EMED Flashcards
__ is the leading cause of death among US adults
___ causes this leading cause w/ ? predominant Sx
Ischemic heart dz
Coronary artery dz
Chest pain
High likelihood of short term risk of death in PTs w/ unstable angina
SHIPMATES BS S3 HOTN Inc TnT Prolonged MR Accelerating Sx frequency Tachy/brady Edema, pulmonary ST >0.5mm
BBB
Sustained V-tach
Low likelihood of short term risk of death from PTs w/ unstable angina?
Left coronary artery divides into ? and ? to supply ?
Reproducible w/ palpation
New/inc angina
Stable EKG
LCX and LAD
LAD: main anterior/septal
LCX: some anterior/lateral
ACS may be caused by secondary reduction of blood flow due to ?
Atherosclerotic plaques develop because of ?
Disruption/erosion of plaques
Platelet aggregation at lesions
Coronary artery spasm
Microvascular dysfunction
Repetitive wall injury
What is the classic location for MI myocardial ischemia pain?
Angina pain can be precipitated by ? events and lasts ?
Substernal/L chest radiating to arm, neck, jaw
Stress Exercise Cold
<5min w/ rest/nitro
Acute myocardial ischemia usually presents w/ more prominent pain and Sxs including ?
? PTs are more likely to have atypical presentation of MI?
Diaphoresis Nausea SoB
w/ little response to Nitro
Female
Advanced age
DM
What are the traditional RFs for ACS/AMI?
These RFs are not useful in ? PT populations
DM Tobacco FamHx
Hypercholesterolemia
HTN
ED PTs >40y/o
? PE finding may be heard indicating a failing myocardium
The presence of a new ? is ominous and may indicated ?
S3- volume overload
New systolic murmur-
Papillary dysfunction
MV leaflet flail w/ MR
VSD
S3 heart sounds are heard normally during ? and can indicate ? failure
Presence of ? on PE is indicative of LV dysfunction and L-sdied HF
Early diastole
Systolic HF
Rales, S3 regardless
Define TIMI Score
What are the parts of it
Thrombosis in MI for unstable angina
Age: >65 Markers elevated ECG depressions RFs, 3 or more Ischemic chest pain, 2 or more Coronary stenosis >50% ASA use <7days Max- 7pts
What is the single best test to identify PTs w/ AMI in the ED
This test must be obtained and interpreted w/in ?min of presentation to ED
12 lead EKG
<10min
What is the ‘general’ definition of an STEMI
ST elevation suggests ? while depression suggests ?
ST elevation of 1mm or more in two contiguous leads w/ reciprocal changes
Ele: transmural injury/infarction
Dep: ischemia
What is the next step for suspected inferior wall AMI?
What finding is Dx
R sided EKG
ST elevation in V4R= RV infarction
PTs w/ RV infarction are ? dependent, be careful if using ?
Pts w/ non-Dx EKG but persistent Sxs have ? follow on test?
Pre-load dependent
Nitro/BBs
Repeat EKG
If reciprocal EKG changes are seen, ? does this indicate?
How does the height of ST elevations correlate to severity?
Larger area Increased severity Severe pump failure Inc CV complications Inc mortality
High= more extensive injury
What leads are used for posterior MIs?
What artery is involved w/ this type?
V7-9
Circumflex
LBBB criteria
What is the MC pacemaker lead location?
Elevation 1mm+, concordant
Elevation 5mm+, discordant
Depression 1mm+ V1-3
RV pacing
Where is Welens seen on EKG and what does it indicate
Why is this difficult to Dx
V2-3, possibly V1-4
LAD stenosis
T-waves present during pain free period
T-waves absent during painful episode
Wellen’s PTs are likely to develop ? type of MI
When are serum biomarkers not needed for Dx
When are these markers useful?
Anterior
Dx ST segment elevations
Non-Dx EKGs of NSTEMI
Risk stratification during N/STEMI and unstable angina
How can cardiac injury be differentiated between acute or chronic?
How long does it take for troponin to rise, peak and return to normal?
Delta troponin over 1-3hrs
3-12hrs
12-24hrs
5-14days
How are STEMI PTs Tx
They usually get ? three meds in the ED?
What medication is added to unstable angina, refractory NSTEMI or pre-PCI?
PCI w/in 90-120min
Fibrinolysis <30min of arrival
Anti platelet/thrombins and Nitrates
G-2b/3a antagonist
What are the 4 anti-platelet meds used during the Tx of STEMI?
What 3 anti-thrombins are used?
Clopidogrel ASA Prasugrel
Ticagrelor
UFH Enoxaparin Fondaparinux
What are the 5 fibrinolytic agents used?
What are the names of the G2a/3b meds?
What are the 4 additional anti-ischemic meds may be used?
Streptokinase
TARA-plase
Abciximab Tirofiban Eptifibatide
Nitro Morphine Metoprolol Atenolol
The invasive Tx approach seen in STEMI Tx is only applied to NSTEMI PTs if ?
If unstable angina/NSTEMI are hemodynamically unstable, start invasive Tx strategies w/in ? time fram
Refractory angina
Hemodynamic/electric instability
Inc risk for clinical events
PCI <2hrs