EM 4 Chest pain (tidbits)

Question 1

Name a key example of atypical chest pain

Answer 1

Paraoxysmal nocturnal dyspnea

Question 2

Who does Prinzmetal angina occur in?

Tx?

Answer 2

Women n

Tx: CCB

Question 3

What leads ST elevn would indicate a lateral MI? (4)

Answer 3

I, V5, V6, I, AVL

Question 4

How does nitroglycerin affect preload and afterload?

Answer 4

decreases both.

Question 5

quick way to check for CHF

Answer 5

Echocardiography

Question 6

Nitro prescription

Answer 6

0.4mg q 5 minutes x 3 PRN for pain

Question 7

6 absolute CI to thrombolytics

Answer 7

History of intracranial hemorrhage
Known IC neoplasm/vascular lesions
Active internal bleeding (except menses) or bleeding d/o
Embolic stroke w/in 3 months (unless within last 3 hours)
Suspected aortic dissection
Facial/head trauma within last 3 months

Question 8

3 clot-specific thrombolytics

Answer 8

t-pa (Alteplase), Retavase, Tecteplase

Question 9

What is the hepatojugular reflex? What for?

Answer 9

Press up on RUQ and the congested liver makes wave in jugular vein.
Due to CHF backup

Question 10

What are Kerley B lines?

Answer 10

engorged lymphatic vessels in chf.

Question 11

Mgmt of CHF

Answer 11

CPAP

Question 12

Management of hypotension (3)

Answer 12

fluids,
dopamine if that don’t work,
Intraaortic balloon pump

Question 13

Define Dressler syndrome

Answer 13

Pericarditis > 1 week

Question 14

Dx & Tx of Pericarditis

Answer 14

Dx: echo
tx: pericardiocentesis

Question 15

Tx of HTNsive Urgency, and dose:

Answer 15

Clonidine
0.1-0.2 mg
Then 0.1 mg/hour

Question 16

Tx of Htnsive encephalopathy/ischemic stroke/intracranial bleed (2)

Answer 16

Nicardipine (protects CNS)

& a Betablocker

Question 17

Tx of Aortic dissection

Answer 17

Stanford type A: surgically

Stanford type B: Labetalol

Question 18

Tx of Acute pulm edema htnsive crisis (2)

Answer 18

Enalapril, Nitro

Question 19

Tx of eclampsia/pre-eclampsia related htnsive crisis (2)

Answer 19

Labetalol, Nicardipine

Mg sulfate for seizure ppx

Question 20

Tx of htnsive crisis w/ acute renal failure (2)

Answer 20

Fenoldopam (renal perfusion), Nicardipine

Question 21

Tx of catechlamine-induced htnsive crisis

Answer 21

Benzodiazepine (IV)