Cardiac Emergencies Flashcards by Krista Chipman

pleuritic-like central chest pain that worsens when patient is supine & improves with sitting

aggravated by movement, coughing, swalllowing

pericarditis

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Most common cause of pericarditis

coxsackie

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other causes of pericarditis

uremia-untreated or w/ dialysis

early post MI (often on 2nd or 3rd day)

neoplastic disease (lung, breast, lymphoma, Hodgkins, leukemia)

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PE for pericarditis

friction rub

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what are the 3 P’s of pericarditis

position

palpation

pleuritic pain

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location of pericarditis

retrosternal or towards cardiac apex

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EKG for pericarditis

diffuse ST segment elevation

(in limb leads & precordial leads)

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Management for pericarditis

bed rest until pain & fever resolved

NSAIDs

**oral anticoagulants should be avoided**

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what is the mortality rate of undiagnoses pulmonary embolisms?

40-50% mortality rate

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risk factors for pulmonary embolism

stasis

cardiac disorders

hypercoagulability (OCP, V Leiden factor)

trauma

chemo

smoking

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S/S for pulmonary embolism

97% will have at least 1 of the following:

tachypnea, dyspnea, pleuritic chest pain

1/3 will also have tachycardia

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elevated in presence of thrombus (97% sensitivity) but not specific (45%)

plasma D-dimer

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how is a pulmonary embolism diagnosed?

helical (spiral) CT angiography

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TX for pulmonary embolism

full anticoagulation for min. 3-6 months or longer

unfractionated heparin

risks: bleeding, thrombocytopenia

low molecular weight heparin

warfarin

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deep, visceral, crushing, heaving, squeezing

+/- burning

radiation: arms, neck jaw

STEMI

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STEMI might be mistaken for what?

indigestion

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What populations are more likely to present with atypical symptoms of a MI?

elderly

women

diabetics (painless MI)

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acute TX for STEMI

NTG

morhpine sulfate

Beta-blockers

want to relieve pain to reduce stress & anxiety

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ultimately, what needs to be done with a STEMI?

PCI

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major difference between unstable agina & NSTEMI

NSTEMI: abnormal cardiac markers that indicated cell necrosis

UA: no cell necrosis has occured (yet)

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high risk of deeloping MI in following days/weeks

unstable angina

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progression to larger MI/death

NSTEMI

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EKG for NSTEMI/UA

ST depression

TW inversion

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what is the lab criteria for NSTEMI

at least one value (serial markers every 6-8hrs) > 99th percentile of upper reference limit

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risk factors for adverse events (TIMI risk score) (for NSTEMI & UA)

age \> 65 yrs at least 2 risk factors for CHD prior coronary stenosis ST seg deviation (or deep TW inversion) 2 or more anginal episodes in prior 24 hrs use of ASA in prior 7 days elevated serum cardiac biomarkers if 6-7 factors, risk of adverse outcome is 41%

What should we do if everything is negative for a NSTEMI/UA work up?

proceed to stress test/imaging within 24-48 hrs

management for ongoing ischemia (NSTEMI or UA)

anti-ischemia rx: NTG, ASA, beta-blockers Ca blockders- 3rd line rx all patients- **ASA (prasugrel or ticagrelor added to ASA w/ NSTEMI)** **LMW heparin**-started on admission

spontaneous tear in intima of aorta allows blood to dissect into media-separating aortic wall

aortic dissection

what is aortic dissection associated with?

long standing, poorly controlled HTN (repetitive torque to ascending/descending aortic wall)

dissection starts in aortic arch proximal to left subclavian artery

Type A

dissection starts in proximal descending aorta beyond subclavian artery

Type B

which type of aortic dissection needs surgery & is a huge operation

Type A

S/S of aortic dissection

severe chest pain often raidating to/down back HTN usually present

imaging for aortic dissection

multiplanar CT

TX for aortic dissection

**must lower BP asap** | (beta blockers)

accumulation of fluid in paricardial cavity

pericardial effusion

causes of pericardial effusion

pericarditis uremia cardiac trauma

what symptoms usually accompany pericardial effusion

cough & dyspnea chest pressure hiccups abdominal fullness

what diagnostics are used to determine the extent of cardiac effusion

CXR or **echocardiography**

EKG for pericardial effusion

low QRS voltage electrical alternans is pathognomonic of effusion

TX of pericardial effusion

pericardiocentesis is necessary to relieve fluid accumulation

how are recurrent effusions treated?

pericardial window

marked elevation & **equilibrium of LV & RV diastolic pressures** ## Footnote **marked decreas in CO**

cardiac tamponade

what happens to the RA & RC in early diastole in cardiac tamponade & can be seen on echo

RA & RV collapse

beck's triad | (cardiac tamponade)

decline in arterial pressure elevation of systemic venous pressure quiet heart

what is pulsus paradoxus

marked exaggeration of normal process ## Footnote **systolic BP drop \> 10mmHg**

diagnostic tool for cardiac tamponade

echocardiogram

what treatment may be life saving in cardiac tamponade?

pericardiocentesis

precipitating factors: discontinuation of meds excessive salt intake myocardial ischemia tachyarrhythmia intercurrent infecion

acute pulmonary edema

is acute pulmonary edema a medical emergency?

**yes**

S/S of acute pulmonary edema

severe dyspnea +/- pink/frothy sputum may have cool extremities cyanosis & diaphoresis anxious/restless unable to breath sitting

CXR for acute pulmonary edema

lungs- vscular redistribution interstitial &/or alveolar edema "butterfly" pattern of alveolar edema

TX for acute pulmonary edema

1. supplemental O2 2. **morphine sulfate** 3. **IV diuretics** 4. **nitrates**

are most patients asymptomatic or symptomatic with high BP?

most are asymptomatic & do not require emergent Rx

hypertensive urgency

warrant BP lowering within a few hours

hypertensive emergencies

warrant substantial BP lowering within 1 hours to avoid severe morbidity or death

S/S of hyptensive encephalopathy

HA irritability confusion altered MS

S/S of hypertensive nephropathy

hematuria proteinuria progressive kidney dysfunction

malignant HTN

encephalopathy or nephropathy + papilledema

We don't use meds to lower BP unles it is greater than what? Why?

\> 200/110 brain will auto-regulate perfusion

What is our goal with decreasing BP?

decreased BP by nore more that 25% within 2 hours then more gradual lowering (2-6 hrs) to BP ~ 160/100

management for hyptensive emergencies

IV nicardipine & clevipine IV NTG, labetalol, esmolol....

dilation of a segment of a blood vessel abdominal or thoracic

aortic aneurysm

abdominal aneurysms 75% are ______ renal arteries

**below**

PE for aortic aneurysms

abdominal aneurysms often palpable- ## Footnote **pulsatile, non-tender mass**

want can accurately measure dimensions of AA's & is useful for serial follow up of small AA's

**abdominal ultrasound**

who do we screen for aortic aneurysms?

male smokers \> 60 yrs old w/ risk factors

what are the risk factors for AAA?

FH of AAA presence of PAD/atherosclerosis presence of peripheral artery aneurysms

risk of rupture for AAA | (over 5 yrs)

\< 5cm- 1-2% over 5 years \> 5cm- 20-40% over 5 years

Tx of AA

operative excision w/ graft replacement for rapidly expanding AA's or those with symptoms

what do we do for asymptomatic AA's?

surgery always if \> 6.5cm probably surgery if \> 5cm

what can precipitate atrial fib/flutter

emotional stress use of stimulants following surgery w/ acute ETOH intoxication ("holidary heart")

with A fib/flutter, what do we do if the patient is not hemodynamically stable?

DC cardioversion

If A fib is stable, what is our initial goal? How do achieve this goal?

rate control is intial goal IV diltiazem or IV beta-blocker

What must we do if A fib is present \> 48-72 hrs?

must fully anticoagulate

PR interval \> 0.20 seconds

first degree AV block

progressive lengthening of PR interval until drop of QRS complex

mobitz type I | (Wenkebach)

P waves followed by aburpt dorp of 1 or more QRS complexes \*\*without PR prolongation

mobitz type II

complete disocciation of atria & ventricles atrial rate usually 60-100 ventricular rate usually 30-40

third degree AV block

3 or more consecutive ventricular premature beats

ventricular tachycardia

TX for unstable ventricular tachycardia

synchronized cardioversion

TX for pulseless V tach

defib & CPR

no effective pumping action without intervention → death sudden unconsciouness

ventricular fibrillation

V tach with QRS twisting around the baseline

torsades de pointes

TX of torsades de pointes

IV magnesium correction of electrolyte abnormalities

Cardiac Emergencies Flashcards

(85 cards)