CP Flashcards
diffuses/poorly localized pain is likely
ischemic/cardiac
well localized pain is likely
musculoskeletal
GI
pulmonary
examples of abrupt onset CP
pneumothorax aortic dissection esophageal rupture/perforation pulmonary embolism acute MI
examples of gradual onset CP
esophageal disease
musculoskeletal complaints
angina episodes typically last
10-15 minutes
if pain lasts _____ or ______, it’s not ischemic
a few seconds (musculoskeletal or GI)
days/weeks/months
pain that lasts longer than ______ should make you think unstable angina or acute MI
15 minutes
pleuritic CP worse with respiration
pulmonary
chest wall
cardiac tamponade
sharp CP
Pulmonary
Chest wall
Neuropathic
burning CP
Neuropathic: HZV, radiculopathy, GI, ischemia
tearing, ripping, searing CP
aortic dissection
dull, heavy, tightness, pressure, ache squeezing
ischemia
Pericarditis is worse when _____ and better with ______
worse lying down
better sitting up and leaning forward
if pain is reproducible with palpation, it’s likely
musculoskeletal
Does relief with a GI cocktail rule out cardiac pain?
It’s likely a GI issue but it doesn’t distinguish it from cardiac pain
Diaphoresis is likely
ischemia
GI causes
N/V is likely
ischemia
GI causes
Typical angina:
substernal, radiates to neck/jaw/shoulders
not reproducible with palpation
worse with exertion, relieved with rest
progressive pressure or achy pain
lasts >15 mins
diaphoresis, Nausea, SOB
Atypical angina:
lateral chest wall or back
reproducible with palpation
not relieved with rest
sharp, pleuritic, positional
lasts for a few seconds or days/weeks/months
no associated symptoms
Order these tests for CP:
CBC, CMP, Coags Troponin, CK-MB D dimer BNP CXR EKG CT Chest
Acute coronary syndrome includes
unstable angina
NSTEMI
STEMI
unstable angina is
reversible ischemia without injury
myocardial infarction is
myocardial ischemia with injury
Maintain 02 above
90%
Who gets morphine?
severe, persistent chest pain
Are cardiac enzymes elevated in unstable angina?
NO
only in NSTEMI or STEMI
STEMI vs NSTEMI
STEMI: occlusive thrombus, transmural infract
NSTEMI: non occlusive thrombus
NSTEMI on EKG
ST depression or T wave changes
STEMI on EKG
ST elevation
Lateral leads
I
aVL
V5
V6
Inferior leads
II
III
aVF
Anterior leads
V1
V2
V3
V4
STEMI initial tx
Anticoagulation
Beta blocker
PCI or thrombolysis
No NSTEMI on EKG but strong suspicion for ischemia tx
catheterization
Normal EKG and normal cardiac enzymes, no evidence of ischemia or infarct
Stress test or imaging
examples of antiplatelet therapy
Aspirin
Clopidogrel
abciximab/eptifibatide/tirofiban
Anticoagulant therapy
unfractionated heparin
3 Cardioselective beta blockers (B1)
Metoprolol
Atenolol
Nebivolol
MOA of diuretics
inhibits sodium reabsorption in the nephron;
reduces plasma volume and peripheral vascular resistance
Hydrochlorothiazide
Thiazide diuretic
Drugs that can treat hypertension
Thiazides
Aldosterone antagonist
Loop diuretics
Triamterene
potassium sparing diuretic
spironolactone
aldosterone antagonists
bumetanide
loop diuretic
Drugs for heart failure
Loop diuretic
Potassium sparing diuretic
Liver failure with ascites tx
Potassium sparing diuretic
Edema tx
Thiazide
Drugs that cause hypokalemia
Thiazides
Loop diuretics
Drugs that cause hyperkalemia
Potassium sparing diuretics
Aldosterone antagonists
***
Can cause gynecomastia
Spironolactone
Can cause orthostatic hypotension and hyperuricemia
Thiazides
Can cause hypomagnesemia and hypocalcemia
Loop diuretics
Don’t give ______ to a patient with sulfa allergies
Thiazides
Loops
Caution combining _____ with ACE, ARBs, potassium supplements
Potassium sparing diuretics (triamterene)
Contraindications to spironolactone
renal impairment
DM with proteinuria
Nitrates MOA
relaxes vascular smooth muscle,
dilates coronary arteries and decreases preload
Nitrates indications
*ACS, angina* hypertension HF Pulmonary hypertension esophageal spasm
Nitrates side effects
headache
hypotension
tachycardia
dizziness
Nitrates contradindications
Systolic BP <90 Bradycardia <50 Tachycardia >100 Right ventricular infarction Use of phosphodiesterase inhibitor within 24 hours Hypertrophic cardiomyopathy Severe aortic stenosis
Beta Blocker MOA
blocks activity of catecholamines at β- adrenoreceptors, decreases heart rate, cardiac output and
myocardial O2 demand
Non-cardioselective beta blockers (B1 + B2)
Propranolol
Nadolol
Beta blocker indications
stable heart failure
post-MI, angina
arrhythmias
hypertension
Beta blocker adverse reactions
bronchoconstriction bradycardia AV block fatigue ED depression dizziness hypotension *avoid abrupt withdrawal, can cause ACS and HTN*
Relative contraindications to beta blockers
COPD
Asthma
Diabetics
Absolute contraindications to beta blockers
Hypotension/Cardiogenic Shock Active Bronchospasm Severe Bradycardia 2nd or 3rd Degree Heart Block Overt Heart Failure
ACE-I MOA
inhibit conversion of angiotensin I to
angiotensin II, causes vasodilation
Indications for ACE-I
*hypertension* heart failure post-MI *diabetic nephropathy* *chronic kidney disease*
Adverse reactions to ACE-I and ARBS
cough ACE-I ONLY
angioedema
hyperkalemia
hypotension
Contraindications to ACE-I or ARBs
pregnancy
history of angioedema
renal artery stenosis
ARBs MOA
antagonizes angiotensin II AT1 receptors, causes vasodilation
ARBs end in _____
ACE-Is end in ____
ARBs: “sartan”
ACE-I: “pril”
ARBs indications
hypertension
post-MI
heart failure
diabetes
chronic kidney disease
CCBs MOA
inhibit calcium influx into arterial smooth
muscle cells, relaxes coronary smooth muscle, decreases
peripheral vascular resistance
Dihydropyridines end in _____
Non-dihydroyridines are called
“dipine”
verapamil or diltiazem
Verapamil and diltiazem are better for
rate control for afib/flutter
dihydropyridines are preferred for
hypertension
CCBs can treat
hypertension
angina
rate control for afib/flutter
adverse reactions to CCBs
constipation
peripheral edema
flushing
dizziness
hypotension
Recommended HTN drugs in pregnancy
Nifedipine Methyldopa (alpha agonist)
