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Flashcards in Cardiac Deck (51):
1

unstable angina

Ischemic Cardiac chest pain WITHOUT myocardial damage

Occurs suddenly, often at rest or with minimal exertion

2

cardiac ischemia without myocardial damage

NSTEMI
Chest Pain, WITHOUT classic EKG findings, +Cardiac Enzymes

3

cardiac ischemia with myocardial damage

STEMI
Chest pain, WITH classic ST elevation Pattern on EKG, +Cardiac Enzymes

4

these pts present with atypical symptoms of chest pain

-diabetes
-advanced age
-AMS
-women

5

initial workup for chest pain

Labs:
CBC (check for anemia/bleeds), Chem (baseline BUN/Cr for cath lab), Coags, Cardiac Enzymes

Chest XR

EKG

Coronary CT-good for people that don’t have preexisting cardiac disease

6

best lab test for MI

-troponins, released within 4-6 hours of onset of MI
-repeat every 4-6 hours
CK-MB peaks at 12 hours

7

common EKG findings for acute coronary syndrome

-peaked T waves, occur early
-ST elevations, Indicates transmural injury & diagnostic of acute infarct
-Q waves, indicate necrosis from previous damage
-new LBBB

8

Non invasive test
Good test for low risk patients
Limitations: not useful in patients w/ areas of old, calcified (hardened) plaque

CT coronary angiogram

9

how to treat ACS?

-immediate IV, O2, cardiac monitor, and EKG
-ASA
-clopidogrel
-nitro
-heparin
-BB
-Morphine

10

main and second line treatment of a STEMI?

main-percutaneous coronary intervention (door to balloon time <90 min)
second-fibrinolytics (door to needle time <30 min)

11

main tx for NSTEMI or unstable angina?

antiplatelet-ASA or plavix
anticoag-LMWH
stress test

12

Chest pain at rest associated w/ transient ST segment elevation

Normal exercise tolerance

Cyclical pain pattern, most episodes in early morning

Due to focal coronary artery vasospasm

Associated w/ acute myocardial infarction, ventricular arrhythmias, and sudden death

variant/prinzmetal angina

13

how to treat prinzmetal angina?

-nitro
-CCB
-BB contraindicated

14

S/S pericarditis

Varies w/ respiration (Pleuritic)
Worsens w/ Lying down
Relieved by leaning forward
may follow a viral illness

15

best diagnostic test for pericarditis

echo

16

how to treat pericarditis?

-outpatient NSAIDs

17

acute endocarditis vs
subacute

acute MCC staph aureus, fatal <6 weeks
subacute caused by less virulent Streptococcus viridans & enterococcus

18

pt presents with new heart murmur and unexplained fever, think...

endocarditis

19

dukes major criteria

2 POSITIVE BLOOD CULTURES
Of an organism that typically causes IE
Or, persistent bacteremia
EVIDENCE ON ECHO
DEVELOPMENT OF NEW REGURGE MURMUR

20

dukes minor criteria

Fever > 38 C
Predisposition, predisposing heart condition, IV drug use.
Vascular phenomena
Immunologic phenomena
Serologic evidence of an active infection

21

positive dukes criteria

Two Major Criteria
Or
One Major Three Minor
Or
Five Minor Criteria

22

anbx prophylaxis is required for

anbx prophylaxis is required for

23

beck's triad is associated with

cardiac tamponade
-JVD
-hypotension
-muffled heart sounds
Other symptoms: tachycardia, narrow pulses pressure, pulsus paradoxus (dropped beats in the peripheral pulse during inspiration)

24

test of choice for cardiac tamponade

echo

25

cardiac tamponade tx

pericariocentesis

26

s/s aortic dissection

Classically sudden onset SEVERE
RIPPING or TEARING
Radiation to the BACK

27

PE findings for aortic dissection

Pulse or BP asymmetry btw limbs
>30 is bad

28

how to dx aortic dissection

-CXR shows widened mediastinum call CT sx stat (>8mm)
-CT is the test of choice in acute setting!!!!
-angiography is the gold standard

29

how to tx aortic dissection

-beta blockers are first line (CCB if BB are C/I)
-Nicardipine/Nitroprusside (vasodilators) started after BB to achieve BP reduction

30

type A vs
type B aortic dissection mgmt

-surgical tx
-medical tx (BP/HR) doesn't involve ascending aorta

31

how to dx CHF?

-BNP (normal range 10-100)
-CXR (cardiomegaly, Kerley B line)

32

how to treat CHF?

-O2
-intubate if needed
-nitro
-diuretics (double pts normal dose)
-dopamine/dobutamine if hypotensive

33

how to treat stable pts with a-flutter/fib >48 hours?

CCBs
Anticoagulation w/ heparin
TEE to r/o atrial thrombus prior to cardioversion

34

how to treat stable pts with a-flutter/fib <48 hours?

electric cardioversion

35

how to treat stable vs unstable SVT

stable-vagal maneuver, valsavla, carotid massage
unstable-synchronized cardioversion
adenosine can be used short term

36

how to treat pulseless V-tach

defibrillation w/ unsynchronized cardioversion

37

how to treat unstable vtach pts with a pulse

synchronized cardioversion

38

how to treat hemodynamically stable pt w/normal cardiac function presenting with vtach

procainamide

39

how to treat hemodynamically stable pt w/impaired cardiac function with tach

amio is first line
lido

40

how to treat vfib?

-defibrillation
-if unsuccessful, CPR and intubate and give epi and vasopressin

41

how to treat heart blocks

-atropine
-external pacing if that doesn't work

42

hypertensive emergency

-elevated BP associated with target end organ damage

43

hypertensive urgency

elevated bp associated w/ risk of imminent target organ dysfunction

44

acute hypertensive episode

Systolic BP > 180 & Diastolic BP >110 w/out evolving or impending target organ dysfunction

45

initial tx for hypertensive emergency

O2 supplementation, cardiac monitoring, IV access

46

how to tx HTN emergency w/CVA

Labetalol
Subarachnoid Hemorrhage: Nimodipine

47

how to tx HTN emergency with hypertensive encephalopathy

Characterized by severe headaches, nausea, vomiting and AMS)
Sodium Nitroprusside (avoid rapid correction to prevent hypo-perfusion)
Labetalol is 2nd line

48

how to tx acute sympathetic crisis?

benzos followed by nitro or phentolamine

49

how to tx acute renal failure

nitroprusside

50

how to tx preeclampsia

labetalol
hydralazine

51

beck's triad is associated with

cardiac tamponade
-JVD
-hypotension
-muffled heart sounds
Other symptoms: tachycardia, narrow pulses pressure, pulsus paradoxus (dropped beats in the peripheral pulse during inspiration)