNP

A

lower

53
Q

BNP may be increased in

A

CHF
pulmonary HTN
PE
MI

54
Q

Standard initial treatment for CHF

A 
Cardiac monitoring
Pulse oximetry
Oxygen
12 Lead ECG, Labs, CXR
IV access
Frequent vitals
Foley cath if critical pt

Spring ER (10 decks)

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