EM MED Chest Flashcards
What are the 7 components of the TIMI score
Age older than 65
More than 3 risk fxs
Prior stenosis >50%
St segment changes
2 or more anginal events w/in 24 hours
Asprin use w/in 7 days
Elevated Cardiac Markers
Components of a HEART score
History
(Slightly sus-0, Mod sus-1, high sus-2)
EKG
(No change-0, Non specific T wave change -, ST depressions-2)
AGE
(<45-0, 45-64-1, >65-2)
Risk fx
(None-0, 1-2-1, <3-2)
Initial Troponin
(NML-0, 1-3x NML-1, >3x ULN-2)
When should NSTEMI pts get PCI
refractory angina
hemodynamic or electrical instability
patients at increased risk for clinical events
If fibrinolytics fail, rescue PCI is recommended for patients:
in cardiogenic shock who are <75 years old
with severe heart failure or pulmonary edema
with hemodynamically compromising ventricular arrhythmias
in whom fibrinolytic therapy has failed and a moderate or large area of myocardium is at risk
STEMI patients who received fibrinolytics should get full-dose anticoagulants for a minimum of
48 hours
C/I for ACEI
hypotension
bilateral renal artery stenosis
renal failure
history of cough
angioedema due to prior angiotensin-converting enzyme inhibitor use
Verapamil and Diltizem benefit what ACS pts
Verapamil and diltiazem are potentially beneficial in patients
with
- ongoing ischemia
-atrial fibrillation with rapid ventricular response who do not have congestive heart failure
-left ventricular dysfunction
-atrioventricular block
-when β-adrenergic antagonists are contraindicated
What is the measurement for Inferior vena cava to Dx Acute HF
An IVC size >2 cm or collapsibility index of <50% is indicative of elevated central venous pressure
Absent pulmonary disease, these are specific for acute HF
A pt is in normotensive heart failure
And has never taken diuretics
What is the recommended dose
If the patient is on furosemide 80 mg/PO twice a day, then an initial ED dose is 80 to 200 mg/IV bolus
Loop diuretic naïve? —> start with furosemide 40 mg/IV
MC findings in Dilated Cardiomyopathy
LVH and LAE
Role of Amioderone or ICD in Acute heart failure
Patients at risk for sudden cardiac death may benefit from amiodarone therapy or an implanted cardioverter-defibrillator
ECG findings in HOCM
Resting ECG is nonspecific in most patients with HCM often demonstrating LVH and left atrial enlargement; Deep broad Q waves in septal, lateral or inferior leads
Indicators of poor prognosis in acute pericarditis
temperature >38°C (100.4°F)
subacute onset over weeks
immunosuppression
history of oral anticoagulant use
associated myocarditis (elevated cardiac biomarkers, symptoms of CHF)
large pericardial effusion (an echo-free space >20 mm)
MC cause of non traumatic pericardial effusion/ Tamp
Cancer
What is the triple rule out for Aortic Dissection
Coronary CT angiography,
