Cardiovascular Flashcards Preview

EM Rotation 2018 > Cardiovascular > Flashcards

Flashcards in Cardiovascular Deck (24):
1

A patient with an inferior MI is placed on a Nitroglycerin drip. Why should you have extra caution with this patient?

Nitroglycerin may precipitate HYPOTENTION via venous dilation.

2

A patient is experiencing a STEMI via EKG findings. BP is 82/50. What should you avoid giving to this patient?

Nitroglycerin

3

A patient is experiencing a Non-STEMI via EKG findings. Besides the standard "MONA" tx, what should this patient receive?

BB IV (Metroprolol; Atenolol)
Heparin IV
Nitroglycerin drip* (unless systolic BP is <90)

4

What is the classic presentation of MI on EKG?

ST elevations of at least 1mm in 2 contiguous leads

5

What are signs of myocardial ischemia on an EKG?

ST segment depression
Symmetrically inverted T waves*

6

In the setting of a Non-STEMI, what will you see on an EKG?

Flat ST depression
Symmetrically inverted T waves*

7

List the risk factors of the CAD?

1. HTN
2. Hypercholesterolemia/Hyperlipidemia
3. Cigarette smoking
4. DM
5. Advanced age
6. Family Hx of early CAD < 55
7. Male gender and post-menopausal woman

8

What will vital signs look like with patients with CAD?

1. HTN/Hypotension (Cardiogenic shock)
2. Tachycardia/Bradycardia

9

What anti-platelet agents are appropriate for tx of patients with unstable angina, STEMI and Non-STEMI?

Aspirin
Clopidogrel
Glyoprotein IIb/IIIa inhibitors

10

What should you be mindful of when treating patients with both aspirin and clopidogrel experiencing unstable angina, STEMI, and Non-STEMI;

jhj

11

What population do the glycoprotein IIb/IIIa inhibitors work best?

High rish patients:
elevated serum tropinin
ischemic ST segment changes
ongoing ischemia

12

Give some examples of glycoprotein IIb/IIIa inhibitors.

Abciximab
Epifibatide
Tirofiban

13

What is the first line agent for bradycardia? Why is this the preferred agent?

Atropine

Because excess vagal stimulation is the most common cause of bradycardia

14

What is sick sinus syndrome?

sinus arrest with alternating paroxysms of atrial tachyarrhythmias & bradyarrhythmias

15

What is most helpful in determining the presence of an AV block?

PR interval

16

What classifies as a 1st-degree block?

Constant prolonged PR interval (>.20 seconds)

17

What classifies a second-degree block?

Progressive lengthening of PR interval --> dropped QRS complex

18

For a stable patient with Atrial Fibrillation, what is the temporary management?

Vagal stimulation
Beta-blockers
Calcium-channel blockers

19

Hearing some doctors talk about a patients EKG, you hear "AV dissociation." What does this mean for the patient? And is the temporary management?

3rd degree heart block*
-It means there is no association between the P waves and the QRS complexes
-this decreases cardiac output

Temporary management: temporary pacing; PPM

20

Hearing some doctors talk about a patients EKG, you hear "AV dissociation." What is the definitive treatment for this patient?

Permanent pacemaker

21

For an unstable patient with Atrial Fibrillation, what is the temporary management?

Direct (synchronized) cardioversion

22

For a patient with Atrial Fibrillation, what is the definitive management?

Radiofrequency ablation

23

Does Atrial fibrillation have a regular rhythm?

Yes, it has an irregular RATE

24

If a patient has an "irregularly irregular rhythm" with a narrow QRS--what else would you expect to see on the EKG?

ATRIAL FIBRILLATION

-No P waves (characterized by the presence of fibrillatory waves @ 350-600bpm)

-Ventricular rate is usually 80-140bpm (rarely >170)