Cardiac Flashcards
(20 cards)
a patient who has chest pain(angina) what medication to give to relieve chest pain, (give 3)
First line (beta Blocker)
Not relieved? Add (calcium channel blocker, a long acting nitrate)
Chest pain with ST segment elevation in aVR, what’s the diagnosis?
Subendocardial ischemia secondary to oxygen supply demand mismatch
Patient who has chest pain no ST segment elevation and troproponen increased (but not doubling), do you discharge this patient?
No ,admit to chest pain, observant unit
Patient with chest pain and ST segment elevation PCI Center is more than two hours away, what to do
Fibrinolytic Therapy
Patient with chest pain and ST segment elevation, that returns to normal after taking nitroglycerin, what’s the diagnosis and what’s the management?
Prinzmetal variant angina
Medication of choice is calcium channel blocker
Patient with chest pain and ST segment elevation, no PCI center close, and the patient had ischemic struck two months ago, what to do?
Give Clopidogrel (antiplatelet)
Analytic therapy is contraindicated (ischemic strok within the last 3months)
Patient who had ST segment elevation and was managed, and has reduced ejection fraction 28% what medication you will add to reduce mortality?
Add Spironolactone( reduce mortality if the ejection fraction is less than 40% after ST MI)
Patient with none-ST segment elevation, and high troponin , what’s the management?
Coronary angiograph within 12 to 24 hours
Angina with exertional dyspnea, high jugular, venous pressure, a lower limb edema, ECG shows LVH abnormalities, how to diagnose?
Transthoracic echocardiograph
Patient with non-ST elevation and high troponin, the family don’t want an invasive treatment, how you will manage?
Subcutaneous enoxaparin= low molecular weight heparin (anticoagulant)
Give enoxaparin if there is no risk of bleeding
Patient with chronic cues of corticosteroid because of rheumatoid arthritis and came to you with chest pain as of angina, what to do?
Cardiac stress testing
(Since glucocorticoid increase cardiovascular, and mortality )
Patient with acute cornocary syndrome getting discharged, what dose of statin therapy to give and why?
Atorvastatin 80 mg
For secondry preventions give high intensity
Patient with chest pain and ST segment elevation who will not manage to reach the PCI unit, how to manage
Give fibronylitic treatment as( Tenecteplase) تيز
Patient with chest pain, shortness of breath and inspirational crackles and a third heart sound what combination of drug to give?
Morphine and nitroglycerin
You started patient on dual antiplatelet therapy, went to discontinue?
You continue low dose aspirin for life and discontinue clopidogrel after one year
Women with diabetes mellitus and old came with nine classic cardiac symptoms and G.I. is negative. What to do.?
ECG(since female old and diabetic, can be non-classic cardiac)
Patient with angina she is taking aspirin, lisnopril, carvedilol, atorvastatin, and chest pain not yet managed, what medication to add??
Calcium channel blocker
Or oral extended release, isosproide mono nitrate
Patient with one hour history of substernal chest pressure , troponin is negative and ECG shows hyper acute T wave, what’s the diagnosis?
Acute Coronary syndrome
Sense troponin is not detectable until two hours after chest pain (it will become abnormal if we waited longer)
If only troponin is high= MI
No ECG no troponin (only symptoms)=unstable angina
Old female with diabetes and chest pain you did ECG it showed left ventricular abnormalities what to do next?
Exercise echocardiograph
Old patient with six hours of chest pain who also has stage four chronic kidney disease troponin is high , ECG with no ST elevation, what to give other than aspirin and clopidogrel?
Infusion of unfractionated hiparin
