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EM quiz readings > Chest pain Quiz - Ch 24 > Flashcards

Chest pain Quiz - Ch 24 Flashcards

1
Q

what is the difference between primary and secondary cardiomyopathy

A

primary - effect myocardium
secondary - associated with other specific systemic disorders.

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2
Q

What is the MC type of cardiomyopathy? what are the subtypes of this cardiomyopathy?

A

dilated

peripartum dilated CM
idiopathic dilated CM (MC)

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3
Q

what is the clinical presentation of DCM (both symptoms and PE)

A
  • Systolic heart failure symptoms (dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea)
  • PE shows rales, dependent edema, enlarged liver, holosystolic murmur.
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4
Q

what are the diagnostic studies used in DCM and what do they show?

A
  • EKG - LVH, LAE, Q waves, poor R wave progression
  • Echo - decreased ejection fraction, ventricular enlargement, increased systolic/diastolic volumes. (definitive)
  • CXR - enlarged cardiac silhouette, biventricular enlargement, pulmonary vascular congestion.
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5
Q

what is the process of ER care for a patient with DCM exacerbation

A
  • establish IV, O2, and cardiac monitoring
  • heart failure standard therapy (diuretics and vasodilators?)
  • complex ventricular ectopy = amiodarone 150mg IV over 10 min then 1 mg/min for 6 hours
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6
Q

what is the chronic therapy for DCM

A
  • diuretics and digoxin (symptomatic not for survival)
  • ACE and carvedilol (improves survival)
  • LVAD while awaiting heart transplant
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7
Q

what is the MCC of dilated cardiomyopathy

A

myocarditis

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8
Q

what is myocarditis and what causes it

A

inflammation of myocardium due to systemic disorder or a viral or bacterial etiology

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9
Q

what is the clinical presentation of myocarditis

A
  • nonspecific sx such as myalgias, HA, rigors, fever, and tachycardia.
  • commonly presents with pericarditis so may see chest pain and pericardial friction rub
  • severe = DOE, rales, pedal edema, cardio shock
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10
Q

what are the diagnostic studies used in myocarditis and what do they show

A
  • EKG - normal or nospecific findings (AV block, prolongs QRS, ST elevation, PR depression)
  • CXR - norm or pulm congestion if severe
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11
Q

what is the treatment of myocarditis patients in ED

A
  • admission w supportive care
  • abx
  • if heart failure sx then ICU admission
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12
Q

what do LVADs do

A

aids in augmenting left ventricular output, used in severe cardiomyopathies

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13
Q

what are key concepts to recall if a patient comes into the ED with an LVAD

A
  • do not do CPR (if you dislodge the LVAD it can cause hemorrhage)
  • auscultate for the “Whirr” of the LVAD. if its not heard, consider changing the battery and controller but DO NOT disconnect it.
  • if Whirr is heard obtain BP via doppler, place pt on monitor, obtain IV access, admin normal saline bolus.
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14
Q

What are common complications of LVAD and how do you treat them

A
  • infection of abdominal wall - Abx
  • anemia secondary to red cell destruction from pump or hemorrhage from anticoags - blood transfusion
  • thromboembolic events - heparin
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15
Q

if a patient presents with an LVAD and has none of the common complications and has hypotension and/or right ventricular failure, what do you do?

A

admin pressors and contact LVAD coordinator

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16
Q

what characterizes hypertrophic cardiomyopathy

A
  • assymetric left and/or right ventricular hypertrophy primarily involving the intraventricular septum.
  • decreased compliance of LV and diastolic dysfunction
  • normal EF
  • hereditary!
17
Q

what is the presentation of hypertrophic cardiomyopathy

A
  • DOE, chest pain, palpitations, syncope
  • PE - S4, systolic ejection murmur heard best at lower sternal border or apex. no radiation
  • murmur enhanced by valsalva/standing and decreased with squatting
18
Q

What are the diagnostic studies used in hypertrophic cardiomyopathy and what do they show

A
  • EKG - LAE and LVH. deep S waves with large septal Q waves
  • echo - septal hypertrophy
19
Q

what is the mainstay of treatment for hypertrophic cardiomyopathy

A

beta blockers (atenolol)

20
Q

what is restrictive cardiomyopathy and what usually causes it

A
  • a disorder where ventricular filling is restricted (diastolic dysfunction)
  • caused by sarcoidosis, amyloidosis, scleroderma, hemachromatosis, ect.
21
Q

what is the clinical presentation of restrictive cardiomyopathy

A
  • dyspnea, orthopnea, pedal edema in the absence of cardiomegaly or systolic dysfunction
  • PE shows S3/4 gallop, rales, JVD, inspiratory JVD, hepatomefaly, ascited
22
Q

what are the diagnostic studies for hypertrophic cardiomegaly

A
  • EKG - nonspecific
  • CXR - signs of heart failure but no cardiomegaly
23
Q

what is the plan for someone who comes into the ED with acute exacerbation of hypertrophic cardiomyopaty

A
  • symptom control w ACE and diuretics
  • corticosteroids for sarcoidosis
  • chelation for hemochromatosis
24
Q

what is pericarditis and its etiologies

A
  • inflammation of layers covering the heart
  • viral, fungal, bacterial.
  • could also be post myocarial infarction (dresslers syndrome)
25
Q

what is the presentation of a patient with pericarditis

A
  • sharp/stabbing precordial or restrosternal chest pain that may radiate to the back, neck or shoulder or arm (left trapezial ridge MC)
  • worse with supine, better with sitting up and forward
  • Viral prodrome, fever, dyspnea, dysphagia
  • pericardial friction rub at lower left sternal border
26
Q

what are the four stages of pericarditis that present on the EKG

A
  1. diffuse ST elevation with PR depression
  2. ST’s normalize and T wave amplitude decreases
  3. T wave inversion.
  4. resolution and normal EKG
27
Q

what would a CXR show in pericarditis

A

usually normal but could show enlarged cardiac silhouette is a large pericardial effusion is present.

28
Q

what is the treatment for patients in the ED with pericarditis

A

NSAIDS
(ibuprofen or colchicine)

29
Q

what is non traumatic cardiac tamponade? what does it result in?

A

when fluid accumulates in the pericardial space and eventually exceeds the filling pressure of the right ventricle, cardiac tamponade occurs resulting in restricted filling and decreased cardiac output.

30
Q

what is the clinical presentation of nontraumatic cardiac tamponade

A
  • mild-severe shock.
  • MC complaint is dypsnea
  • PE - tachycardia, low systolic BP, narrow pulse pressure.
  • pulsus paradoxus!!!! (drop in systolic >10 mmHg during normal inspiration
31
Q

what are the diagnostic studies used in nontraumatic cardiac tamponade

A
  • EKG - low voltage QRS complexes and ST elevations with PR depression. (similar to pericarditis)
  • electrical alternans is classic but uncommon
  • echo - large pericardial effusion w RA or RV collapse.
32
Q

what is the treatment plan for nontraumatic cardiac tamponade in hte ER

A
  1. 2 large bore IVs, O2, continuous cardiac monitoring
  2. IV fluid bolus
  3. pericardiocentesis
33
Q

what is constrictive pericarditis and what does it result it

A

pericardial injury and inflammation that leads to abnormal diastolic filling of the cardiac chambers

34
Q

what is the presentation of constrictive pericarditis

A
  • exertional dyspnea, pedal edema, hepatomegaly, ascities.
  • Kussmaul’s sign!! (inspiratory neck vein distention)
35
Q

what are the diagnostics for constrictive pericarditis

A
  • EKG - nonspecific but can see low volt QRS and inverted T waves
  • CT, MRI , or Doppler echo helpful for dx!
36
Q

what is the tx for constrictive pericarditis?

A

surgical pericardiectomy

EM quiz readings (43 decks)

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