Risk factors for ischemic heart disease
male sex, age >55, family hx of CAD, DM, hypercholesterolemia, HTN, tobacco use
sxs of angina
pressure, heaviness, tightness, fullness; radiate to shoulder, arms, eck or jaw
PE of angina
tachycardia, HYPERtension, S3/S4, new/changed murmur
what are some anginal equivalents
exertional dyspnea, nausea, diaphoresis, fatigue, dizziness (these are more common in the elderly and DM patients)
length of time for stable angina
substernal chest pain lasting 2-5 minutes
tx of stable angina
nitrates SL x 3 doses
first line for chronic angina
beta blockers
indicated for pts who dont respond to nitrates and beta blockers
Ca channel blockers
dx of angina
12 lead EKG, stress testing, coronary angiography
when is an exercise stress test stopped
development of chest pain, dyspnea, ST depression >2mm, decreased systolic pressure >10mmHg or ventricular dysrhythmias
medication used for pharmacologic stress echo
dobutamine
what is radionuclide myocardial perfusion imaging
- obtain rest images
- exercise/pharm stress induced
- radioactive tracer administered
- look for perfusion defect
gold standard for dx CAD
coronary angiography
disposition for low risk patients with normal EKG
observe, serial cardiac enzymes, stress test
what is variant angina
episodes of angina (5-15 min) usually at rest and often b/t midnight and early morning
dx of variant angina
coronary angiography
tx of variant angina
nitrates and Ca channel blockers
STEMI tx
ABCs, cardiac monitoring, IV access, MONA, revascularization with fibriniolytics, PCI, or CABG
contraindications to thrombolytics
hx of hemorrhagic CVA, hx of ischemic CVA in last 3mo, presence of cerevral vascular malformation or malignancy, suspected aortic dissection, active internal bleeding, significant closed-head or facial trauma within the preceding 3 mon.
NSTEMI/UA management
ABCs, cardiac monitoring, IV access, MONA, no thrombolytics!
peri-infarction pericarditis
pericarditis in the first 2-3 days
PE of peri-infarctin pericarditis
pericardial rub
tx of peri-infarction pericarditis
supportive, ASA+colchicine
labs for pericarditis
leukocytosis, elevated ESR, elevated troponin with no elevation of CK
ekg of pericarditis
ST elevation, PR segment depression
tx of pericarditis
NSAIDs and colchicine
Dressler’s syndrome
develops weeks to months post MI
tx of dressler’s syndrom
NSAIDs
-corticosteroids or colcichine if refractory
signs/sxs of myocarditis
prodrome, fever, rigors, myalgias, chest discomfort, exertional dyspnea
EKG findings of myocarditis
non-specific ST/T wave changes, ST elevation, AV blocked, prolonged QT
gold standard for dx myocarditis
endomyocardial bx
tx of myocarditis
supportive, limit physical activities
hx of endocarditis
fever, chills, cough, dyspnea, orthopnea
PE of endocarditis
palatal, conjunctival or subungual petechiae, splinter hemorrhages, osler nodes, janeway lesions, roth spots, pallor, splenomegaly, new murmur
labs for endocarditis
blood cultures x3 at least an hour apart
duke criteria for definitive dx of endocarditis
2 major or 1 major and 3 minor
tx of endocarditis
empiric abx therapy
heart failure clinical presentation
dyspnea, fatigue, non productive and nocturnal cough
PE of heart failure
tachycardia, tachypnea, rales at the base, S3/S3, JVD, LE edema
CXR findings for heart failure
cardiomegaly, cephalization, kerley B line
tx of heart failure
ABCs, sublingual nitrates for active chest pain without hypotension, ACE-I, Lasix, sodium restriction
ICU admission criteria for heart failure
pulmonary edema, cardiogenic shock, concomitant MI or ischemia
D/c criteria for heart failure pts
mild exacerbation that responds to ED treatment and no other cardiac and pulmonary findings
most common type of cardiomyopathy
dilated
PE of DCM
S3 gallop, rales, increased JVP
DCM tx
abstinence from EtOH, tx underlying ds
PE for HCM
S4 gallop, systolic murmur, biphasic carotid pulse, jugular venous pulsations
tx of HCM
beta blockers or CCB, surgery
hx c/w RCM
decreased exercise tolerance, dyspnea
collagen disorders a/w RCM
amyloidosis, radiation, DM
heart sound heard with RCM
S3
tx of RCM
diuretics
diff between hypertensive urgency and emergency
emergency a/w acute end-organ damage
tx of hypertensive urgency
rest, est. pts-increase dose of current meds, new pts-reduce BP over 24-48h
tx of hypertensive emergency
treat end-organ damage; reduce BP
tx of asx carotid disease
ASA + statin
tx of sx carotid ds with >70%
CEA
tx of superficial thrombophlebitis
local heat
DVT tx
anticoag (heparin followed by warfarin
virchow’s triad
stasis, hypercoagulable state, endothelial damage
EKG finding for PE
S1 Q3 T3
CXR findings for PE
hamptom’s hump, westermark sign
Test of choice for PE in non-pregnant
Spiral CT
test of choice for PE in pregnancy
V/Q perfusion scan
gold standard for dx PE
pulm. angiography
what is well’s criteria used for
dx of PE
tx of PE
O2, IV access, cardiac monitoring, anticoag (heparin, LMWH, warfarin, rivaroxaban)
