Foundations of Emergency Medicine (2020) Flashcards
Comprehensive Board Review
Cardiology
What underlying pathologic process distinguishes myocardial infarction from anginal/unstable angina?
Atherosclerotic plaque rupture → exposed endothelium → clot attaches
→ reduced blood flow; if cell death occurs (usually due to complete
vascular obstruction) then positive trop and MI; if no cell death occurs
then negative trop and angina/unstable angina
Cardiology
What is the difference between transmural and non-transmural
infarction?
- Transmural: usually STEMI, large vessel affected, benefit from thrombolytics/PCI;
- Non-Transmural: usually NSTEMI, smaller subendocardial artery, may benefit from PCI but no thrombolytics
Cardiology
What defines Unstable Angina?
- Stable Angina + pain at rest, new pain, increasing pain severity, hemodynamic changes with pain
Cardiology
Acute chest pain at night, EKG with STEMI, all symptoms and EKG changes resolve with nitro?
- Prinzmental’s Angina (coronary spasm, most do not have CAD; treat with CCBs)
Cardiology
What are early to late EKG changes with ACS?
- Hyperacute T’s and Giant R (very early and transient)
- STE
- STD (ischemia or reciprocal)
- Q waves (1 square wide, 1/3 height QRS)
- TWI
Cardiology
Biphasic T-wave in V2/V3
- Wellen’s Syndrome: biphasic (type A) or deeply inverted, symmetric (type B) TW in septal leads = early signal of proximal LAD lesion
Cardiology
Chest Pain with STE V1-V4 with
STD II, III, aVL
Anterior MI 2/2 LAD occlusion, may affect large territory of LV, septum and conduction sysytem (high grade blocks, wide complex bradycardias), commonly have shock, possible ruptures
Chest Pain with STE I, aVL, V5, V6 with STD V1
Lateral MI 2/2 LAD vs LCx occlusion, may affect LV
Chest Pain with STE II, III, aVF
with STD V1-V4
Inferior MI 2/2 occlusion of PDA (RCA > LCx), may affect AV node (usually transient narrow complex bradycardias), may cause papillary muscle rupture