EM Rot Cardiac
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| 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
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| NONSTEMI EKG | usually shows ST segment depression from subendocardial ischemia.
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| 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
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| Non-atherosclerotic causes of ischemia heart disease | valvular heart disease, congenital heart disease, coronary artery vasculitis, and coronary dissection
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| Life threatening causes of chest pain | AMI, aortic dissection, PE, Pneumothorax, Esophageal rupture
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| 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
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| 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
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| 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
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| ST segment depression and symmetrically inverted T waves are classic signs of | myocardial ischemia
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| 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
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| ST elevation does not exclusively mean AMIs. ST elevation is also seen in | pericarditis, myocarditis, acute aortic dissection, acute cholecystitis, and PE
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| Risk factors for Ischemic heart disease | hypertension, hyperlipidemia, smoking, diabetes, and a family hx of premature CAD
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| Unstable angina has one of the following three characteristics | new onset, increasing pattern (frequency, duration, severity), and angina at rest
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| The most common cause of a STEMI | acute thrombus or rupture of an atherosclerotic plaque
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| ___ is superior to thrombolysis for the treatment of AMI | PCI (percutaneous coronary intervention)
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| Ischemic strokes are divided into 3 categories | 1. thrombotic, 2.embolic, 3. hypoperfusion
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| 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)
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| 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
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| 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
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| Signs of increased ICP and brain herniation | anisocoria (unequal pupils) and papilledema
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| A carotid bruit may suggest what in a stroke patient? | hypoperfusion, atheromatous emboli, or carotid dissection
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| 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
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| 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
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| 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
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| 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.
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| Most common source of thrombi or emboli in strokes and TIAs | the heart (thrombi, vegetations, tumors)
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| 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
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| People with ____ _____ are 5-17x more likely to develop stroke | atrial fibrillation. Almost 20% of stroke patients have A-fib on their admission EKG
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| 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
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| 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
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