Sketchy cardio

Question 1

Therapy for angina

Answer 1

Beta blockers
Calcium channel blockers
Nitrates short acting sublingual
Coronary arterial dilation
Sublingual nitrates should be taken every 5 min at 3 doses

Question 2

Prophylaxis before physical exertion
Isosorbide dinitrate
Tolerance, tachyphylaxis.
Nitrates free interval
Contraindications PDE 5

Answer 2

Ranolazine is for stable angina with refractory symptoms
Preventative: 2nd preventation
Aspirin for MI, p2y22 receptor inhibitor, clopidogrel
Statina too

Question 3

ACS
Stemi, nstemi, unstable angina
Rupture of plaque leading to thrombosis

Answer 3

Rest, new onset pain
Can occur with or without ECG changes
St segment elevation or depression or new inversion of T wave

Question 4

Stemi complete transmural infarct nstemi
Both present w elevation of troponins

Answer 4

Diffuse, radiating, diaphoresis, nausea vomiting
>30 min. Not improved w rest or NG
Atypical: SOB, palpitations, weakness( diabetes,elderly🥳🥳, women)

Question 5

Prev MI
ABC pulse BP and peripheral pulse if no pulse, chest compression
prepare with Bipap or intubated if respiratory distress IV lines asap, fluid for perfusion. Give supplemental oxygen
Keep them on cardiac monitor and pulse oximeter

Answer 5

V tach can develop
12 lead in 10 min arrival check for ischemia or infarction

Question 6

STEMI

Answer 6

1 or more ST elevation in 2 contiguous leads or 2 mm or more ST elevation in V2 and V3

Answer 7

New BBB on ECG
UA and NSTEMI differentiated w biomarkers and new ECG changes that are persistent in NSTEMI.
Repeat ECG every 10-15 min

Question 8

History
HPI symptoms, characterize pain, assess associated symptoms

Answer 8

Give 325 mg aspirin immediately. Irreversible inhibitor of COX, prevents thromboxane A2, less thrombosis

Question 9

Contraindications for thrombolysis

Answer 9

Prev ICH, AVM , intracranial neoplasm ischemic stroke, head trauma within 3 months, suspected aortic dissection, active bleed

Question 10

Medic

Answer 10

Sildenafil not with nitrates

Question 11

Signs of pe

Answer 11

Diaphoresis, MI signs S3 (fluid enters LV and hits the residual fluid living there or S4 gallop(stiff wall) and signs of mitral regurgitation due to papillary muscle
Large MI>HF> cardio genic shock
Lethargic, cool pale extremities, hypotension w tachycardia

Question 12

Signs of hf in MI

Answer 12

S3 gallop, jvp elevation, bibasilar crackles, hypotension

Question 13

Keep an eye out for bradycardia
Check for neurological deficits ( fibrinolytic)
Normal PE on ACS doesn’t exclude ACS

Question 14

Investigations

Answer 14

CBC, BNP, cardiac biomarkers. Inc troponins in 2-3 hr
Peaks at 12 h, elevated for weeks
CK MB
12 h peak, baseline 36-48 h
Tells about re infarction
Repeat troponins and ECG every 6 h
Neurological+bradycardia monitor
UA not elevation, EKG can have ischemic changes
Nstemi and stemi change biomarkers

Question 15

Differential

Answer 15

Esophageal rupture, sub CT emphysema and sharp chest pain. Watch for mediastinal air in CXR
Tearing chest pain radiating to back> AD
PE: pleuritic chest pain, dyspnea and tachycardia
DVT symptoms and D-dimer
CTA
No breath sounds and resonant lungs pneumothorax

Question 16

Cardiac tamponade:

Answer 16

hypotension,raised jvp, muffled HS
ECG: low voltage, electrical alternans

Question 17

Vasospastic angina

Answer 17

Young pts and angina at night

Question 18

ACS management Mona B’s

Answer 18

Morphine oxygen(<90 PC) nitrates SABA
aspirin beta blockers statin
IV nitrates venous preload
Arterial dilation: afterload

Question 19

Nitrates avoid in

Answer 19

Rt ventricle MI cuz they need preload, hypotension, pts w PDE 5 inhibitor ( ED+pul HTN)

Question 20

B blocker

Answer 20

Mortality Dec, give in first 24 h
Contraindications
Bradycardia, heart failure asthma, give CCB

Question 21

Morphine

Answer 21

Only if nitrates are insufficient
contraindications
Rt ventricular infarcts, hypotension

Question 22

Statins

Answer 22

High intensity

Question 23

Cardio genic shock
Pul edema

Answer 23

Vasopressin like norepinephrine
Nitrates+diuretics for pul edema(unload the left ventricle) less hydrostatic pressure, less CVP, don’t give in RV infarct, Cardio genic shock

Question 24

RVI

Answer 24

Hypotension
Inf wall+ clear lungs and shock
Give fluids

Question 25

Sinus bradycardia

Answer 25

Treat w atropine

Question 26

Definitive treatment

Answer 26

STEMI
Immediately reperfusion
Coronary angiography , balloon catheter within 90 min
PCI immediately place a stent
Metal or drug eluting stents
Duration
Sometimes CABG if LCA is stenosed or 3 vessel disease
Before PCI we used to give fibrinolytic T-PA
PCI give within 120 min
If not possible,give thrombolysis

Question 27

Thrombolysis

Answer 27

AVM, ischemic stroke,trauma, stress,bleeding, prev ICH

Question 28

STEMI

Answer 28

Aspirin+clopidogrel ( for pt going thrombolytic therapy)both dual antiplatelet therapy

Question 29

Therapy for anti coag in STEMI

Answer 29

UFH continuous infusion short HL
Fondaparinux, enoxaparin more HL

Question 30

NSTEMI treated

Answer 30

Dual antiplatelet therapy
Anticoagulation
Immediately angiogram for high risk pt
In 24-48 h
Timmy and GRACE score

Question 31

NSTEMI

Answer 31

No thrombolysis therapy

Question 32

Indications for immediately angiography

Answer 32

Hemodynamic unstable, HF, recurrent rest angina, acute MR VSD
Sustained V tach , dynamic ST, t wave changes

Question 33

aeiouS for urgent dialysis

Answer 33

Acidemia
Electrolytes
Inflammation
Intoxication
Overload
Uremia

Question 34

Pericarditis

Answer 34

ASA+ Colchicine
Not use immediately after MI cuz scar formation is impaired
Systemic glucorticoids. Primary treatment for underlying cause
Avoid strenuous activity