Foundations of Emergency Medicine (2020) Flashcards

Comprehensive Board Review

1
Q

Cardiology

What underlying pathologic process distinguishes myocardial infarction from anginal/unstable angina?

A

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

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1
Q

Cardiology

What is the difference between transmural and non-transmural
infarction?

A
  • Transmural: usually STEMI, large vessel affected, benefit from thrombolytics/PCI;
  • Non-Transmural: usually NSTEMI, smaller subendocardial artery, may benefit from PCI but no thrombolytics
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2
Q

Cardiology

What defines Unstable Angina?

A
  • Stable Angina + pain at rest, new pain, increasing pain severity, hemodynamic changes with pain
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3
Q

Cardiology

Acute chest pain at night, EKG with STEMI, all symptoms and EKG changes resolve with nitro?

A
  • Prinzmental’s Angina (coronary spasm, most do not have CAD; treat with CCBs)
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4
Q

Cardiology

What are early to late EKG changes with ACS?

A
  • 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
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5
Q

Cardiology

Biphasic T-wave in V2/V3

A
  • Wellen’s Syndrome: biphasic (type A) or deeply inverted, symmetric (type B) TW in septal leads = early signal of proximal LAD lesion
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6
Q

Cardiology

Chest Pain with STE V1-V4 with
STD II, III, aVL

A

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

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7
Q

Chest Pain with STE I, aVL, V5, V6 with STD V1

A

Lateral MI 2/2 LAD vs LCx occlusion, may affect LV

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8
Q

Chest Pain with STE II, III, aVF
with STD V1-V4

A

Inferior MI 2/2 occlusion of PDA (RCA > LCx), may affect AV node (usually transient narrow complex bradycardias), may cause papillary muscle rupture

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