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EM Rot. Cardiac
EM Rot Cardiac
| Question | Answer |
|---|---|
| Difference between STEMI and NonSTEMI | STEMI:typically from full-thickness (transmural)necrosis by total prolonged occlusion of a coronary artery. NonSTEMI:usually from incomplete coronary artery occlusion, causing ischemia of only the inner myocardium - subendocardial |
| NONSTEMI EKG | usually shows ST segment depression from subendocardial ischemia. |
| Ischemia and infarction | Ischemia does not mean infarction. If ischemia persists long enough to cause injury, the patterns of NSTEMI or STEMI wave infarction develop |
| Non-atherosclerotic causes of ischemia heart disease | valvular heart disease, congenital heart disease, coronary artery vasculitis, and coronary dissection |
| Life threatening causes of chest pain | AMI, aortic dissection, PE, Pneumothorax, Esophageal rupture |
| Non life threatening (immediate) causes of chest pain | Mitral valve prolapse, pericarditis, pneumonia, costochondritis, esophageal spasm, esophageal reflux, peptic ulcer dz, biliary colic, herpes zoster neuropathy |
| Anginal sx typically last more than ___ seconds, but less than ___ minutes | 15 seconds, 15 minutes. The sx of AMI may be similar, but AMI generally last longer |
| PE signs of acute coronary syndromes: Vital signs- tachy/brady cardia, hyper/hypotension (cardiogenic shock); Cardiac exam - systolic murmur, S3 or S4 gallop, Pericardial friction rub (with pericarditis); | Pulmonary exam - bibasilar crackles or rales (with CHF), Neck exam - Jugular venous distention (with R ventricular MI), Extremities - pulse deficits, bruits, and lower extremity edema |
| ST segment depression and symmetrically inverted T waves are classic signs of | myocardial ischemia |
| Tx of Chest pain | EKG, pulse ox, blood pressure cuff, IV access, Oxygen, ASA, Nitroglycerin (unless systolic bp <90), Morphine IV if pain not relieved after 3 sublingual nitro. Also, BB IV, Heparin IV, Nitro IV drip |
| ST elevation does not exclusively mean AMIs. ST elevation is also seen in | pericarditis, myocarditis, acute aortic dissection, acute cholecystitis, and PE |
| Risk factors for Ischemic heart disease | hypertension, hyperlipidemia, smoking, diabetes, and a family hx of premature CAD |
| Unstable angina has one of the following three characteristics | new onset, increasing pattern (frequency, duration, severity), and angina at rest |
| The most common cause of a STEMI | acute thrombus or rupture of an atherosclerotic plaque |
| ___ is superior to thrombolysis for the treatment of AMI | PCI (percutaneous coronary intervention) |
| Ischemic strokes are divided into 3 categories | 1. thrombotic, 2.embolic, 3. hypoperfusion |
| Two types of hemorrhagic stroke | Intracerebral (usually result from rupture of small arterioles or AV malformations often in the setting of htn), Subarachnoid Hemorrhages (usually due to rupture of arterial aneurysms or AV malformations) |
| What kind of strokes are associated with headache? | HAs often accompany hemorrhagic strokes due to the irritant effects of blood on the dura. b/c of the lack of pain fibers within brain parenchyma, ischemic strokes do not typically cause HA |
| A recent hx of neck trauma should suggest what in a stroke patient? | Carotid dissection. This should be considered especially when evaluating a young patient |
| Signs of increased ICP and brain herniation | anisocoria (unequal pupils) and papilledema |
| A carotid bruit may suggest what in a stroke patient? | hypoperfusion, atheromatous emboli, or carotid dissection |
| Diagnostic Evaluation when suspecting stroke | serum glucose (potentially reversible cause of neuro deficit), EKG, and non-CT of head (MRI if within 6 hours of sx onset). Gold standard is imaging with angiography or CT angiography to demonstrate degree of occlusion of cerebral or cervical vasculature |
| Tx of stroke | Oxygen, BP maintained, IV line established (HTN after ischemic stroke is part of the brain's regulatory response to low blood flow; don't correct the HTN unless severe SBP>220). IV Anticoag tx or t-PA |
| When can you administer t-PA? | t-PA should be considered in patients presenting with ischemic strokes of less than 3 hours duration since sx onset and without evidence of hemorrhage on CT of the head |
| Because of the risk of seizure, most hemorrhagic stroke patients should receive | phenytoin. It is still controversial whether patients with HTN and hemorrhagic stroke should have their BP decreased. |
| Most common source of thrombi or emboli in strokes and TIAs | the heart (thrombi, vegetations, tumors) |
| Which populations are more likely to have lacunar (small vessel) strokes? | more commonly occur in African Americans and patietns with diabetes and hypertension. A hx of hypertension is present in 80%-90% of patietns who have lacunar strokes |
| People with ____ _____ are 5-17x more likely to develop stroke | atrial fibrillation. Almost 20% of stroke patients have A-fib on their admission EKG |
| 1-2% of patients with acute MI have a subsequent stroke within the first month after their cardiac event. ___ of these strokes occur within the first 5 days of the MI | Half |
| Predisposing factors to stroke | pregnancy, oral contraceptives, antiphospholipid antibodies (SLE anticoagulant, and anticardiolipin antibodies), protein S & C deficiencies, polycythemia, migraine syndrome, recreational drugs that are vasoconstrictors, trauma |
Created by:
ltm12