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Surgery/ER Fall 2013 > EM- Cardio > Flashcards

EM- Cardio Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Mechanisms causing MI

A

Atherosclerotic CAD, vasospasm caused by prinzmetal angina or cocaine, and Takotsubo (broken heart syndrome)

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2
Q

Chest pain that comes in predictable manner, is relieved with rest, and is not reproducible upon palpation=

A

stable angina

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3
Q

precursor to acute MI; a medical emergency

A

unstable angina

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4
Q

primary risk factors for ACS

A

known CAD and diabetes

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5
Q

Diagnostics of ACS

A

repeat EKG’s, CXR, troponin I, CBC, BMP, UDS, catheterization

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6
Q

“elephant sitting on chest” sensation- retrosternal crushing pressure, N/V, sweats, radiation to back and left neck/left jaw. Occurs sometimes at rest, other times with exersion.

A

ACS

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7
Q

Tx of ACS

A

MONA, fluids, BB, Heparin, plavix, integrelin, tpa, cath/PCI, CABG

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8
Q

Beck’s triad

A

hypotension, distant or muffled heart sounds, and jugular vein distention- triad in cardiac tamponade

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9
Q

pulsus paradoxus

A

decreased BP with inspiration, increased BP with exhalation- in cardiac tamponade

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10
Q

accummulation of fluid between the visceral and fibrous pericardium

A

pericardial effusion (cardiac tamponade)

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11
Q

HR in cardiac tamponade

A

increased- tachycardia

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12
Q

diagnostics in cardiac tamponade

A

CXR, EKG, echo

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13
Q

tx of cardiac tamponade

A

send to hospital- treat effusion (pericardiocentesis, pericardial effusion), treat shock, and treat arrest

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14
Q

weakened and bulging area in upper part of aorta

A

thoracic aortic aneurysm

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15
Q

size most aneurysms are considered for sugical repair

A

5 cm and greater

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16
Q

location of chest pain in thoracic aortic aneurysm vs. ACS

A

ACS- retrosternal crushing pressure. TAA- substernal chest pain

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17
Q

medical tx in Thoracic aortic aneurysm

A

control BP, control cholestereol, and control DM, stop smoking

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18
Q

diagnostic studies in thoracic aortic aneurysm

A

Xray, CT, MRI

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19
Q

when is surgery indicated for thoracic aortic aneurysm?

A

presence of symptoms (usually asymptomatic) like substernal chest pain radiating to back, SOB, difficulty breathing, if aneurysm growing more than 1 cm/year, signs of an aortic dissection, age of patient and overall medical condition

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20
Q

“the great imitator”

A

thoracic aortic dissection

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21
Q

When does risk of rupture increase in thoracic aortic aneurysm?

A

when the aneurysm is larger than about twice the normal diameter of a healthy aorta blood vessel

22
Q

Patient presents with Ripping or tearing sensation in the chest, severe back pain, SOB, dizziness, lightheadedness, hx of thoracic aneurysm and marfans syndrome. Appears in acute distress, hypertensive with SBP greater than 200. Muffled heart sounds, decreased breath sounds, and pulse deficit or more than 20mmHg difference in BP between right and left arms, murmur

A

thoracic aortic dissection

23
Q

diagnostic study of choice in thoracic aortic dissection

A

CT. can also to CXR or MRI

24
Q

tx - thoracic aortic dissection

A

CALL SURGEON. ABC’s, intubation, control HTN - esmolol (BB), add vasodilator like nitroprusside. If hypotensive give fluids and blood.

25
Q

BP and HR maintaned at what level in thoracic aortic dissection?

A

BP 100-120 mmHG, HR below 60 bpm

26
Q

hypertensive emergency (malignant HTN)

A

SBP gretaer than 180, DBP greater than 120 with findings of end organ tissue damage (CNS, heart, or kidneys)

27
Q

Hypertensive crisis or urgency

A

SBP gretaer than 180, DBP gretaer than 120 but no evidence of organ tissue damage

28
Q

malignant HTN/hypertensive emergency vs. accelerated HTN

A

emergency- presence of keithWagener grade IV retinal changes, papilledema. accelerated HTN- presence of Grade III retinopathy (cotton wool spots, hemorrhages, hard exudates, but no papilledema)

29
Q

diagnostics for thoracic aortic dissection

A

CBC, CMP, PT, PTT, type and screen, troponin, EKG

30
Q

diagnostics for hypertension

A

EKG, CBC, CMP, troponin, UA, CT- chest/head

31
Q

tx of HTN

A

with emergency HTN, DRIP used. - labetolol, nicardipine, nitrodlycerin, sodium nitroprusside, or hydralazine IV push

32
Q

most common cardiac arrhythmia

A

AF

33
Q

tx of PSVT

A

vagal maneuvers, adenosine, cardioversion

34
Q

saw tooth appearance

A

A flutter

35
Q

Arrhythmia with absent P waves, HR above 150, regular appearing. Patient has papitations, dyspnea, chest heaviness, lightheaded, and syncope

A

SVT

36
Q

SVT occurs d/t

A

AV nodal re-entry

37
Q

CHADS2 score determines

A

when to anticoagulate or not- C- CHF. H- HTN. Age 75 or older. D- DM. Stroke or TIA (2 points)

38
Q

A FIb tx

A

rate control with BB like digoxin. rhythm control with amiodarone, sotalol, flecanide. or cardioversion

39
Q

ONLY drug for A Fib tx secondary to HF

A

digoxin

40
Q

Type 1 2nd degree heart block almost always disease of

A

AV node

41
Q

Type 2 2nd degreee heart block almost always disease of

A

conduction system (His-purkinje)

42
Q

V tach tx if hemodynamically stable

A

amiodarone or lidocaine

43
Q

V tach tx if hemodynamically unstable

A

shock. Defib early

44
Q

If V tach not recognized and fixed, may progress to

A

asystole or V Fib

45
Q

bag of warms

A

V fib

46
Q

form of polymorphic v tach causing twisting of QRS complexes around isoelectric line. ventricular rate 150-250

A

torsades de pointes

47
Q

torsades de pointes tx

A

shock, pacer, other meds- IV magnesium sulfate, BB with pacing, isoproterenol

48
Q

risk factors for infectious endocarditis

A

IV drug use, rheumatic fever, indwelling device

49
Q

IV drug use thought to cause…

A

more right sided (tricuspid valve disease)- causing infectious endocarditis

50
Q

Febrile patient iwth new heart murmur. Also has janeway lesions, splinter hemorrhages, osler’s nodes, roth spots, AKI, stroke. Night sweats, fever, fatigue, cough,

A

infectious endocarditis

Surgery/ER Fall 2013 (11 decks)

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