EM- Cardio Flashcards
Mechanisms causing MI
Atherosclerotic CAD, vasospasm caused by prinzmetal angina or cocaine, and Takotsubo (broken heart syndrome)
Chest pain that comes in predictable manner, is relieved with rest, and is not reproducible upon palpation=
stable angina
precursor to acute MI; a medical emergency
unstable angina
primary risk factors for ACS
known CAD and diabetes
Diagnostics of ACS
repeat EKG’s, CXR, troponin I, CBC, BMP, UDS, catheterization
“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.
ACS
Tx of ACS
MONA, fluids, BB, Heparin, plavix, integrelin, tpa, cath/PCI, CABG
Beck’s triad
hypotension, distant or muffled heart sounds, and jugular vein distention- triad in cardiac tamponade
pulsus paradoxus
decreased BP with inspiration, increased BP with exhalation- in cardiac tamponade
accummulation of fluid between the visceral and fibrous pericardium
pericardial effusion (cardiac tamponade)
HR in cardiac tamponade
increased- tachycardia
diagnostics in cardiac tamponade
CXR, EKG, echo
tx of cardiac tamponade
send to hospital- treat effusion (pericardiocentesis, pericardial effusion), treat shock, and treat arrest
weakened and bulging area in upper part of aorta
thoracic aortic aneurysm
size most aneurysms are considered for sugical repair
5 cm and greater
location of chest pain in thoracic aortic aneurysm vs. ACS
ACS- retrosternal crushing pressure. TAA- substernal chest pain
medical tx in Thoracic aortic aneurysm
control BP, control cholestereol, and control DM, stop smoking
diagnostic studies in thoracic aortic aneurysm
Xray, CT, MRI
when is surgery indicated for thoracic aortic aneurysm?
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
“the great imitator”
thoracic aortic dissection
When does risk of rupture increase in thoracic aortic aneurysm?
when the aneurysm is larger than about twice the normal diameter of a healthy aorta blood vessel
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
thoracic aortic dissection
diagnostic study of choice in thoracic aortic dissection
CT. can also to CXR or MRI
tx - thoracic aortic dissection
CALL SURGEON. ABC’s, intubation, control HTN - esmolol (BB), add vasodilator like nitroprusside. If hypotensive give fluids and blood.
BP and HR maintaned at what level in thoracic aortic dissection?
BP 100-120 mmHG, HR below 60 bpm
hypertensive emergency (malignant HTN)
SBP gretaer than 180, DBP greater than 120 with findings of end organ tissue damage (CNS, heart, or kidneys)
Hypertensive crisis or urgency
SBP gretaer than 180, DBP gretaer than 120 but no evidence of organ tissue damage
malignant HTN/hypertensive emergency vs. accelerated HTN
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)
diagnostics for thoracic aortic dissection
CBC, CMP, PT, PTT, type and screen, troponin, EKG
diagnostics for hypertension
EKG, CBC, CMP, troponin, UA, CT- chest/head
tx of HTN
with emergency HTN, DRIP used. - labetolol, nicardipine, nitrodlycerin, sodium nitroprusside, or hydralazine IV push
most common cardiac arrhythmia
AF
tx of PSVT
vagal maneuvers, adenosine, cardioversion
saw tooth appearance
A flutter
Arrhythmia with absent P waves, HR above 150, regular appearing. Patient has papitations, dyspnea, chest heaviness, lightheaded, and syncope
SVT
SVT occurs d/t
AV nodal re-entry
CHADS2 score determines
when to anticoagulate or not- C- CHF. H- HTN. Age 75 or older. D- DM. Stroke or TIA (2 points)
A FIb tx
rate control with BB like digoxin. rhythm control with amiodarone, sotalol, flecanide. or cardioversion
ONLY drug for A Fib tx secondary to HF
digoxin
Type 1 2nd degree heart block almost always disease of
AV node
Type 2 2nd degreee heart block almost always disease of
conduction system (His-purkinje)
V tach tx if hemodynamically stable
amiodarone or lidocaine
V tach tx if hemodynamically unstable
shock. Defib early
If V tach not recognized and fixed, may progress to
asystole or V Fib
bag of warms
V fib
form of polymorphic v tach causing twisting of QRS complexes around isoelectric line. ventricular rate 150-250
torsades de pointes
torsades de pointes tx
shock, pacer, other meds- IV magnesium sulfate, BB with pacing, isoproterenol
risk factors for infectious endocarditis
IV drug use, rheumatic fever, indwelling device
IV drug use thought to cause…
more right sided (tricuspid valve disease)- causing infectious endocarditis
Febrile patient iwth new heart murmur. Also has janeway lesions, splinter hemorrhages, osler’s nodes, roth spots, AKI, stroke. Night sweats, fever, fatigue, cough,
infectious endocarditis
