Cardiovascular Emergencies Flashcards
1
Q
chest discomfort (heaviness, pressure, squeezing) precordial +/- radiation to the shoulder/arm/neck, crescendo-decrescendo, lasting 2-5 minutes, provoked with exertion/stress
A
stable angina
2
Q
- felt with rest, prolonged > 20 minutes
- new onset w/ significant physical activity limitation
- previously diagnosed hx becoming more frequent, longer duration, or lower in threshold
A
Unstable angina
3
Q
- atherogenesis, outward growth
- fibrous cap rupture- thrombosis
- arterial occlusion
- fibroproliferative remodeling eccentric plaque, stenosis
A
Ischemic Heart disease
4
Q
when looking at an ECG during cardiac emergencies- what should you keep in mind?
A
- ST segment elevation of 1mm or more in 2 contiguous leads represents STEMI
- ST depressions and T-wave inversions associated with increased risk of AMI
- new LBBB in context of angina= AMI
- Wellens syndrome- abnormal T waves in V2-3 suggestive of LAD stenosis
- New Q-waves suggest subacute MI or prior infarction
- normal ECG does not exclude ACS or NSTEMI
5
Q
what should be used in ACS management?
A
- Oxygen if SPO2 < 90%
- aspirin 160-325mg +/- additional antiPLT
- heparin
- glycoprotein IIb/IIIa inhibitors
- nitroglycerin
6
Q
if a patient is having a STEMI? what should be done in less than 12hrs?
A
- PCI- door to balloon goal < 90min
- fibrinolysis- door-to needle < 30 min
7
Q
if a patient is having a NSTEMI, UA or STEMI that is greater than >12 hrs, what should be done?
A
- PCI within 48 hours
- emergent PCI if hemodynamically or electrically unsstable
8
Q
what HEART score is needed to be discharged, admitted, early revascularization?
A
- 0-3= dishcarged
- 4-6= admitted
- 7= early revascularization
9
Q
- wall motion abnormalities suggest ischemia or infarction
- ejection fraction is a global measurement of systolic function, may be reduced in AMI or (ischemic) cardiomyopathy
- evocative testing with exercise or dobutamine may unmask functional abnormalities due to ischemia
- helpful for active chest pain without clear-cut ACS, valvulopathy, decompensated heart failure
A
Echocardiogram
10
Q
what are some complications of ACS?
A
- dysrhthmia
- heart failure
- ventricular free wall rupture: 1-5 days
- papillary muscle rupture: 3-5 days
- pericarditis
- RV infarction
- acute MR
- mural thrombus
11
Q
management of stable angina?
A
- activity adaptation and management of aggravating factors
- treat modifiable risk factors- diet, weight loss, smoking, dyslipidemia, diabetes, hypertension
- pharmacologic therapy to reduce symptoms, MI risk and mortality
- Nitrates, B-blockers, calcium channel blockers, antiplatelet, ACE-I, avoid NSAIDS- assoicated with increased risk of MI
12
Q
- acute exacerbation of chronic heart failure (aka CHF) vs new onset
- poor prognosis- 50% mortality within 5 years
- pathophysiology- structural or functional impairment of ventricular filling or ejection of blood (aka bad pump)
A
Heart failure
13
Q
what are clinical features of heart failure, how is it diagnosed?
A
clincial features
- dyspnea and fatigue, orthopnea, JVD, rales, possible S3
- fluid retention- pulmonary edema +/- peripheral edema +/- splanchnic congestion
Diagnosis
- ECG
- CXR- pulmonary edema
- echocardiography (systollic dysfunction- reduced ejection fraction; diastolic dysfunction- heart failure with preserved ejection fraction)
- bedside US: B lines, IVC collapse, RV strain
- BNP- not routine, aids with uncertainty
14
Q
Management of Heart Failure
A
- IV, O2, monitor
- airway managment if critically ill
- oxygenation if spO2 < 95
- ventilation
- Hypotensive- give fluids, add inotropy- dobutamine, epi, norepi, addmission to CCU
- hypertensive- afterload reduction- nitroglycerin, nitroprusside, loop diuretics
15
Q
- Risk factors: bicuspid aortic valve, marfan’s syndrome, ehlors danlos, familial history, prior cardiac surgery
- Violation of intima, blood enters media, dissects between intima and adventitia, creating false lumen
- sudden onset of severe, sharp or ripping/tearing chest pain radiating to back- between the scapulae
- abdominal pain, neurological sx (stroke, anterior cord syndrome, horners syndrome)
- blood pressure abnormalities- hypertension most common, BP differential in extremities. Hypotension, new aortic regurgitation murmur-bad prognosis
A
Aortic dissection
