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Emergency Medicine Part 1 > Cardiac Emergencies > Flashcards

Cardiac Emergencies Flashcards

1
Q

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

aggravated by movement, coughing, swalllowing

A

pericarditis

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2
Q

Most common cause of pericarditis

A

coxsackie

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3
Q

other causes of pericarditis

A

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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4
Q

PE for pericarditis

A

friction rub

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5
Q

what are the 3 P’s of pericarditis

A

position

palpation

pleuritic pain

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6
Q

location of pericarditis

A

retrosternal or towards cardiac apex

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7
Q

EKG for pericarditis

A

diffuse ST segment elevation

(in limb leads & precordial leads)

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8
Q

Management for pericarditis

A

bed rest until pain & fever resolved

NSAIDs

**oral anticoagulants should be avoided**

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9
Q

what is the mortality rate of undiagnoses pulmonary embolisms?

A

40-50% mortality rate

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10
Q

risk factors for pulmonary embolism

A

stasis

cardiac disorders

hypercoagulability (OCP, V Leiden factor)

trauma

chemo

smoking

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11
Q

S/S for pulmonary embolism

A

97% will have at least 1 of the following:

tachypnea, dyspnea, pleuritic chest pain

1/3 will also have tachycardia

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12
Q

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

A

plasma D-dimer

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13
Q

how is a pulmonary embolism diagnosed?

A

helical (spiral) CT angiography

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14
Q

TX for pulmonary embolism

A

full anticoagulation for min. 3-6 months or longer

unfractionated heparin

risks: bleeding, thrombocytopenia

low molecular weight heparin

warfarin

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15
Q

deep, visceral, crushing, heaving, squeezing

+/- burning

radiation: arms, neck jaw

A

STEMI

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16
Q

STEMI might be mistaken for what?

A

indigestion

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17
Q

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

A

elderly

women

diabetics (painless MI)

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18
Q

acute TX for STEMI

A

NTG

morhpine sulfate

Beta-blockers

want to relieve pain to reduce stress & anxiety

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19
Q

ultimately, what needs to be done with a STEMI?

A

PCI

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20
Q

major difference between unstable agina & NSTEMI

A

NSTEMI: abnormal cardiac markers that indicated cell necrosis

UA: no cell necrosis has occured (yet)

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21
Q

high risk of deeloping MI in following days/weeks

A

unstable angina

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22
Q

progression to larger MI/death

A

NSTEMI

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23
Q

EKG for NSTEMI/UA

A

ST depression

TW inversion

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24
Q

what is the lab criteria for NSTEMI

A

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

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25
Q

risk factors for adverse events (TIMI risk score)

(for NSTEMI & UA)

A

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%

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26
Q

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

A

proceed to stress test/imaging within 24-48 hrs

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27
Q

management for ongoing ischemia (NSTEMI or UA)

A

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

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28
Q

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

A

aortic dissection

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29
Q

what is aortic dissection associated with?

A

long standing, poorly controlled HTN

(repetitive torque to ascending/descending aortic wall)

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30
Q

dissection starts in aortic arch proximal to left subclavian artery

A

Type A

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31
Q

dissection starts in proximal descending aorta beyond subclavian artery

A

Type B

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32
Q

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

A

Type A

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33
Q

S/S of aortic dissection

A

severe chest pain often raidating to/down back

HTN usually present

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34
Q

imaging for aortic dissection

A

multiplanar CT

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35
Q

TX for aortic dissection

A

must lower BP asap

(beta blockers)

36
Q

accumulation of fluid in paricardial cavity

A

pericardial effusion

37
Q

causes of pericardial effusion

A

pericarditis

uremia

cardiac trauma

38
Q

what symptoms usually accompany pericardial effusion

A

cough & dyspnea

chest pressure

hiccups

abdominal fullness

39
Q

what diagnostics are used to determine the extent of cardiac effusion

A

CXR or echocardiography

40
Q

EKG for pericardial effusion

A

low QRS voltage

electrical alternans is pathognomonic of effusion

41
Q

TX of pericardial effusion

A

pericardiocentesis is necessary to relieve fluid accumulation

42
Q

how are recurrent effusions treated?

A

pericardial window

43
Q

marked elevation & equilibrium of LV & RV diastolic pressures

marked decreas in CO

A

cardiac tamponade

44
Q

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

A

RA & RV collapse

45
Q

beck’s triad

(cardiac tamponade)

A

decline in arterial pressure

elevation of systemic venous pressure

quiet heart

46
Q

what is pulsus paradoxus

A

marked exaggeration of normal process

systolic BP drop > 10mmHg

47
Q

diagnostic tool for cardiac tamponade

A

echocardiogram

48
Q

what treatment may be life saving in cardiac tamponade?

A

pericardiocentesis

49
Q

precipitating factors:

discontinuation of meds

excessive salt intake

myocardial ischemia

tachyarrhythmia

intercurrent infecion

A

acute pulmonary edema

50
Q

is acute pulmonary edema a medical emergency?

A

yes

51
Q

S/S of acute pulmonary edema

A

severe dyspnea

+/- pink/frothy sputum

may have cool extremities

cyanosis & diaphoresis

anxious/restless

unable to breath sitting

52
Q

CXR for acute pulmonary edema

A

lungs-

vscular redistribution

interstitial &/or alveolar edema

“butterfly” pattern of alveolar edema

53
Q

TX for acute pulmonary edema

A
  1. supplemental O2
  2. morphine sulfate
  3. IV diuretics
  4. nitrates
54
Q

are most patients asymptomatic or symptomatic with high BP?

A

most are asymptomatic & do not require emergent Rx

55
Q

hypertensive urgency

A

warrant BP lowering within a few hours

56
Q

hypertensive emergencies

A

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

57
Q

S/S of hyptensive encephalopathy

A

HA

irritability

confusion

altered MS

58
Q

S/S of hypertensive nephropathy

A

hematuria

proteinuria

progressive kidney dysfunction

59
Q

malignant HTN

A

encephalopathy or nephropathy + papilledema

60
Q

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

Why?

A

> 200/110

brain will auto-regulate perfusion

61
Q

What is our goal with decreasing BP?

A

decreased BP by nore more that 25% within 2 hours

then more gradual lowering (2-6 hrs) to BP ~ 160/100

62
Q

management for hyptensive emergencies

A

IV nicardipine & clevipine

IV NTG, labetalol, esmolol….

63
Q

dilation of a segment of a blood vessel

abdominal or thoracic

A

aortic aneurysm

64
Q

abdominal aneurysms

75% are ______ renal arteries

A

below

65
Q

PE for aortic aneurysms

A

abdominal aneurysms often palpable-

pulsatile, non-tender mass

66
Q

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

A

abdominal ultrasound

67
Q

who do we screen for aortic aneurysms?

A

male smokers

> 60 yrs old w/ risk factors

68
Q

what are the risk factors for AAA?

A

FH of AAA

presence of PAD/atherosclerosis

presence of peripheral artery aneurysms

69
Q

risk of rupture for AAA

(over 5 yrs)

A

< 5cm- 1-2% over 5 years

> 5cm- 20-40% over 5 years

70
Q

Tx of AA

A

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

71
Q

what do we do for asymptomatic AA’s?

A

surgery always if > 6.5cm

probably surgery if > 5cm

72
Q

what can precipitate atrial fib/flutter

A

emotional stress

use of stimulants

following surgery

w/ acute ETOH intoxication (“holidary heart”)

73
Q

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

A

DC cardioversion

74
Q

If A fib is stable, what is our initial goal?

How do achieve this goal?

A

rate control is intial goal

IV diltiazem or IV beta-blocker

75
Q

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

A

must fully anticoagulate

76
Q

PR interval > 0.20 seconds

A

first degree AV block

77
Q

progressive lengthening of PR interval until drop of QRS complex

A

mobitz type I

(Wenkebach)

78
Q

P waves followed by aburpt dorp of 1 or more QRS complexes

**without PR prolongation

A

mobitz type II

79
Q

complete disocciation of atria & ventricles

atrial rate usually 60-100

ventricular rate usually 30-40

A

third degree AV block

80
Q

3 or more consecutive ventricular premature beats

A

ventricular tachycardia

81
Q

TX for unstable ventricular tachycardia

A

synchronized cardioversion

82
Q

TX for pulseless V tach

A

defib & CPR

83
Q

no effective pumping action

without intervention → death

sudden unconsciouness

A

ventricular fibrillation

84
Q

V tach with QRS twisting around the baseline

A

torsades de pointes

85
Q

TX of torsades de pointes

A

IV magnesium

correction of electrolyte abnormalities

Emergency Medicine Part 1 (8 decks)

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