May 30 Flashcards
(36 cards)
What are the Big 6 for Chest Pain?
Squeeze: tamponade, tension pneumothorax
Starve: MI/UA, PE
Burst: esophageal rupture, aortic dissection
Chest Pain - other causes:
Myocarditis, pericarditis Chest wall pain syndromes GERD, spasm, PUD Pancreatitis, cholecystitis Pneumothorax, pneumonia, pluritis Psych: hyperventilation...
Most frequent critical chest pain dx?
MI
- time is muscle
- get EKG and CXR promptly
Why harsh HSM radiating to axilla in MI?
Papillary muscle ischemia
What 3 things does Dr. Sharpless want?
Story, risk factors, hard clinical findings
Aside from vitals, what tells me the pt is critically ill or hypo-refused?
Diaphoresis - sweating pt makes me sweaty Cool, clammy skin Poor capillary refill AMS Poor urine output
What are 4 anginal equivalents?
Substernal pressure/pain rad to left arm = classic
- dyspnea
- weakness
- syncope
- confusion
What are the top 6 MI risk factors?
- DM
- Hypercholesterolemia
- HTN
- Smoking
- Family history early CAD
- Age (Men>45, women>55)
How can you tell if systolic ejection murmur rad to carotids is severe?
Aortic Stenosis
- Parvus et tardus
- late peak in intensity of the murmur = tight
What order for eval Chest Pain?
EKG, CXR, telemetry
IV, O2, Pox
Troponin, CBC, BMP, Mg, PT/PTT
What is classic EKG changes in MI?
ST elevation >1mm in 2 contiguous leads
Describe 4 shapes of ST elevations:
Smile: you have chance not MI
Concave upward: often MI but others
Convex: huge risk MI (frown or elevated but flat)
Inferior wall MI: leads? worry?
II, III, AvF
- may be assoc w/ RV MI = NO nitrates
What are reciprocal leads for inferior wall?
I, L
What is an anterior wall MI?
V1-V4 - knock on the anterior door
What are reciprocal leads to anterior wall?
II, III, AvF
What is a lateral wall MI?
V5-6, I, L
How see posterior wall MI on EKG?
ST depression in V1-V4
- but also could be sub-endocardial infarct
What is Acute MI therapy?
Aspirin - 4x 81mg chewable - MOST important Nitroglycerin (sub-lingual + IV) Morphine Heparin (bolus + drip) Cardiology - ASAP
Chest pain + back pain = ?
Aortic Dissection
- abrupt, excruciating, tearing pain
What kind of murmur w/ aortic dissection?
Aortic regurg - proximal dissection
- dilation of aortic valve ring
- loss of commissural support of aortic valve
Risk factors for aortic dissection?
HTN
Bicuspid aortic valve
Marfan / Ehlers-Danlos
Pregnancy
What is common in proximal aortic dissections?
Aortic insufficiency (regurg)
Tests/imaging for aortic dissection?
EKG - usually normal
CXR - abnormal 80% of the time
