Cardio ER Flashcards
(156 cards)
1
Q
What is the most common cause of ischemic heart dz
A
Atherosclerosis of coronary arteries
2
Q
Risk factors of CAD
A
Age >50, Family Hx, Male, smoker, Htn, Hyperlipidemia, DM
3
Q
Presentation of stable angina
A
CP lasting 5-10 mins
Relieved by rest and SL nitro
4
Q
Treat a stable angina in ER
A
1) Cardiac work up
2) ASA
3) O2
4) Nitrates if needed
5) Follow up in office
5
Q
EKG, Troponin, and CXR findings in Stable angina
A
EKG-unchanged
Troponin- neg
CXR- neg
6
Q
Presentation of unstable angina
A
1) New exertional CP
2) Someone with previous stale CAD that now has angina a rest and no relief with nitro
7
Q
Work up unstable angina
A
Cardiac work up, ASA, O2, nitrates, Admit to tele to have angiogram scheduled, Cardiac consult, BB, Heparin drip, CCB
8
Q
What does a cardiac work up consist of
A
Troponin EKG CXR CBC CMP
9
Q
What do my EKG, Troponin and CXR show in unstable angina?
A
1) EKG- ST depressions at time of pain, and normal with no pain
2) Troponin- sligh elevation
3) CXR- normal
10
Q
What is unstable angina a precursor for?
A
MI
11
Q
What is variant angina
A
Coronary artery vasospasm
12
Q
What will EKG show in variant angina at the time of pain
A
ST elevations
13
Q
What will the troponin show in variant angina
A
Negative
14
Q
Treat my variant angina
A
Go home
15
Q
I have cp while waling up the stairs at school. By the time I have sat down in my seat for a few minutes the pain subsides . If I were in your ED would you admit me?
A
No- Stable angina
16
Q
I woke up last night at 2am with intense CP, I rushed to the ED and the pain had subsided when I got there and my EKG and biomarkers are negative. What should you do for me
A
Refer to cardiology - Variant angina
17
Q
I am having severe substernal crushing CP. My EKG shows ST elevations in II and III. Help Me!!
A
Straight to Cath lab in <90 mins-STEMI
18
Q
I have had CP in the past, but it has always resolved. This time I have taken my nitro and rested, but the pain has not been relieved. My EKG shows ST depressions, but my serial troponins are negative. What is my most likely diagnosis
A
Unstable Angina
19
Q
How long does typical CP last for an MI
A
15-30 mins
20
Q
In an MI do I respond to nitro
A
Nope
21
Q
Describe typical CP in an MI
A
severe, crushing substernal pain
22
Q
Associated symptoms with MI
A
SOB, Diaphoresis, N/V
23
Q
Elderly presentation of MI
A
Weakness and CP
24
Q
DM presentation of MI
A
Diaphoretic, holding chest, but no CP
25
Women presentation of CP
SOB, easy fatigability
26
How many patients will die of V. Fib arrest due to MI in ED
1 in 5
27
What is a Q wave
Old, transmural infarction
28
What do ST elevations mean?
Transmural ischemia
29
What do T wave inversions mean
Ischemia
30
What do ST depressions mean?
Ischemia
31
How long does it take to see a rise in troponin
3-6 hours
32
Can you have an elevated troponin without an MI?
Of course. Renal dz is the most common
33
I have typical CP that is not relieved with nitro or rest. My EKG is normal, but my troponin is elevated? Help me!!
1) Oxygen
2) Aspirin 325 chewed
3) Nitro
4) Morphine
5) Anticoagulation
6) BB/rate control
34
What is cardiogenic shock characterized by
depression of myocardial contractility, decreased Cardiac output
35
What are risk factors for cardiogenic shock
Elderly, female, impaired EF, Extensive infarct
36
How to patients with Cardiogenic shock present
Ill, Tachy, lethargic, hypotensive, JVD, crackles or rales
37
Drug you give me for Cardiogenic shock
PRESSORS- dopamine
38
What should you not give me if I am hypotensive in cardiogenic shock
beta blockers
39
If I am having cardiogenic shock due to AMI what do you do for me
PCI or balloon pump until you can get to PCI
40
I did some coke what drug is contraindicated in me
beta blockers
41
What does dresslers syndrome consist of
Pericarditis, Fever, leukocytosis, pericardial or pleural effusion (Friction rub)
42
How long after a heart attack can you get dresslers syndrome
1-6 weeks
43
How do you manage my dresslers syndrome
Supportive care- admit
44
What is contraindicated if I have dresslers syndrome
Anticoagulant- can cause hemorrhage or tamponade
45
I have JVD, Pitting edema, and clear lungs - what do I have
Isolated Right heart failure
46
I have crackles, rales and orthopnea, but no JVD or pitting edema- what do I have
Isolated LEft heart failure
47
I have JVD, piting edema, orthopnea, crackes and rales- what do I have
Combined right and left HF
48
Causes of Right heart failure
Acute:MI or PE
Chronic: pulm stenosis, COPD, pulm Htn, Left sided
49
Causes of Left heart failure
Infarct
50
Most common symptoms of CHF
SOB, DOE
51
On exam of left CHF what heart sound can be heard
S3
52
What are the CXR findings seen in CHF
Interstitial pulmonary edema
| Kerly B lines
53
Treat my CHF exacerbation in the ER
1) IVLasix
2) Bipap
3) Vasodilators (nitro)
4) Positive inotropes
5) Morphine
54
I am hypertensive in a CHF exacerbation treat me
Nitropureside
55
I am hypotensive in a CHF exacerbation treat me
Pressors
| Cannot give lasix or nitro
56
How many patients with infective endocarditis will have a murmur
90%
57
MCC and valve of acute endocarditis
Staph tricuspid
58
MCC in IVDA
Staph
59
MCC in normal people
Strep viridians
60
MCC valves infected in subacute
Aortic +Mitral
61
Major criteria of Jones criteria
1) Positive blood culture
| 2) Evidence of endocardial involvment
62
Minor criteria of Jones criteria
1) Predisposition
2) Fever >38
3) Vascular phenomena
4) Immunologic phenomena
5) Microbiological evidence
6) Echo
63
Endocarditis is diagnosed by what
need 2 major or 1 major and 3 minor from jones criteria
64
How many blood cx do you need for an endocarditis patient
3
65
Emperic tx of endocarditis
IV Pen G or ceftriaxone
| IF MRSA-vanco
66
What is myocarditis
Inflammation of the heart muscle
67
MCC of myocarditis
Viral
68
I am febrile, with tachycardia out of proportion to fever with a pleural rub,-- what lab value of mine will be elevated?
CK-MB
| ESR
69
I have ST elevations in V1-V6
Pericarditis
70
I have CP that is better with leaning forward
Pericarditis
71
MCC of pericarditis
Idiopathic
72
Tx of pericarditis
3 weeks of NSAIDS, get echo
73
Becks triad
Hypotension, Kussmals sign, pulsus paradoxis
74
What is Kussmals sign
JVD with inspiration
75
What is pulsus paradoxis
drop on pulse with inspiration
76
I have muffled heart sounds and hypotension treat me
Emergent pericardiocentesis
77
I have breast cancer and I just took a long plane ride to see my new grandchild. Now I am presenting to your ER with sudden onset SOB- Work up for me
High risk- CTA
78
I am a healthy 23 year old male with sudden onset cp -- work me up for PE
Low risk- D dimer
79
What percentage of people diagnosed with PE have a predisposing factor
90%
80
Most common finding on EKG for PE
Tachycardia
81
Most specific finding on EKG for PE
S1Q3T3
82
What is the "Gold standard" for PE diagnosis
pulmonary angiography
83
What is the "gold standard" for DVT diagnosis
Venogram
84
When do you do a V/Q scan
Allergic to dye
| Elevated Bun/Cr
85
Treat my stable PE
Heparin bolus then drip
Admit
Convert to coumadin
86
What must you do before starting anticoagulation
guaiac
87
Therapeutic INR for coumadin
2.5
88
PT is used to monitor what
Heparin
89
Treat my unstable PE
Embolectomy or TPA
90
Does Lovenox work for PE...what about DVT
No, Yes
91
What is a hypertensive Urgency
BP >115 diastolic
92
What is a hypertensive Emergency
BP>115 with signs of end organ damage
93
What is end organ damage?
Blurred vision, elevated troponin, HA, renal problems, CP
94
What is malignant hypertension
Htn emergency +papilledema
95
Treat my Htn emergency
Nitropresside
96
How fast should you lower my bp?
Not more than 25-30% in the first hour, return to baseline within 24-48 hrs
97
I have sharp tearing pain that radiates up into my shoulder blades-- what will my CXR look like and what other imaging should you get
1) Mediastinum widening
| 2) CTA of chest, abdomen and pelvis with IV contrast
98
What is the "gold standard" for Aortic aneurysms
Aortography
99
My aortic aneurysm involves the ascending aorta- do i need surgery
Yes- I have type A in stanford classification
100
My aortic aneurysm does not involve the ascending aorta- do i need surgery
No- mange me medically - I have type B in stanford classifications
101
I have a pulsiile abdominal mass and right hip pain- what should you do
Call vascular NOW
102
Manage my dissecting aneurysm
IV Esmolol (lower BP)
Prep for OR
2 large Bore IV
103
Name 2 signs of retroperitoneal bleeding
Cullen, grey turners
104
What is another cause of retroperitoneal bleeding
Coumadin
105
I am 85 and experiencing abdominal pain after eating with a syncopal event- what diagnostic test will you get, and which is the "gold standard"
1) CT of the abdomen with IV contrast
| 2) Arteriography
106
Treat my messinteric ischemia if the CT detected a thrombus
Heparin drip
107
Treat my messinteric ischemia if no thrombus
Admit, NPO and bowel rest
108
What are the 6 P's
pain, pallor, paralysis, pulselessness, paresthesias, and polar (for cold).
109
What is the work up for extremity ischemia
1) Bedside doppler
| 2) CT with run off
110
What is the treatment for confirmed extremity ischemia
1) Heparin drip
| 2) Call vascular
111
What is virchows triad
1) stasis of blood flow
2) endothelial injury
3) hypercoagulability
112
I just had an IV in and now I have redness, tenderness along that vein. what test do I need. and if that test is negative what do you do with me
Doppler- warmth, elevation, NSAIDS
113
If I have a positive doppler of a superficial thrombophlebitis what do you do with me
Out patient follow up- can communicate with outside
114
What is the Sign of pain with dorsiflexion of the foot, and what does it indicate
Homans sign- DVT
115
I have unilateral pain and edema of my right leg- what test should you do
Doppler
116
I have a positive doppler fir a DVT with no PE symptoms- treat me!
Lovenox with bridging to coumadin
117
I have elevated venous pressure in my upper body --why?
Malignancy- Lung cancer (70%)
118
Management of SVC
Supportive- O2, Diuretics, steroids, head elevation
119
Syncope with a prodrome
Psychogenic or neurogenic
120
Syncope without prodrome
Cardiac
121
Work up of syncope
Work up what you think it is
121
Work up of syncope
Work up what you think it is
121
Work up of syncope
Work up what you think it is
122
What can cause High output CHF
Anemia or thyroxicosis
122
What can cause High output CHF
Anemia or thyroxicosis
122
What can cause High output CHF
Anemia or thyroxicosis
123
I have unilateral sharp stabbing pain in the temporal region of my head- what do you do with me?
Temporal arteritis-> High dose prednisone 60mg
| Biopsy to temporal artery
123
I have unilateral sharp stabbing pain in the temporal region of my head- what do you do with me?
Temporal arteritis-> High dose prednisone 60mg
| Biopsy to temporal artery
123
I have unilateral sharp stabbing pain in the temporal region of my head- what do you do with me?
Temporal arteritis-> High dose prednisone 60mg
| Biopsy to temporal artery
124
What test is elevated in temporal arteritis
ESR>50
124
What test is elevated in temporal arteritis
ESR>50
124
What test is elevated in temporal arteritis
ESR>50
125
I have sinus bradycardia treat me
1) IV atropine (Up to 2 doses)
2) If Atropine doesn't work - pace
3) Call cardio- may have pacer placed
125
I have sinus bradycardia treat me
1) IV atropine (Up to 2 doses)
2) If Atropine doesn't work - pace
3) Call cardio- may have pacer placed
125
I have sinus bradycardia treat me
1) IV atropine (Up to 2 doses)
2) If Atropine doesn't work - pace
3) Call cardio- may have pacer placed
126
I have A fib treat me
1) IV Cadizem
| 2) Cardiovert
126
I have A fib treat me
1) IV Cadizem
| 2) Cardiovert
126
I have A fib treat me
1) IV Cadizem
| 2) Cardiovert
127
Before you cardiovert what test must you have
TEE
127
Before you cardiovert what test must you have
TEE
127
Before you cardiovert what test must you have
TEE
128
If you have new onset A fib can you cardiovert
yes if less than 48 hours
128
If you have new onset A fib can you cardiovert
yes if less than 48 hours
128
If you have new onset A fib can you cardiovert
yes if less than 48 hours
129
Treat my SVT
1) Increase vagal tone
2) Adenosine (up to 3 doses)
3) IV vardizem or BB
129
Treat my SVT
1) Increase vagal tone
2) Adenosine (up to 3 doses)
3) IV vardizem or BB
129
Treat my SVT
1) Increase vagal tone
2) Adenosine (up to 3 doses)
3) IV vardizem or BB
130
Treat my unstable V tac
cardiovert
130
Treat my unstable V tac
cardiovert
130
Treat my unstable V tac
cardiovert
131
Treat my stable V tac
IV antiarrhythmic
131
Treat my stable V tac
IV antiarrhythmic
131
Treat my stable V tac
IV antiarrhythmic
132
Treat my V fib
1) CPR
2) Shock
3) CPR
4) Rhythm/pulse chek
5) Shock
6) Epi
7) CPR
8) Rhythm/pulse check
9)
132
Treat my V fib
1) CPR
2) Shock
3) CPR
4) Rhythm/pulse chek
5) Shock
6) Epi
7) CPR
8) Rhythm/pulse check
9)
132
Treat my V fib
1) CPR
2) Shock
3) CPR
4) Rhythm/pulse chek
5) Shock
6) Epi
7) CPR
8) Rhythm/pulse check
9)
