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CEN cardiology (ACS) Flashcards

1
Q

Stable angina is

4 things to know

A

chest pain that occurs with physical exertion, short lived, relieved by NTG or rest, negative trop.

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2
Q

Unstable angina is

4 things to know

A

chest pain with little physical exertion, longer lasting, unrelieved, negative trop

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3
Q

NSTEMI three things to know

A

Plaque rupture, elevated trop, no ST segment elevation

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4
Q

STEMI three things to know

A

ST elevation, vessel(s) obstructed by thrombosis, elevated trop

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5
Q

Prinzmetal’s angina (variant angina) is

A

ischemia due to coronary vasospasm

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6
Q

Prinzmetal’s angina is caused by two things

A

stimulants and stress

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7
Q

3 things to know about Prinzmetal’s angina

A

cyclical pain at rest, ST elevation and pain resolve when vasospasm ends, beta-blockers may exacerbate d/t unopposed alpha stimulation

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8
Q

9 S/S of ACS

A
  1. chest tightness
  2. jaw pain
  3. left arm pain
  4. epigastric pain
  5. scapular discomfort
  6. N/V
  7. dysrhythmias
  8. diaphoresis
  9. dizziness
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9
Q

ACS presents as ______ in women sometimes

A

increased fatigue

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10
Q

diabetics are more likely to

A

have a silent MI

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11
Q

The best lab indicator of MI is

A

troponin

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12
Q

Trop elevation is noticed within

A

3-12 hours

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13
Q

trop elevation peaks at

A

10-24 hours

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14
Q

viagra and cocaine within 24 hrs

A

no nitro or beta blockers

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15
Q

inferior leads

A

II, III, aVF

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16
Q

Anterior leads

A

V1-V4 (V1 & V2 septal)

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17
Q

Lateral leads

A

I, aVL(high lateral), V5, V6

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18
Q

ischemia manifests as

A

ST depression and/or inverted or tall t-waves

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19
Q

Injury manifest as

A

ST elevation (STEMI) t wave may invert

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20
Q

Old injury shows as

A

deep and wide Q wave

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21
Q

STEMI/vessel occlusion

A

ST elevation in two contiguous leads

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22
Q

Inferior STEMI (II, III, aVF)

A

Most commonly RCA (supplies SA and AV nodes

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23
Q

5 S/S of Inferior STEMI (II, III, aVF)

A
  1. epigastric pain
  2. bradycardia resulting in hypotension
  3. 2nd degree heart block type 1
  4. risk of mitral valve regurgitation
  5. risk of papillary muscle rupture (new heart murmur)
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24
Q

Anterior (V1-V4)

A

Most common LAD (widow maker)

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25
9 S/S Anterior (V1-V4)
1. Crushing chest pain 2. ventricular dysrhythmias (VF) 3. tachycardia 4. feeling of impending doom 5. Bundle Branch Block 6. SOB 7. Crackles in lungs and S3 (caused by L. vent failure) 8. 2nd degree heart block type 2 (ominous sign) 9. New onset heart murmur-VSD-emergency
26
Right Ventricle MI
26
Right Ventricle MI
30-50% of inferior MIs
27
Right ventricle MI ekg needs
Get a right sided EKG
28
Right Ventricle MI is usually
proximal RCA
29
4 S/S of Right ventricle MI
1. JVD 2. hypotension 3. ST elevation at V4R (5th ICS, right MCL)
30
TX for Right ventricle (three things)
1. use caution with preload reducing agents (NTG and Morphine) 2. NS bolus 3. Dobutamine infusion (to increase contractility)
31
Lateral MI is usually
LAD/circumflex
32
Lateral MI shows in
I and aVL (high lateral) V5 and V6
33
Lateral MI has...
reciprocal changes in II, III, and aVF
34
Posterior MI has elevation in
V7-V9 or depression in V1 and V2
35
8 treatments for STEMI
1. Oxygen for SpO2 less than 94% or resp distress 2. NTG (0.4 SL) q 5 up to 3x. Hold for low SBP, Low HR, viagra. 3. ASA 162-324. 4. PCI (goal 90 min or less) or fibrinolytic if PCI more that 90-120 min. (reperfusion dysrhythmias AIVR and VT good) 5. beta-blockers early for HTN (not with coke) 6. ACE/ARB reduce size, improve remodeling 7. antiplatlets (plavix, asa, effient, brilenta) 8. anticoagulants
36
Aortic dissection is
a tear in the intimal layer of aorta
37
Aortic dissection is caused by 5 things
1. age above 60 2. cocaine use 3. Trauma (1st and 2nd rib fx) 4. heart disease 5. connective tissue disease (Marfans Ehlers-Danlos)
38
Three ways to DX aortic dissection..
Transthoracic echo (TTE) transesophageal echo (TEE) or CT/MRI chest (widened mediastinum obscured aortic knob)
39
7 things for TX of Aortic dissection
1. support ABCs 2. anticipate rapid deterioration 3. 2 large bore IVs 4. Maintain SBP 100-120 and HR 60-80 5. IV beta-blockers first 6. analgesia 7. prep for OR
40
6 H's of cardiac arrest
hypovolemia, hypoxemia, hydrogen ion (acidosis), hyper K, hypo K, hypothermia
41
5 T's of cardiac arrest
Toxins, Trauma, tension pneumothorax, Tamponade, thrombosis
42
traumatic cardiac arrest (penetrating cardiac tamponade)
prep for thoracotomy
43
four maternial cardiac arrest causes
DIC, embolism, eclampsia, abruption
44
three things to know for maternal compressions
1. chest compressions higher on the chest. 2. displace uterus to the left to avoid vena cava syndrome 3. prep for emergency c-section
45
three things for ROSC
1. secure airway ETCO2 35-45 SpO2 >90 2. increase circulation with 1-2 L bolus and pressor by weight to SBP >90. 3. Targeted Temperature Management 32-36 C for 24 hours.
46
5 things for Stable Tachycardia (alert, normal BP)
1. vagal maneuvers 2. adenosine 6 mg rapid push 3. calcium channel blockers or beta blockers for stable svt. 4. amiodarone 150 for stable v-tach 5. lidocaine or procainamide for PVC's and Sotalol for stable V-tach.-monitor for hypotension and long QT.
47
Unstable Tachycardia is
SVT or VT with a pulse, conscious, but crashing
48
Unstable tachycardia TX is
Sync cardioversion (consider sedation first)
49
AICD inappropriately firing
medical management of rate or magnet over generator
50
AICD persistent VT/VF
shock, keep pads 10 cm away from AICD
51
a-fib with RVR has rate
greater than 100
52
A-flutter has
saw tooth patteren, 2:1, 3:1, or variable
53
Wolff-Parkinson-White syndrome (WPW)
tachycardia and delta wave ) short PR, slurring of upstroke of Q wave
54
Prolonged QT is
> 1/2 the total R-R length
55
6 meds that can cause long QT
1. procainamide and sotalol 2. mycin ATBs 3. Haldol and lithium 4. Tricyclics like Elavil and Tofranil 5. antihistamines 6. antifungals
56
ABCDE of long QT
A-antiArrhythmics (sotolol, amiodarone, procainamide) B- antiBiotics (Flouroquinolones, macrolides, aminioglycosides) C-antiCycotics (haldol, risperidone, thorazine, geodon) D- antiDepressants (SSRIs, TCAs) E- antiEmetics (ondansetron, droperidol, compazine)
57
torsades de pointes is
polymorphic VT due to prolonged QT
58
Torsades TS if there is a pulse
cardiovert and mag (slow infusion)
59
Pulseless torsades TX is (4 things)
1. BLS 2. defib 3. epi 4. 2g mag IV push
60
5 causes of bradycardia
1. respiratory distress 2. aging 3. CAD 4. Cardiac defects 5. medication induced
61
5 S/S of bradycardia
1. hypotension 2. AMS 3. signs of shock 4. cardiac ischemia 5. acute heart failure
62
1st degree heart block is...
prolonged PR interval >.20, consistent PR and R to R intervals (if the r is far from P then you have first degree)
63
2nd degree Type 1
longer, longer, longer Drop (progressively longer pr until blocked impulse)
64
2nd degree type 2
consistent PR interval with random dropped beats | if some Ps dont get through then you have mobitz 2
65
Third degree heart block
R to R is consistent, P waves are not | if your p's and q's dont agree, then you have third degree
66
bradycardia TX 5 things
1. correct underlying cause (BVM for resp distress) 2. atropine 1 mg IVP q 3-5 (low degree blocks) 3. transcutaneous pacing 4. Epi drip (2-10 mcg/min) or Dopamine (5-20 mgc/kg/min) 5. Pacemaker for refractory bradycardia or HB.
67
Two things to know about Brady TX
1. atropine is ineffective for high degree HB and heart transplants. 2. Isoproterenol (Isuprel) for transplanted hearts
68
Transcutaneous Pacing TCP two things to know
1. anterior-posterior pad placement is prefered | 2. start at rate of 60-80 with 60 mA, increase to capture with palpable pulse (not carotid)
69
Three things that cause Pericarditis
infection, MI (dressler's), renal failure
70
Pericarditis is
inflammation of the pericardial sac
71
6 S/S of pericarditis
1. sudden onset of retrosternal pain exacerbated by inspiration, activity, and supine position 2. pain relieved by leaning forward or sitting up 4. friction rub best heard leaning forward 3. tachycardia 4. tachypnea 5. low grade fever
72
DX for pericarditis (three things)
1. CXR 2. Echo 3. EKG
73
EKG changes for pericardidtis 2 things
1. concave global ST elevation in most leads without reciprocal changes 2. tall peaked T-waves in all leads except aVR
74
endocarditis is
inflammation of the endocardium
75
endocarditis is caused by three things
cardiac surgery, IV drug use, and body piercing affecting the cardiac valves
76
S/S of endocarditis 11 things
fever, chills, night sweats, myalgias, new onset murmur, pleuritic chest pain, splinter hemorrhages in nail beds, conjunctival petechiae, Osler's nodes (tender nodules on digits), Janeway lesions (macules on palms and soles, Roth spots (retinal hemorrhages)
77
Pericarditis TX (three things)
NSAIDs, allow to lean forward, no NTG
78
Endocarditis DX 4 ways
1. increased WBC 2. blood cultures 3. increased ESR 4. echo to assess valves
79
TX of endocarditis (3 things)
IV ATB, prep for admission, possible valvular repair
80
Heart failure is
inadequate cardiac output, stroke volume, and oxygen delivery to tissues. increased peripheral vasoconstriction and BNP over 100
81
systolic HF is
the inability to pump properly
82
diastolic HF is
the inability to fil adequately
83
Left sided HF S/S 8 things
1. SOB 2. paroxysmal nocturnal dyspnea 3. crackles 4. S3 heart sound 5. Kerly B lines on x-ray 6. pulmonary edema 7. dyspnea 8. most common from anterior MI
84
right sided heart failure 6 things
1. JVD 2. peripheral edema 3. acites 4. hepatomegaly 5. increased CVP pressure 6. usually from Cor pulmonale, pulmonary HTN, or RV MI.
85
Treatment for heart failure (6 things)
1. support ABC's 2. cardiac monitoring. 3. titrate oxygen to >90% 4. consider NIPPV 5. caution with IV fluids and loop diuretics (watch K+) 6. vasodilators (NTG, ACE, ARB)
86
hypertensive crisis is
SBP >180 or DBP > 120 and impending organ damage
87
hypertensive urgency is
SBP >180 DBP > 120 but no impending organ damage, can be treated over days
88
7 S/S of hypertensive emergency
1. Altered LOC 2. chest pain 3. dizziness 4. nose bleed 5. headache 6. seizures 7. visual disturbances
89
5 diagnostics for hypertensive emergency
1. 12 lead 2. CXR 3. urinalysis 4. BUN 5. Creatinine
90
Three things for TX of hypertensive emergency
1. O2 2. IV 3. consider art line (allens test, transducer leveled at 5th ICS AAL)
91
two goals of HTN crisis
1. NTG or Nipride to decrease MAP by 25% in two hours | 2. SBP 140-160 slowly
92
labetalol is best for...
slower onset and pregnant women
93
pericardial tamponade is
life threatening condition where the pericardial sac accumulates additional fluid (20-50 mL)
94
three things that cause pericardial tamponade
1. pericarditis 2. trauma 3. MI leading to obstructive shock

CEN Cardiology (4 decks)

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