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! Y6 Emergency Care - Laura Lazzari > CV emergencies > Flashcards

CV emergencies Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

What is included in Acute Coronary Syndrome ACS?

A

Unstable angina
STEMI
NSTEMI

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2
Q

How do you differentiate unstable angina from STEMI/NSTEMI

A

ECG:

  • changes: STEMI
  • no changes: NSTEMI/Unstable angina

Trop:
- elevated: STEMI/NSTEMI
- not elevated: unstable angina
STEMI/NSTEMI: high trop

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3
Q

When would you do PCI vs CABG

A

PCI: 1 or 2 vessel disease, not including LAD

CABG: 2 or 3 vessel disease, including LAD

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4
Q

What are the reversible causes of cardiac arrest?

A

4Hs and 4Ts

Hypoxia
Hypovolaemia
Hypothermia
Hypokalaemia, hyperkalaemia, hypoglycaemia

Toxins
Tamponade
Tension pneumothorax
Thrombosis

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5
Q

What are MI complications

A

DARTH VADER

Death 
Arrythmia 
Rupture 
Thrombus 
Haemorrhage 
Valvular heart disease 
Aneurysm 
Dressler / pericarditis 
Embolism 
Re-infarct
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6
Q

What is the Killip classification used for?

A

predicts risk of 30 day mortality following MI

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7
Q

What is the difference between Dressler and pericarditis

A

Dressler syndrome: 2-6 weeks after

Pericarditis: >48 hours

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8
Q

What investigation should you do if suspecting re-infarct 4-10 days after initial MI?

A

CK-MB rather than troponin

This is because troponin remains raised for up to 10 days
while CK-MB is only raised for 3-4 days

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9
Q

What ECG changes do you see in STEMI

A

ST elevation
Hyperacute T wave
LBBB

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10
Q

What ECG changes may occur in NSTEMI/unstable MI

A

ST depression

T wave inversion

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11
Q

What are sx of ACS

A

central retrosternal chest pain
heavy, crushing, tight
radiates to arms, neck, jaw, epigastrium
onset at rest

Assoc sx: SOB, sweating, nausea, vomiting

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12
Q

Who can a silent infarct occur in

A

Elderly or diabetic

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13
Q

What Ix should you get in suspected ACS

A

Full bloods - FBC, UE, CRP, Gluc, Lipid, Troponin, CK-MB, amylase (exclude pancreatitis), AST (elevated 24h post), LDH (elevated 48h post)

ECG
CXR (exclude heart failure)
Echo (LV EF)

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14
Q

What do you give for management of STEMI

A

ROMANCE

Reassure 
Oxygen if SpO2 <94
Morphine + metoclopramide 
Aspirin + ticagrelor 300mg 
Nitrite SL 
Coag resolution - PCI / thrombolysis + heparin/fondaparinux as appropriate
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15
Q

What are contraindications for beta blockers

A 
Low BP/HR
HF 
COPD/asthma 
cardiogenic shock 
heart block
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16
Q

How do you decide what type of reperfusion you should do in STEMI?

A

If pt presenting <12 hours from sx onset:

  • PCI available within 120 mins: ANGIOGRAPAHY + PCI + enoxaparin
  • PCI not available in 120 mins: THROMBOLYSIS

If pt presenting >12 hours from sx onset / low GRACE score / NSTEMI:
- FONNDAPARINUX

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17
Q

What is long term management of STEMI

A

ABCDS

ACEi 
Beta blocker 
Cardiac rehab (med diet + exercise 
DAPT 
Statin
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18
Q

What is pulmonary oedema

A

Fluid in alveolar spaces (in lung)

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19
Q

What are causes of severe pulmonary oedema

A
  • Cardiac: LVF e.g. post MI, Valvular heart disease
  • ARDS
  • Fluid overload
  • Neurogenic e.g. head injury
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20
Q

How do you manage acute pulmonary oedema

A
  1. Sit patient up
  2. High flow O2
  3. IV Morphine (reduce dyspnoea) 10mg+ IV metoclopramide 10mg
  4. IV furosemide 40-80mg
  5. GL GTN spray (or IV GTN if SBP >100)
  6. CPAP
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21
Q

How do you manage pulm oedema once stable?

A
  • daily weights
  • repeat CXR
  • manage meds (change to oral furosemide, consider thiazide, ACEi, beta blocker, spironolactone)
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22
Q

what are signs of pulm oedema on CXR

A

Alveolar shadowing, bat-wing shadowing / kerley B lines, cardiomegaly, diverted upper lobes, pleural effusion

23
Q

What is a common side effect of GTN?

A

It reduces blood pressure

24
Q

When do you give IV GTN compared to spray?

A

When SBP >100

25
Q

What must you do if BP drops after giving GTN?

A

Stop giving GTN
Wait 10 mins then reassess
As GTN has very short half life!

26
Q

What do you do once pull oedema patient is stable=

A

Daily weights
Repeat CXR
Manage medications: Oral Furosemiide, consider thiazide if on high Furosemide dose, start ARB / beta blocker, spironolactone

27
Q

What investigations must you get if suspecting pulmonary oedema

A

ECG to exclude MI
ABG, BNP immediately
CXR (portable if pt unwell)

28
Q

What are causes of severe pulmonary oedema?

A

CV (left ventricular failure - commonly post MI or post ventricular heart disease)

ARDS

Fluid overload

29
Q

What is cardiogenic shock?

A

Shock caused by insufficient cardiac contractility

30
Q

What are causes of cardiogenic shock

A 
MI 
Arrythmia 
Cardiac Tamponade 
PE 
Myocarditis 
Valve destruction 
Aortic dissection
31
Q

How do you manage cardiogenic shock?

A

MOVE TO ITU ASAP

  1. Oxygen
  2. Diamorphine
  3. Underfilled: plasma expander // Overfilled: Inotrope e.g. dobutamine
32
Q

What must you insert for cardiogenic shock, and why?

A

Insert Swan-Gantz catheter (insert into pulmonary artery via RA)

  • Measure pulmonary wedge pressure and monitor left and right ventricular funciton
  • Purely diagnostic
  • Other indications: complicated MI, measure inotrope effects, thrombolysis for PE
33
Q

What are causes of bradycardia

A
  • physiological
  • cardiac (e.g. Post-MI, third degree heart block, mobitz T2, sick sinus syndrome, aortic valve disease, cardiomyopathy)
  • non-cardiac (vasovagal, hypercalaemia, hypothermia, Cushings triad, hypothyroid)
  • Drug induced
34
Q

How do you manage bradycardia

A

ABC
If either low GCS or low SBP <90 call for SENIOR HELP / CARDIAC ARREST TEAM
IV cannula + bloods
Check ECG

Tx: Atropine 0.5mg IV (anticholinergic)

If unsatisfactory response: repeat every 3-5 mins
Transcutaenous pacing > transvenous pacing

35
Q

what is GRACE score used for

A

To estimate 6 month mortality of patient with ACS

36
Q

What must you define when you see a tachycardia?

A

Broad complex / narrow complex tachy

37
Q

What are causes of broad complex tachy

A

VT (incl TdP)
SVT
Pre-excited tachycatdia with underlying WPW (e.g. AF, atrial flutter)

38
Q

What do you see on ECG to define a broad complex tachy?

A

ECG rate >100

QRS >120 ms (more than 3 small squares)

39
Q

What is the first thing you give in a broad complex tachy with a pulse?

A

High flow O2
IV access
12 lead ECG

40
Q

What adverse signs are eyou looking out for in a broad complex tachy

A

Shock
CHest pain /ischaemia on ECG
HF
Syncope

41
Q

What do you do if no adverse signs present in pt with broad complex tachy

A
  1. Correct electtrolyte problems

2. Assess rhythm: if regular, indicates VT >

42
Q

What do you give for pulse VT

A

Amiodarone 300mg IV over 20 mins
Then 900mg over 24h

Sedate and cardiovert if unsuccessful

43
Q

What do you do if adverse signs present in pt with broad complex tachy

A 
1. Get expert help 
2- Sedate 
3- 3 synchronised DC shocks 
4- Check and correct electrolyes 
5. Amiodarone 300mg IV / 20 mins > 900mg IV / 24y 
6. Further cardioversin
44
Q

what is sick sinus syndrome

A

Sinus node fibrosis typically in elderly
Sinus node becomes dysfuncitonal
can cause sinus bradycardia / tachyarrhythmia

45
Q

what are sx of sick sinus syndrome

A

Syncope
Light headed
Palpitations
SOB

46
Q

What is a narrow complex tachy

A

ECG shows HR >100, QRS <120ms (3 small squares)

47
Q

What do you do if patient with narrow complex tachy has advere signs

A 
Expert help 
Sedate 
3 synchronised DC shocks 
Check and correct electrollyte 
Amiodarone
48
Q

What do you do in patient with narrow complex tachy without adverse signs, with regular rythm

A
  1. Vagal maneuvres

2. IV adenosine bolus (6mg, 12mg, 12mg)

49
Q

What do you classify a narrow complex tachy with irregular rhythm

A

AF

50
Q

what bloods do you NEED TO GET if thinking PE (thinkthat you will need to start anticoag!)

A

FBC, U&E, renal, LFT, PT, APTT

51
Q

What DOAC do you give for PE

A

Rivaroxaban / Apixaban

52
Q

Management of ruptured AAA

A

volume resus, analgesia, VTE prophylaxis

EVAR

53
Q

what is a type 2 MI

A

Ischaemia of myocardium occurring due to insufficient perfusion (NOT due to atherothrombosis)

54
Q

How do you manage an NSTEMI

A

DAPT
Anticoag: SC Fondaparinux 2.5 mg OD
Morphine + metoclopr
Beta blocker

+ assess risk and need of angiography with GRACE score

! Y6 Emergency Care - Laura Lazzari (9 decks)

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