EMED Phase 2 Flashcards
ACS includes ? three Dxs
What is the MC Sx for ACS
What are the atypical Sxs
N/STEMI, UA
Angina
Diaphoresis Dizzy Palpitations Nausea SOB Back/Ab pain
? type of MI doesn’t produce Q-waves and is Dx by ?
Repeat troponins in ? time frame if Dx is uncertain
What are the 3 characteristics of UA
Posterior- tall R-wave in V1-2
3hrs
Began <2mon,
Inc frequency, intensity, duration
Occurs at rest
Vessel involvement of MIs
Inferior- RCA > RCX Lateral- LCX Septal- LAD septal branch Anterior- LAD RV- RCA Posterior- LCX Atrial- RCA
What are the absolute c/i for fibrinolytic therapy when Tx STEMIs
Any prior intracranical hemorrhage Structural cerebral vascular lesion Intracranial neoplasm Ischemic stroke <3mon Actively bleeding Suspected dissection/pericarditis
Define Cardiogenic Shock
This is MCC by ?
What causes coronary artery hypoperfusion
NSTEMI reduction of output leading to dec perfusion despite normal volume available for circulation
AMI dec contractility= pump failure w/ dec CO and hypoperfusion
Dec DBP d/t lack of systemic resistance
Define Situational Syncope
Define Carotid Sinus Hypersensitivity
When does this DDx become a likely Dx
Autonomic reflex response from urination, defecation or coughing
Syncope w/ head turning/wearing tight neck clothes
Recurrent syncope w/ neg cardiac workup
What are S/Sxs of brain stem ischemia/vertebrobasilar insufficiency
What structure is occluded if syncope was induced by overhead physical activity
What is the MC Dx mistaken as syncope and what makes this more likely
Posterior circulation deficits-
Diplopia Vertigo Focal neuro deficit Nausea
Brachiocephalic, Subclavian artery
Seizures- Postictal state, Epileptic aura, Tongue bite, Incontinence
What are the 3 most important parts of a syncope work up
What PE results suggests Subclavian Steal Syndrome
Per San Francisco Syncope Rules, ? Pts are at increased risk for adverse events from their syncope
Hx, PE, EKG
> 20mmHg difference between extremities
Abnormal EKG, SOB, SBP <90, Hct <30%, Age >45, MedHx of ventricular dyshythmia/CHF
What are the MC precipitating factors to acute HF
What are the 6 classifications of HF
Afib, MI, D/c meds, Inc Na, Overexertion
HTN: SBP 140 w/ S/Sx of CHF, +CXR and Sxs <48hrs
Pulm edema
Cardiogenic shock: hypoperfusion and SBP <90
Acute on Chronic- SBP <140 but >90 w/ edema
High output: Tachy, Warm w/ pulmonary congestion
Right HF: low output w/ JVD, hepatomegaly, HOTN
What is the most useful part for Dx acute HF
What Sxs have the highest sensitivity for this Dx
What Sxs have the highest sensitivity for this Dx in order
Hx of acute HF
Dyspnea
Paroxysmal nocturnal dyspnea
Orthopnea
Edema
What are the most specific CXR findings for Dx of Acute HF
How can the Sxs of HF be reduced
? is the primary indication for cardiac transplant in the US
Venous congestion, Megaly, Interstitial edema
Dec after load w/ vasodilators
Idiopathic dilated cardiomyopathy
How are cardiomyopathies Dx
How are complex ventricular ectopy Tx in the setting of cardiomyopathy
What meds are used for the chronic therapy
Echo
Amiodarone
ACEI, BB (carvedilol)- improve survival
Diuretics Digoxin- improve Sxs
What are the MC Sxs of HOCM in order
What should be prescribed to Pts once Dx is made
What is an uncommon Sx of Restrictive Cardiomyopathy
Dyspnea > Angina, Palpitations Syncope
Atenolol
Chest pain
Define Kussmaul Sign and when is it seen
How are Pts w/ Restrictive Myopathy Tx
What is the MC Sx of pericarditis
Inspiratory JVD w/ restrictive myopathy
ACEi w/ diuretics
CCS- Sarcoidosis
Chelation- Hemachromatosis
Sharp/stabbing chest pain worse w/ supine, relieved w/ sitting and leaning fwd
What c/c is unique and specific to pericarditis
What is the best location to hear the friction rub
What are the 4 stages of EKG findings
Pain radiating to left trap muscle ridge
LLSB, Apex
1: ST elevation w/ PR depression
2: ST normalizes, dec T-wave amplitude
3: T-wave inversions
4: resolution, returns to normal EKG
How is Pericarditis Dx when sequential EKGs are not available
When should pericarditis Pts be admitted
Early repolarization:
ST/T-wave amplitude ratio > 0.25 in leads 1, V5-6= pericarditis
Myocarditis Enlarged silhouette on CXR Effusion Uremic pericarditis Hemodynamic compromise
What is a classic but rare EKG finding of cardiac tamponades
How are these Dx
Gold standard for Dx myocarditis
Electrical alternans
Bedside US or Echo w/ RA/RV collapse
Biopsy
What are two rare but significant findings for DVT
What are the two MC Sxs of PEs
Phlegmasia Cerulea Dolens- swollen, cyanotic limb d/t obstruction and inc compartment pressure
Phlegmasia alba dolens- pale limb d/t arterial spasm
Dyspnea, Pleuritic chest pain
What cardiac d/os can present w/ Sxs similar to PE
What 3 PE findings also aid w/ a Dx of PE
Well’s Score for PE
CHF Angina MI Pericarditis Tachydysrhythmia
Clear lungs w/ hypoxemia/dyspnea and clear CXR
Suspected DVT/PE, Alternative Dx less likely- 3
HR >100, Prior VTE, Immobile <4wks- 1.5
Active malignancy, Hemoptysis- 1
>6: high 2-6: mod <2: low
What can cause an elevated D-dime w/out DVT presence
Age Pregnancy Malignancy Surgery Liver/Rheum dz Infection Trauma Sicle cell dz
Image of choice to Dx PE
Only medication approved for fibrinolysis Tx of PE
Indications for this type of Tx
Pulmonary angiography
Alteplase w/ UFH/LMWH started after
SBP <90 Dec in SBP >40mm Right heart strain on EKG Inc troponin/BNP Hypoxemia/Respiratory distress
Pts w/ PE are admitted to ? ward
Define HTN Emergency
What are examples of end organ damage
Telemetry monitoring
Organ dysfunction d/t persistent wall stress/endothelial injury leading to inc permeability and fibrinoid necrosis
Chest pain, SOB, Neuro Sxs, Peripheral edema
JNC-7 HTN Classifications
What are the secondary precipitants of acute HTN
Norm: <120 and <80
Pre: 120-30 or 80-90
1: 140-59 or 90-99
2: ≥160 or ≥100
Pregnancy Sympathomimetic toxicity Adverse drug reaction Drug interactions Withdrawal
What lab results suggest renal injury from HTN
How are Aortic Dissections Tx
What are the VS goals
Hema/Protein-uria and Red cell casts
Inc BUN, Cr, K
B-antagonists before vasodilators:
Esmolol/Labetalol or Diltiazem/Nicardipine
HR <60, SBP 100-140 w/ ideal target <120