Heart Stuff Flashcards
Patient with concerns for ACS.
Aside from Nitroglycerin what else do they get FIRST
Aspirin
Criteria for STEMI include ST-segment elevation in 2 contiguous leads.
When confirmed pt should immediately go for ____
cardiac catheterization
with percutaneous coronary intervention
(treatment of NSTEMI)
Unstable sinus bradycardia treated with (2)
IV atropine
If ineffective, do emergency Transvenous pacing (electrode through IV)
If no IV site do emergency Transcutaneous pacing
Heparin is given after Aspirin for patients with chest pain with positive ___ or ___ on ECG.
troponin
ST elevations
Before giving someone Anticoagulation what two things should you do first?
For PE concerns calculate Wells score. 5+ points = AG
For A-Fib concerns calculate CHADSVASc score first. 1 point = consider AG. 2+ points = AG.
What is the CHADSVASc score?
CHF (+1) HTN (+2) Age 65+ (+1) DM (+1) Stroke (+2) Vascular disease hx (+1) Age 75+ (+1) Sex Female (+1)
\+1 = think about Anticoagulation \+2 = patient should be on Anticoagulation (Aspirin at least)
What is the cornerstone treatment for NSTEMI?
DAPT
Dual Anti-platelet Therapy
with Aspirin and P2Y12-i (Clopidogrel, Ticargrelor)
(if NO c/i to it)
For one year (like after stent placement)
____ rupture with thrombotic occlusion is the MCC of STEMI.
Atherosclerotic plaque
Pt w/ 10 day h/o having had a STENT placed in the LAD has substernal chest pain.
ECG shows ST-segment elevation in leads V1-V4
Diagnosis:
The ST-segment elevation in leads V1-V4 correspond
with his recently stented LAD making
Stent Thrombosis (2/2 to DAPT non-adherence)
much more likely than a new plaque rupture.
If this patient had developed ST-segment elevation in the lateral (I, aVL, V5-V6) or inferior (II, III, aVF) leads, this would have suggested new atherosclerotic plaque rupture.
3 complications of Cocaine
Acute MI Aortic Dissection ICH Dilated cardiomyopathy Vasospastic angina
Inferior wall myocardial infarction (II, III aVF) (aka R-heart MI)
commonly presents with chest or ___ pain
and involves ____ symptoms
____ is seen on ECG.
Epigastric
vagal (N/V, sweating)
bradyarrhythmias (sinus or heart block)
Right ventricular myocardial infarction presents with jugular venous distension, clear lungs, and often profound ___ caused by impaired delivery of blood to the left ventricle.
hypotension
thus reflexive increase in SVR
RV outflow obstruction can be caused by a(n)
Pulmonary Embolism
Hypertriglyceridemia, can be 2/2 inherited disorder (ex: familial hypertriglyceridemia), diabetes mellitus, heavy alcohol use, or as an adverse effect of meds (ex: beta blockers, corticosteroids)
Elevated triglyceride levels (>150 mg/dL) are associated with increased CVD risk
Severely elevated levels (>1,000 mg/dL) can cause ____.
Treatment for Hypertryglyceridemia?
pancreatitis
Mild hypertriglyceridemia (50-500 mg/dL) w/CVD risk = Statins (atorvastatin)
Severe hypertriglyceridemia (500+ mg/dL) =Fibrates (gemfibrozil, fenofibrate)
S3 heard in what 3 pathological cases?
HFrEF
High Output-HF
A/M Regurgitation
S4 heard in what 3 pathological cases?
Acute MI
LV Hypertrophy
Restrictive Cardiomyopathy
AS/HoCM
Causes of dilated cardiomyopathy
think ABCCCDD:
Alcohol use,
Beriberi,
Cocaine, Coxsackie B, Chagas,
Doxorubicin/Daunorubicin
Causes of restrictive cardiomyopathy
think RASH:
Radiation/Postsurgery fibrosis
Amyloidosis
Sarcoidosis/sclerosis
Hemochromatosis
___ are recommended for flash pulmonary edema 2/2 acute myocardial infarction
Diuretics
Nitroglycerin can be used if patient is NOT hypotensive
___ has a poor prognosis and warrants the same prompt management as non–ST-segment elevation myocardial infarction.
Unstable angina
___ is the most common cause of sudden cardiac arrest in acute MI and is the most common cause of acute MI-related death.
Ventricular fibrillation
__ refers to a cardiac rhythm that is usually perfusing (eg, sinus tachycardia, sinus bradycardia) but cannot generate sufficient cardiac output to create a measurable blood pressure or palpable pulse.
Pulseless electrical activity (PEA)
Tx: Compressions
Left ventricular free wall rupture can occur within ___ Post-MI.
Affected patients present with acute chest pain and rapid development of ____ that quickly leads to ___ shock and pulseless electrical activity to
finally cardiac arrest.
5 days to 2 weeks
cardiac tamponade
obstructive
