Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

SD: Hospital Medicine > Common Hospital Cardiac Issues > Flashcards

Common Hospital Cardiac Issues Flashcards

1
Q

what are some sysmptoms suggestive of ACS?

A

distress/unwell

diaphoresis

Levine’s sign

EKG → > 1 mm elevation in 2 continguous leads, new LBBB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

patient demographic that can present w/ “atypical” symptoms

A

women

elderly

diabetics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

our initial evaluation to rule out ACS is based on what two things?

A

history & EKG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what might cause false positives troponin levels?

A

renal disease

myocarditis

cardiac contusion

recent cardiac surgery or cath

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

criteria that makes somebody high risk for ACS

A

ST elevation or new LBBB

ST depression or T inversion

CP with hemodynamic instability

dynamic EKG changes

known CAD with reminiscent paint

high risk history +/- positive tropnin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

criteria that makes somebody moderate risk for ACS

A

atypical CP w/ CAD & normal or unchanged EKG

CP w/ nonspecific ST depression

low risk histoyr w/ normal EKG and + troponin

angina patient w/ rest angina w/ spontaneous resolution or primarily after NTG SL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

criteria that makes somebody low risk for ACS

A

atypical CP with negative troponins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

criteria that makes somebody extremely low risk for ACS

A

clearly MSK pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

intial treatment in patients with chest pain in which the diagnosis is uncertain

A

admission → observation vs in-patient

MONA (morphin, O2, NTG, aspirin)

ACLS protocol as needed

Troponin-I

telemetry

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

when do we usually check troponin levels?

A

usually 0, 6, 12 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is the TIMI score?

A

estimates mortality for patients w/ UA and NSTEMI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is included in the TIMI score?

A

age > 65 yrs

> 3 risk factors for CHD

prior coronary stenosis > 50%

ST segment deviation on admit EKG

> 2 anginal episodes in prior 24 hours

elevated cardiac biomarkers

ususe of asirin in prior 7 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

TIMI risk for:

0-1?

2?

3?

4?

5?

6-7?

A

0-1 → 4.7%

2 → 8.3%

3 → 13.2%

4 → 19.9%

5 → 26.2%

6-7 → 40.9%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what are some immediate issues with A fib?

A

verify rhythm

verify hemodynamic stability

ventricular rate control

BP managment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what are some post-immediate issues with A fib?

A

identification of precipitating factors

consideration of cardioversion (if initially stable)

anticoagulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what are the managment goals of A fib?

A

minimize symptoms related to A fib

prevent thromboembolic complications (especially stroke)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what do we do if a patient in A fib is hemodynamically unstable?

A

ACLS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what are some things we want to know about a patient presenting with A fib?

A

frequency

duration

precipitating factors & mode of prior termination

vital signs

apical rate

detailed CV exam

19
Q

what does pre-excitation on an EKG indicate?

A

WPW syndrome

20
Q

what additional testing should be done on A fib patients?

A

thyroid function tests (TSH, FT4)

CXR looking for pulmonary disease

ambulatory monitoring and/or exercise testing for rate control if indicated

eval for CAD if anti-arrhythmics considered

21
Q

what are some indications for hospitalization in A fib patients?

A

cardioversion

initiation of anti-arrhythmics

rate managment

tx of associated medical conditions

elderly patients more safely treated in hospital

patients w/ risk of complications from A fib, therapy of A fib

22
Q

what is the beneift to rhythm control in A fib?

A

maintain sinus rhythm & optimal cardiac output

23
Q

what is the problem with rhythm control in A fib?

A

at best, 50-60% effective in maintaining sinus rhythm long term

24
Q

with is an adverse efffect to rhythm control of A fib?

A

pro-arrhythmia (VT, torsades, VF) which can be life threatening

25
Q

who would want rhythm control for A fib?

A

younger more active patients who benefit from optimal CO or increase risk of bleed

especially athlets & occupations with increased risk of trauma

patients in who rate is uncontrollable or symptomatically can’t tolerate AF

patients who request it

26
Q

risk progressively increases after _____ hrs of sustained AF in patients w/ risk factors for stroke

A

48 hours

27
Q

what does drug therapy do in the rate control approach to A fib?

A

slows AV donuction (we’re owrried about ventricular rate)

control rate at rest/exercise

28
Q

what drugs do we use for the rate control approach in A fib?

A

CCB (diltiazem, verapamil)

beta-blocker

digoxin

often a combo is needed

29
Q

alternative if rate control is not obtained via drug therapy

A

ablate AV node w/ radiofrequency

permanent ventricular or AV pacement

30
Q

what are some risk factors that increase a patient’s stroke risk with chronic AF?

A

age > 65

prior history of stroke

diabetes mellitus

history of systemic hypertension

31
Q

anticoagulation reduces stroke incidence to ___ each year

A

1%

32
Q

oral anticoagulation

CHAD score 0?

CHAD score 1?

CHAD score 2?

A

0 → generally not

1 → consider

2 → generally yes

33
Q

for chronic A fib, what should be use for anticoagulation?

aspirin?

coumadin?

NOAC?

A

aspirin → no

coumadin → possible

NOAC → yes

34
Q

how should anticoagulation be initiated in chronic A fib patients?

A

no bridging for NOACs

Warafin- no bridging if no history of thromboembolism

35
Q

what is the definition of heart failure?

A

decreased pump function of the heart due to cardiomyopathy or wall motion abnormality

36
Q

what is the EF in systolic heart failure?

A

< 40%

37
Q

what is impaired in diastolic heart failure?

A

impaired relaxation

38
Q

what are some possible causes of iatrogenic heart failure and/or acute pulmonary edema?

A

IVF

medicatino adjustments or errors

transfusion

post-operative

A fib

39
Q

what should be included in our assessment of heart failure?

A

focused H & P or consult

12 lead EKG

continuous EKG monitoring

labs- CBC, BMP, CKMB, troponin, TSH

CXR

consider 2D echo if iatrogenic

40
Q

acute management for heart failure

A

IV diuretic, O2, NTG, morphine

sodium & fluid restriction

avoid NSAIDs

avoid empiric use of anti-arrhythmics

correct aggravating or precipitating factors

41
Q

managment of systolic heart failure

A

ACE inhibitor

beta blocker (once stable)

thiazide diuretic in addition to furosemide

spironolacton for severe CHF in addition to loop diuretic & ACE-I

42
Q

further managment of heart failure

A

anticoagulant if AF or hx of systemic or pulmonary embolism

isosorbide

hydralazine

NTG IV

43
Q

management of mild to moderate acute on chronic CHF

A

IV or oral diuretics

unless complicated by a precipitating factor or a concurrent threatening condition

many do not require hopsital admission beyond several hours observation in ED

44
Q

management of moderate to severe acute on chronic CHF

A

admit

approach as per acute CHF

consider SCU

SD: Hospital Medicine (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions