Chest Pain and Cardiac Emergencies

Question 1

How soon after arrival does an EKG need to be done in a patient with chest pain?

Who has set this guideline?

Answer 1

Within 10 minutes

JACHO

Question 2

If there is ST-depressions or signs of ischemia in leads II, III, and aVF why can you not give nitroglycerin?

What type of MI is this? What arteries are affected?

Answer 2

Right ventrical is load pre-dependent, can’t stop the squeeze

Inferior Leads, RCA and or LCx

Question 3

For serum biomarkers, what is the timing of orders?

Answer 3

Obtain troponin at arrival and again 3 hours later, this is because Troponin will begin to elevate 3 hours after onset. Peak is 12 hours.

Question 4

What is the initial management for ACS?

Who can’t get nitroglycerin?

Answer 4

• ABC, IV, O2, Monitor
• Concern for ACS: chew 325mg non-enteric coated ASA and nitroglycerin for active CP

Right sided MI or patients of PD5-inhibitors

Question 5

A patient should be door to balloon within how many minutes?

Patient should be started on anticoagulation, what are you starting?

Answer 5

90 minutes

Start with heparin, can also use Clopidogrel

Question 6

Will there be an elevated troponin in an NSTEMI?

Answer 6

Yes

Question 7

The classic symptoms of chest pain radiating to the left arm and jaw, along with diaphoresis and anxiety, are suggestive of what clinical diagnosis?

What is the initial work-up?

Answer 7

Coronary Artery Disease
Myocardial Infarction or Ischemia

ECG to look for any signs of ischemia

Question 8

What is the best test for diagnosing cardiac tamponade?

What work-up modality is both theraputic and diagnositic in tamponade?

Answer 8

ECHO

Pericardiocentesis