CV and Pulmonary Emergencies Flashcards Preview

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Flashcards in CV and Pulmonary Emergencies Deck (106)
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1

What are critical differentials that must be ruled out with chest pain?

ACS
Aortic dissection, PE, tension pneumo, pericardial tamponade, mediastinitis, perforated ulcer

2

Diagnostic tests for chest pain

ECG
CXR
Pulse ox
CBC, CMP, d-dimer, lipids, BNP, cardiac enzymes
Echo

3

Classic history of angina

Pressure, heaviness, tightness or squeezing in center or left of chest PRECIPITATED by exertion and relieved by rest (can radiate to shoulder, arms, jaw)

4

What is angina indicative of?

Some type of ischemic event happening in coronaries

5

Who will prevent atypically for angina?

Women, elderly, DM

6

Atypical presentation sxs for angina

SOB, n/v, diaphoresis, fatigue, dizzy, weak, palpitations, syncope

7

Different classifications of CAD

Stable angina (stable sxs, resolve with rest)
ACS:
Unstable angina (increasing severity or duration OR occurs at rest)
MI-NSTEMI (non-occlusive thrombus) or STEMI (occlusive thrombus or transmural infection)

8

CAD risk factors

Male
>55
DM
Hyperlipidemia
HTN
FHx of CAD (especially premature)
Tobacco use
Obesity
Hx of ASCVD

9

Risk calculators for CAD

HEART score (used more now)
TIMI score

10

Purpose of 12 lead EKG with CAD

Look for ST-T wave changes (T wave inversion or ST depression or elevation)
-resting ECG may be normal

11

Cardiac enzymes for CAD

Get an initial troponin and then trend q6H
hs-cTN is sensitive and specific to determine acute process causing the myocardial injury (but tends to be more positive even in ppl not having a cardiac event)

12

When do you do stress testing with CAD?

If unsure if pt is having ACS (not for STEMI pt)

13

How to actually diagnose CAD

Coronary angiography

14

Options of stress tests

Stress echo
Radionucleotide myocardial perfusion imaging (nuclear for higher risk pt)

15

What should be monitored during a stress test?

BP, ECG changes, echo changes
-Stop if have CP, SOB, ST changes (elevation or depression) or have decreased BP or ventricular arrhythmias

16

What is stable angina?

Substernal chest pain about 2-5 min only with activity and never at rest
No ECG changes or enzyme elevation
Should do angiography at some pt tho

17

Meds for stable angina

Nitrates (SL nitro PRN for pain)-- no more than 3 doses
BBs
Maybe CCBs
Antiplatelets (ASA, clopidogrel or combo)

18

What is Prinzmetal angina?

Due to vasospasm
Episode of angina about 5-15 min at rest and often b/w midnight and early morning
ST elevations

19

Diagnostics for prinzmetal angina

Serial cardiac enzymes to rule out MI
Holter monitor at home
Coronary angiography is diagnostic

20

Tx for prinzmetal angina

Nitrates of CCBs

21

What do you always need to ask before giving nitrates?

If pt recently took sildenafil (viagra) vardenafil or tadalafil (women might have taken them for pulm HTN)

22

Initial management for a STEMI

ABCs and cardiac monitoring (telemetry)
IV access
SL nitro
Aspirin 325 mg chew (this is full strength)
MONA (morphine, O2, nitro, aspirin)
Maybe BBs or UFH
*call cardiology emergently so cath lab

23

Options for revascularization in a STEMI

Percutaneous coronary intervention (if not ready in 120 min consider fibrinolytics unless C/I)
Maybe CABG (bypass) if severe

24

Gold standard to diagnose CAD

Coronary angiography (can do angioplasty with balloon or stent)

25

Factors to consider before coronary artery bypass graft

Number of vessels occluded (multi vessel or large area of potentially ischemic myocardium)
Anatomic complexity of lesions
Likelihood to be revascularized with PCI
Co morbidities

26

Management for UA/NSTEMI

Same as STEMI but no thrombolytics
PCI if not contraindicated
Otherwise heparin continuous infusion and ASA

27

Contraindications of PCI

Renal failure, sepsis, unstable pt

28

Contraindications of nitro

Hypotension
RV infarction of inferior MI
Recent PDE5 inhibitors

29

Peri-infarction emergencies in the post MI period

Peri-infarction pericarditis, acute mitral regurgitation, Dresslers syndrome
(hemorrhage, arrhythmias, rupture of LV free wall or IV septum)

30

When does peri-infarction pericarditis occur?

Soon after MI (2-3 days)