EMED Flashcards
Where is classic chest pain described
How is classic chest pain described
Time frame for angina, unstable angina and AMI pain
Retrosternal in left, anterior chest
Tight Pressure Crushing Squeeze
A: 2-10min UA: 10-30min MI: >30min
Pts w/ ? Hx can suggest an accelerated atherosclerosis process
Why can ACS present w/ tachy or bradycardia
? EKG finding is Dx of acute MI
Cocaine abuse, HIV infection/antivirals
Tach: inc symp tone
Brady: conduction system ischemia
ST elevation ≥1mm in two leads
MI Pts w/ ? findings are suggestive of ischemia and need further work up
? is the biomarker of choice
What is more sensitive than the above
ST elevation Q-wave LBBB T-wave inversion Normalization of Sxs
cTN: cardiac troponin
Delta cTn
? Pts have have an elevated cTN despite no cardiac pathology
What rare test may be used for suspected MI Pts when infarction time is unclear
ACS encompasses ? DDxs and presents w/ ? MC Sx
Renal failure
Creatine kinase MB
N/STEMI and UA; Chest pain
EKG findings for:
Antero/Septal/Lateral
Inferior/Lat
Posterior
Right ventrical
AS: Elevation V1-3
A: Elevation V1-4 LAD (septal too)
AL: Elevation 1, aVL, V1-6
L: elevation 1, aVL; LCX
I: elevation 2, 3, aVF; RCA>LCX
IL: elevation 2, 3, aVF and V5-6
P: R waves V1-2 w/ R/S ratio ≥1; LCX
RV: Elevation 2, 3, aVF and R sided V4; RCA
MI w/ atrial origin will have ? vessel involved
How often are repeat troponins drawn
How does UA present
RCA
q3hrs
Chest pain and one of:
Began <2mon ago
Inc frequency/intensity/duration
Angina at rest
STEMI Tx options and times
Thrombolytics <30min
PCI <90min
Fibrinolytics if <12hrs since Sxs
NSTEMI Tx path
Clopidogrel and ASA
Anticoag w/ UFH or LMWH
UA Tx path
? anticoagulant is used If Pt is heading to CABG
Read Cardio slides in N/STEMI
Anticoagulate w/ UFH or LMWH
UFH
And UA
What are the 6 classifications of HF
HTN: SBP >140, Sxs <48hrs
Pulm Edema: resp distress w/ dec O2 sats
Cards Shock: HOTN/SBP <90
Acute on Chronic: SBP 90-140 w/ inc edema
High Output: tachy, warm skin and pulm congestion
R HF: low output w/ JVD, hepatomegaly
What is the most sensitive Sx for CHF
What are the 3 most specific Sxs for CHF
What are the most specific CXR findings
Dyspnea w/ exertion
Paroxysmal nocturnal dyspnea
Orthopea
Edema
Pulm venous congestion
Interstitial edema
Cardiomegaly
MCC of cardiogenic shock
What is a commonly seen dysrhythmia
What are signs of end organ hypoperfusion
AMI
Sinus tach
Cool mottled skin
AMS
Oliguria
? is the preferred revascularization method for Pts w/ cardiogenic shock
What meds need to be avoided
? vasopressor and positive ionotrope can be used for these Pts
PCI > fibrinolytics
BBs
NorEpi
Cardiogenic shock w/ MR is manged w/ ? drug combo
? structural heart Dz can cause syncope
? tachydysrhythmias can cause syncope
Nitroprusside w/ dobutamine
HOCM AS MI
VTach Torsades SVT
? type of syncope needs to be considered in elderly Pts w/ repeat syncope and negative cardiac work ups
? d/o is MC mistaken for syncope
What are the San Fran Syncope rules for features suggesting adverse events and may need admission
Carotid sinus hypersenitivity
Seizures
Abnormal EKG SOB SBP <90 HcT <30% >45y/o CHF/Ventricular dysrhythmia
