CIS 4: Cardio Case

Question 1

What are 4 cardiovascular causes of chest pain that are an emergency and need to be ruled out in the ED?

Answer 1

• NSTEMI
• STEMi
• Pericardial tamponade
• Aortic dissection

Question 2

What are 2 pulmonary causes of chest pain which are emergencies and need to be ruled out in the ED?

Answer 2

• Pulmonary embolism (PE)
• Pneumothorax (PTX)

Question 3

Why endocrine abnormality can cause chest pain?

Answer 3

Hyperthyroidism

Question 4

What is the most common description of the chest pain associated with acute coronary syndrome?

Answer 4

Pressure + squeezing + sharp + burning

Question 5

What is the most common angina equivalent presentation?

Answer 5

Unexplained new-onset or ↑ exertional dyspnea

Question 6

Which 4 patient populations are more likely to have atypical presentations of acute coronary syndrome?

Answer 6

• Older pt’s (≥75 yo)
• Diabetes
• Impaired renal function
• Dementia

Question 7

What are some of the atypical sx’s of acute coronary syndrome which should raise concern?

Answer 7

• Epigastric pain
• Indigestion
• Stabbing or pleuritic pain
• ↑ dyspnea in absence of chest pain

Question 8

What is a protective factor for CVD?

Answer 8

HDL ≥60 mg/dL

Question 9

During the immediate treatment for acute coronary syndrome should oxygen be given if the O2 stat looks good?

Answer 9

Give O₂ regardless of saturation –> 2-4 L NC is good start

Question 10

What is the immediate tx for acute coronary syndrome?

Answer 10

• Morphine
• O₂
• Nitroglycerine
• Aspirin (non-enteric coated chewable)
• Beta-blocker if NOT contraindicated

Question 11

After getting an EKG immediately upon presentation for ACS, how often should you obtain one thereafter?

Answer 11

EKG q8h x3

Question 12

Which 3 findings in a patient with ACS require STAT cath lab?

Answer 12

• Uncontrollable chest pain
• New LBBB
• STEMI

Question 13

What is an absolute contraindication to use of nitroglycerin for presentation of ACS?

Answer 13

Use of PDE inhibitors within 24 hrs of presentation

Question 14

OMT may be beneficial to a cardiac patient, but care should taken in patients with what cardiac abnormality?

Answer 14

Arrhythmias

Question 15

Location of anterior chapman’s reflexes for myocardium, bronchus, upper and lower lung?

Answer 15

• Myocardium = 2nd ICS at SB
• Bronchus = 2nd ICS at SB
• Upper lung = 3rd ICS at SB
• Lower lung = 4th ICS at SB

Question 16

Where is the posterior chapmans reflex for the bronchus?

Answer 16

Lateral to T2 spinous process

Question 17

Before considering lymphatic tx’s for patient with HF what should be assessed?

Answer 17

Fluid status BEFORE tx - can the heart tolerate ↑ fluid return/circulation/stress?