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19 Cards in this Set
- Front
- Back
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what do you think about 64 y/o man having GERD for the first time |
not likely, see if pain like this has ever happened before |
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if you give pt nitroglycerin and their pain goes away, does that mean it was probably angina? |
no. NGN is powerful and could remedy or distract from many things |
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what is the accuracy of "chest pain" in hx for angina or MI |
50-60%
description chest discomfort is variable and often atypical.
pain is autonomic and vague. Feeling of doom. |
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who has the most atypical chest discomfort? |
women diabetics |
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what stands out
diaphoretic, anxious L arm pain HR 60 bpm, BP 145/90 |
low HR for being in pain and stressing out |
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before you give NTG need to make sure |
you have the BP. if it's too low you'll cause problems |
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when does troponin go up as far as causes and timing |
6 hours after acute event
any time there's stress- so pneumonia, UTI with tach, whatever |
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what dx tests are key to dx MI? |
ECG hx biomarkers
risk factors and CABG tell more about coronary dz in general |
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if you have ST elevation in all leads think:
if some have reciprocation think:
q wave |
pericarditis possibly
STEMI
marker for scar from MI |
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guy is having STEMI- what do you do?
cath lab thrombolytic endoscopy to r/o ulcers NSAID's CT to r/o aortic dissection |
*cath lab sounds good thrombolytic only if no cath endoscopy- way past that NSAID would be terrible in MI pt past aortic dissection since had ECG confirm and pulses were symmetrical |
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why give pt going in cath lab that already has MI formed clopidogrel and ASA |
further thrombosis putting in stent so will need it |
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if you have CA occluded, cath and balloon them and still sluggish, what is px |
probs been there a while or other material was in there and has flushed through
not good |
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how can you tell cardiomegaly on chest radiograph
what does this indicate?
what else look for on CXR? |
width is over half the throacic width
bad px, prior heart dz, heart failure
pulm vasc congestion; lung mass, pleural effusion, pulm infarc, pneumonia |
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if pt has been cathed and fixed and the next couple days has chest pain more, what is concern |
could be iatrogenic- cath poked hole and he has effusion or something.
recurrence |
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pt with MI has metabolic acidosis. why |
lactate production
low CO from MI and dehydration |
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if the ST elevation never goes away with time, might signify |
aneurysm |
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post MI
hypotension dyspnea tachycardia
what is concern? |
arrhythmia mechanical complication like torn papillary muscle, actue VSD, rupture etc reinfarction pulmonary embolus retroperitoneal hematoma if punctured during process pericarditis |
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when pts get afib when post-MI what is the cause |
CHF pericarditis atrial infarct |
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what drug did the MI pt have that made his liver enzymes come up and start to have right upper quadrant pain? |
statin |
