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45 Cards in this Set
- Front
- Back
- 3rd side (hint)
(5)* deadly causes of chest pain
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TAPUM:
Tension pneumothorax; Aortic Dissection; PE; Unstable Angina; MI |
TAPUM
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how is the maximum HR determined?
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220-patient's age = Max HR
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(6) Major risk factors for CAD which is most prevetable?
which is the greatest risk? |
Diabetes (greatest);
Smoking (most preventable); HTN; Hypercholesterolemia; Family Hx; Age |
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Dx:
Chest pain that has an established character, timing and duration; pain is transient, reproducable and predictable. What is cause? What is Tx? (2 together) |
Dx: Stable Angina
Cause: Reduced coronary blood flow through fixed athrosclerotic plaque in vessel of heart Tx: rest + Nitroglyerin |
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exertional substernal (precordial) chest pressure and pain radiating to left arm, jaw or back. N/V, diaphoresis, dyspnea, HTN and tachycardia can accompany it.
Name the types |
Angina:
Stable Unstable Variant (Prinzmetal's) |
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Angina type that is also considered an Acute Coronary Syndrome (ACS).
What (3) factors must it have for diagnosis? |
Unstable Angina
1) New-onset 2) angina that changes or accelerates in pattern, location or severity 3) Occurs at REST |
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Dx:
Similar characteristics of stable angina, but due to vasospasm instead of atherosclerosis. Tx? (2 drugs together) |
Variant (Prinzmetal's) Angina
Tx: 1. Calcium Channel blockers + 2. Nitrates |
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what (2) groups of patients may not show the classic signs pain seen in stable angina?
Why? |
Elderly and diabetics (b/c: neuropathies)
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What does the EKG look like for the (3) angina types?
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Stable + Unstable:
- ST Depression - T-wave Inversion Variant: - ST elevation |
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62-yo smoker w/ 3 episodes of severe heavy chest pain in the morning. Each lasted 3 - 5 minutes, but he has no pain now. He has never had this before.
What is it? |
Unstable Angina
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62-yo man w/ frequent episodes of chest pain on and off for 8 months. He says the pain wakes him from sleep at night.
What is it? |
Variant (Prinzmetal's) Angina
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what is the alternative to an exercise Stress Test if the patient cannot get on a treadmill?
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IV Dobutamine is given to stimulate myocardial function
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What is the criteria for a "positive" Stress Test? (5)
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either:
- ST elevation - ST depression >1 mm in multiple leads - Dec BP - failure to go more than 2 minutes - failure to complete for reason other then cardiac symptoms (i.e. arthritis) |
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what does Myocardial Perfusion Imaging detect? (3)
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- Myocardial perfusion
- Ventricular volume - Ejection Fraction |
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An ultrasound of the heart revealing abnormal wall motion due to ischemia or infarction. It also assesses left ventricular function and EF
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Echocardiography
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What are (5) Dx that need a cardiac catherization?
Describe procedure for each |
1) MI / Unstable angina: stent or angiography
2) Valvular disease: valvuloplasty 3) Arrhythmias: mapping bypass tracts 4) Myocardial dz Bx: glycogen storage dz or cardiomyopathies 5) Congenital heart dz identification: angiography and closure of defects |
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(4) serum markers for MI
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Myoglobin;
Troponin T/I; CK; Lactate Dehydrogenase |
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How is the right heart accessed in a cardiac catherization? (2)
Left heart? (2) |
Right:
Femoral or Internal Jugular Left: Femoral or Radial artery (from right heart) |
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what is the wave morphology changes sequence in a MI ECG? (6)
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1. peaked T-waves
2. T-wave inversion 3. ST elevation 4. Q-waves 5. ST normalization 6. T-waves return upright |
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which cardiac enzyme is the most sensitive and specific for acute MI?
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Troponin-I/T
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which cardiac enzyme remains increased (peaked) the longest?
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LDH
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what does ST depression mean?
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ST goes in the opposite direction of the QRS
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what does a Q-wave on an EKG in the presence of an infarction indicate?
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Transmural infarction
(extends through full thickness of the myocardial wall) |
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Time of onset for the (4) serum markers for MI
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Myoglobin (1-4 hrs)
Troponin-I/T (3-12) CK-MB (3-12) LDH (6-12) |
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which cardiac enzyme has the shortest duration?
Longest? |
Myoglobin (1 day)
Troponin-I/T (7-10 days) |
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ST elevation in II, III & aVF
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Inferior wall MI
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ST depression in II, III & aVF
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Cor Pulmonale
(right-sided heart failure) |
None
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ST elevation in V1, V2, V3
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Anterior/septal MI
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ST elevation in V4, V5, V6
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Lateral wall MI
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ST depression in V1, V2
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Posterior wall MI
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difference b/t unstable angina & non-ST elevation MI? (2)
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non-ST elevation MI has:
1. more severe lack of Oxygen (more severe myocardial damage) 2. Enzyme leakage (Unstable angina has none) |
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Tx for Unstable angina & MI (6)
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MONA has HEP B:
Morphine Oxygen Nitrates Aspirin HEParin Beta-blockers |
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primary Tx (2) for the acute MI w/in 6 hours of infarct
(name 3 other drugs) |
Throbolytics:
1. tPA + 2. Heparin (DOC) - Urokinase - streptokinase - Alteplase |
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At what level should LDL be in person w/ MI history?
What is given to lower it? |
less then 100
statins |
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When are throbolytics indicated in MI? (3)
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- patients < 80 yo
- within 6-12 hrs of chest pain - evidence of infarct on ECG |
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Contra-indications of Throbolytics (9)
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Having Some Breaks A Blood Clot In Small Pieces:
- Hx of intracranial bleed - stroke < 1 year - BP > 180/110 - active internal bleed - bleeding disorder - CPR - Intracranial tumor - suspected aortic dissection - Peptic ulcer |
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drug class that is used to break up clots
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thrombolytics
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name a specific drug that prevents future clots from forming
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heparin
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None
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procedure Tx of choice for MI if there is a high risk of ST elevation (cardiogenic shock) or it has been 3 hours since initial symptoms presented?
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PTCA
(Percutaneous Transluminal Coronary Angioplasty) |
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which throbolytic is highly immunogenic and cannot be used in the same patient twice in a 6 month period?
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streptokinase
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what should be given 48 hours post infarct if tPA was used?
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heparin
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drug class that is excellent for late and long-term therapy for acute MI to decrease afterload and prevent remodeling?
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ACEi
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58-yo man discharged from hospital after MI 2 weeks ago presents w/ fever, chest pain and malaise. EKG shows diffuse ST-T wave changes.
What is Dx? What is Tx? (2 possible meds) |
Dressler's syndrome
Tx: 1. NSAIDs or 2. Corticosteroids |
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Medication orders w/ discharge of an ACS (post-MI) patient? (5)
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easy AS ABC:
- Aspirin (indefinitely) - Statin to lower LDL < 100 - ACE-inh (if EF <40%) - Beta-blocker (indefinitely) - Clopidogrel for 1 - 12 mo depending on stent placement |
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Dx:
fever, pericarditis and possible pericardial or pleural effusions post cardiac surgery |
Dressler's syndrome
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