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23 Cards in this Set

  • Front
  • Back
What's your job when the step 2 exam describes a pt with chest pain?
Do what you have to do to rule out an MI
What elements of the H & P steer you away from an MI Dx?
Wrong age (any pt under 40 in the absence of known heart dz, strong FmHx, or multiple risk factors)
Lack of Risk Factors (if their only one is age, and otherwise healthy, probably not MI)
Physical char of pain; if reproducible by palpation, MI pain shouldn't be sharp or well localized
What EKG findings should make you suspect an MI?
Flipped or flattened T waves, ST segment elevation (depression means ischemia, elevation means injury), and/or Q waves in a segmental distribution
Describe the classic pattern of chest pain in an MI?
Classically crushing or pressure sensation, poorly localized substernal that may radiate to shoulder, arm, or jaw. Usually not reproducible on palpation, and often doesn't resolve with Nitro. Usually lasts at least half an hour
What tests are used to Dx an MI?
EKG, Serial CK-MB, Troponin, or myoglobin. Echo may show ventribular wall motion abnormalities
Describe the classic physical exam findings in pts with MI?
Diaphoretic, anxious, tachycardic, tachypneic, and pale, may have N/V. With larger heart attacks that cause heart failure, look for bilateral pulmonary rales in absence of other pneumonia like Sx, distended neck veins, S3 or S4, new murmurs, hypotension, and/or shock
What historical points should steer you toward Dx of MI?
Hx of angina, murmurs, arrhythmias, risk factors for CAD, HTN, or DM. May also be taking digoxin, furosemide, cholesterol, or other meds
Describe Tx for an MI?
Early thrombolysis (under 6 hrs from pain onset) or PTCA or CABG if not thrombolysis.
EKG monitoring, O2, Control pain with morphine, Nitro, Beta Blockers, ASA, consider an ACE and a statin acutely
When is heparin indicated in the setting of chest pain and MI?
Should be started if unstable angina is Dx, if pt has a cardiac thrombus, or if severe CHF is seen on echo.
Clues that suggest Pericarditis instead of MI?
Look for viral URI prodrome, EKG shows diffuse ST-segment elevation, sed rate is elevated, and a low-grade fever is present. Classically the pain is relieved by sitting forward.
Most common cause of pericarditis infection?
Coxsackievirus. Others include TB, uremia, malignancy, and SLE or other autoimmune dzs
Describe Prinzmetal's angina?
Rare angina char by pain at rest and ST elevation. Cardiac enzymes are normal, and the cause is coronary artery spasm. Usually it responds to Nitro, and is Tx over long term with Ca channel blockers
Define silent MI, and how common it is?
They don't devp chest pain, they present with CHF, shock, or confusion and delirium (esp in elderly). MIs are silent in up to 25% of cases
PE findings with Mitral stenosis?
Late diastolic blowing murmur (best heard at apex). Also opening snap, loud S1, AF, LAE, and PH
PE findings with Mitral regurg?
Holosystolic murmur (radiates to axilla). Also, soft S1, LAE, PH, LVH
Aortic Stenosis Physical char?
Harsh systolic ejection murmurs (best heard in aortic area, radiates to carotids). Also, slow pulse upstroke, S3/S4, ejection click, LVH, cardiomegaly, syncope, angina, heart failure
Aortic Regurg Physical char?
Early diastolic decrescendo murmur (best heard at apex). Also widened pulse pressure, LVH, LV dilatation, and S3
Mitral Prolapse Physical char?
Midsystolic click, late systolic murmur. Also panic disorder
Who should receive endocarditis prophylaxis?
People with known valvular heart dz, or prosthetic valves. In pts with MVP, use only if murmur is heard on PE, or if Hx of previous endocarditis
What are the protocols for endocarditis prophylaxis?
For oral surgery: amoxicillin before and after, clinda or azithro may be substituted for PCN allergy. For GI or GU procedures: Ampicillin + Gentamicin before and amoxicillin after, can sub vanco for PCN allergy
What's Virchow's triad?
Endothelial damage, venous stasis, and hypercoagulability, all assoc with DVT
Common clinical scenarios for dev't of DVT?
surgery, malignancy, trauma, immobilization, pregnancy, birth control pills, DIC, hematologic disorders
S/Sx of DVT?
Unilateral leg swelling, pain, tenderness, and/or + Homan's (in about 30%). Best Dx by dopplar US, gold standard is venography