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46 Cards in this Set
- Front
- Back
What is Acute Coronary Syndrome?
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Myocardial ischemia - Unstable Angina (neg enzymes), NSTEMI (+ enzymes), STEMI (+ enzymes)
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What are criteria for STEMI on EKG?
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1 mm or 1 box elevation above baseline in 2 contiguous leads OR 2 mm/2 box in 2 precordial leads
Don't forget you need enzymes too! |
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Relevant history items about ACS?
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CHARACTERIZE THE PAIN: radiation, exertion vs rest, relation to food, diaphoresis, N/V, Nitro?, reproducibility
SOB, palpitations, etc... Ask FH (early MIs, strokes, ...) Ask SH (smoking, lifesytle, drugs, ...) |
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Management of suspected ACS?
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- Admit to hospital on tele
- EKG - Cardiac enzymes q6 - CXR - CBC, CMP - Pulse Ox - Fingerstick glucose - Chest CT - MONA BASH (morphine, oxygen, nitro, ASA, B-blocker, ACEI, Statin, Heparin) - Start Plavix - Consult cardiology for potential PCI - Start thrombolytics if in po-dunk, NE - TTE - Angiography |
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DDx of chest pain?
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*MI/ACS, *Dissecting aorta, *PE, *PNA, *Tamponade, *AS, * Acute Pulmonary edema, *Endocarditis, Zoster, GERD, Tietze's, Esophageal spasm, PTX
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What is cardiac tamponade?
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A pericardial effusion that impairs filling of the heart
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Relevant history items for tamponade?
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OLD CARTS
Recent MI, chest pain, SOB, trauma, hx of pericarditis, |
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Px exam for tamponade?
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JVP, Narrow pulse pressure, hypotension, tachy, distant heart sounds, pulsus paradoxus
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EKG finding of tamponade?
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Electrical Alternans
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DDx for tamponade?
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MI, Cardiogenic shock, Constrictive pericarditis, PE, AS, Dissection, Acute Pulm edema
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Management of suspected tamponade?
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- Admit to hospital
- EKG - CXR - Enzymes - CBC, CMP - Pulse Ox - Fingerstick glucose - TTE - IV Fluids - Cardiac Cath - Consult cards for potential cardiocentesis - Consult surgery - Pericardiocentesis? - MONA BASH? |
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What is a dissection?
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Blood getting b/w the layers of the aorta causing obstruction of the aorta and vessels arising from it
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Relevant history of dissection?
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Chest pain radiating to back or scapula, diaphoresis, not relieved by nitro, syncope?, Hx of HTN, Hx of Marfans, hx of trauma
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Px exam in dissection?
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Diff in pulses b/w upper extremities, aortic regurgitation murmur, check carotid pulses, neurologic symptoms (hemiplegia, hemianesthesia)
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Management of dissection?
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- CXR (mediastinal widening)
- EKG - Chest CT - Cardiac enzymes - CMP, CBC - Fingerstick glucose - Pulse Ox - MRI - TEE - Angiography - B-blocker and Nitroprusside (think dec afterload) - Consult cardiology - Consult surgery |
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What other lab should you include in chest pain not mentioned before?
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D-dimer, PT/PTT/INR
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What is endocarditis?
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Infection of the endocardium
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Relevant history for endocarditis?
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Recent illness (esp strep throat), Fever, change in mental status, recent dental procedure, any heart valves, IV drug use, myalgia, arthralgia, night sweats
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Px exam for endocarditis?
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Fever, new murmur, hematuria, roth spots in eye, janeways lesions, oslers nodes, arthritis, splinter hemorrhages
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Management of endocarditis?
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- EKG
- CXR - Chest CT - CBC, CMP - Blood & Urine cultures - PT/PTT/INR - Fingerstick glucose - TEE or TTE - ESR, CRP - IV antibiotics (Acute = Naf, Gent, Vanc, Subacute = vanco, gent, rifampin) - Fluids |
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What is a PE?
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Ummmmm
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Relevant history for PE?
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SOB, Acute, tachypnea, chest pain, recent hospitalization, recent travel, recent surgery, swelling in leg, redness of leg, smoking, oral contraceptives, history of cancer, history of leg pain, IV drug use, FH of coag disorders
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Management of PE?
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- EKG - sinus tach
- CXR - Cardiac Enzymes - D-dimer - Chest CT w/ contrast - If poor renal fxn, do V/Q scan - U/S LE - CBC, CMP, PT/PTT/INR - ABG - Angiography - Start O2 - Heparin drip w/ coumadin bridge - Lyse is hemodynamically unstable - Filter placement is cannot anti-coag - Consult pulm/vasc/cards |
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What is AS?
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Obstruction of the aortic outflow tract
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Historical findings of AS?
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Bicuspid aortic valve, syncope, chest pain, fatigue, smoking history, cyanosis, PND, dizziness, DOE
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Px exam on AS?
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Aortic stenosis (right second sternal border radiating to the carotids), can get mitral regurg, pulsus parvus et tardus (palpate carotids), feel for PMI, feel for thrill, S4
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DDx for AS?
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MI, PE, Acute pulm edema, dissection, carotid stenosis, arrhythmia, hypotension, hypoglycemia, HCM, rheumatic fever
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Management of AS?
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- TTE
- Afterload reduction (treat as CHF - ACEI, statin, hydralazine, B-blocker,...) - Consult surgery - CXR - EKG - CBC, CMP, PT/PTT/INR - Fingerstick glucose - Chest CT - Cardiac Cath |
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What is acute pulmonary edema?
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ummmm...
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Hx in acute pulm edema?
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Acute onset SOB, cough w/ frothy pink sputum, orthopnea, PND, cardiac Hx, hemoptysis
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DDx of acute pulm edema?
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PE, MI, AS, Dissection, Asthma, PTX, PNA, COPD exacerbation, ARDS
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Px exam of Pulm Edema?
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JVD, Dullness to percussion, crackles, ronchi, egophany, tactile vocal fremitus, heart murmur, S3 S4
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Tx of Pulm Edema?
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- Admit
- EKG - Chest XR - Chest CT - Basic labs - Cardiac enzymes - Blood cultures/Sputum culture - LMNOP (lasix, morphine, nitro, oxygen, positioning) |
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What is malignant HTN?
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SBP > 220, DBP > 110 w/ evidence of end organ damage (renal, eyes, etc...)
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Hx of malignant HTN?
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Drug use, neuro deficits, chest pain, dyspnea, HA, vision changes, hematuria, SOB, altered mental status, change in urination
*Ask about heart, kidney, eyes, and brain |
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Px of mal HTN?
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Papilledema, high BP, murmurs/bruits, focal neuro deficit, flame hemorrhage, JVD, crackles
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Managment of Malignant HTN?
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- EKG
- CXR - Basic labs - Cardiac enzymes - Head CT - TTE - IV nitro drip OR IV labetalol (dec. BP 10% in 1st hour, dec to normal in 24-48 hrs) - If vol. overload give Lasix - O2 |
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What is Vtach?
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Look at EKG
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Hx for Vtach?
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Cardiac arrest, syncope, confusion, pulseless, mental status change, chest pain, palpitations, recent MI
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Management?
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- EKG
- CXR - Cardiac Enzymes - Basic labs - O2 - If pulseless, cardiovert If sustained (> 30 sec) = DC cardiovert and IV amio followed by pacemaker If non-sustained = consider pacer and get EP studies |
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Hx of Vfib?
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Unresponsive, may be seizing, no heart sounds, no pulse, no BP, cannot get history -- they are basically almost dead!
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Management of Vfib?
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- Admit to ICU on tele
- Get EKG, look at EKG - Start CPR - Shock 200 J - Shock 200-300 J - Reanalyze - Shock 360 J - If still in Vfib, intubate - Give epi IV and q3-5 min after - Shock again at 360 J - Refractory = IV amio and shock - CPR (repeat above 2 in cycle) - Start IV drip of last anti-arrhythmic given |
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Hx of status?
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Dyspnea, cough, wheezing, chest tightness, palpitation, insomnia, use of inhaler, triggers (food, etc...), steroids, ever been intubated, smoking, recent illness, meds
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DDx of status?
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COPD exacerbation, asthma, PTX, PNA, PE, MI, Dissection, Acute pulm edema, Endocarditis
*Likely more chronic (days) |
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Px of status?
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Wheezing, tachypnic, tachycardic, mental status changes, cyanosis, unable to speak full sentences
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Management of status?
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- Admit
- EKG - CXR (clear) - Normal labs - ABG - Blood cultures - PFTs - O2, Methylprednisolone, Duonebs, prophylactic ABx - Outpt: inhaled steroid, salmeterol, albuterol, epi pen |