EMED

Question 1

Where is classic chest pain described

How is classic chest pain described

Time frame for angina, unstable angina and AMI pain

Answer 1

Retrosternal in left, anterior chest

Tight Pressure Crushing Squeeze

A: 2-10min UA: 10-30min MI: >30min

Question 2

Pts w/ ? Hx can suggest an accelerated atherosclerosis process

Why can ACS present w/ tachy or bradycardia

? EKG finding is Dx of acute MI

Answer 2

Cocaine abuse, HIV infection/antivirals

Tach: inc symp tone
Brady: conduction system ischemia

ST elevation ≥1mm in two leads

Question 3

MI Pts w/ ? findings are suggestive of ischemia and need further work up

? is the biomarker of choice

What is more sensitive than the above

Answer 3

ST elevation
Q-wave
LBBB
T-wave inversion
Normalization of Sxs

cTN: cardiac troponin

Delta cTn

Question 4

? Pts have have an elevated cTN despite no cardiac pathology

What rare test may be used for suspected MI Pts when infarction time is unclear

ACS encompasses ? DDxs and presents w/ ? MC Sx

Answer 4

Renal failure

Creatine kinase MB

N/STEMI and UA; Chest pain

Question 5

EKG findings for:

Antero/Septal/Lateral

Inferior/Lat

Posterior

Right ventrical

Answer 5

AS: Elevation V1-3
A: Elevation V1-4 LAD (septal too)
AL: Elevation 1, aVL, V1-6

L: elevation 1, aVL; LCX
I: elevation 2, 3, aVF; RCA>LCX
IL: elevation 2, 3, aVF and V5-6

P: R waves V1-2 w/ R/S ratio ≥1; LCX

RV: Elevation 2, 3, aVF and R sided V4; RCA

Question 6

MI w/ atrial origin will have ? vessel involved

How often are repeat troponins drawn

How does UA present

Answer 6

RCA

q3hrs

Chest pain and one of:
Began <2mon ago
Inc frequency/intensity/duration
Angina at rest

Question 7

STEMI Tx options and times

Answer 7

Thrombolytics <30min
PCI <90min
Fibrinolytics if <12hrs since Sxs

Question 8

NSTEMI Tx path

Answer 8

Clopidogrel and ASA

Anticoag w/ UFH or LMWH

Question 9

UA Tx path

? anticoagulant is used If Pt is heading to CABG

Read Cardio slides in N/STEMI

Answer 9

Anticoagulate w/ UFH or LMWH

UFH

And UA

Question 10

What are the 6 classifications of HF

Answer 10

HTN: SBP >140, Sxs <48hrs

Pulm Edema: resp distress w/ dec O2 sats

Cards Shock: HOTN/SBP <90

Acute on Chronic: SBP 90-140 w/ inc edema

High Output: tachy, warm skin and pulm congestion

R HF: low output w/ JVD, hepatomegaly

Question 11

What is the most sensitive Sx for CHF

What are the 3 most specific Sxs for CHF

What are the most specific CXR findings

Answer 11

Dyspnea w/ exertion

Paroxysmal nocturnal dyspnea
Orthopea
Edema

Pulm venous congestion
Interstitial edema
Cardiomegaly

Question 12

MCC of cardiogenic shock

What is a commonly seen dysrhythmia

What are signs of end organ hypoperfusion

Answer 12

AMI

Sinus tach

Cool mottled skin
AMS
Oliguria

Question 13

? is the preferred revascularization method for Pts w/ cardiogenic shock

What meds need to be avoided

? vasopressor and positive ionotrope can be used for these Pts

Answer 13

PCI > fibrinolytics

BBs

NorEpi

Question 14

Cardiogenic shock w/ MR is manged w/ ? drug combo

? structural heart Dz can cause syncope

? tachydysrhythmias can cause syncope

Answer 14

Nitroprusside w/ dobutamine

HOCM AS MI

VTach Torsades SVT

Question 15

? type of syncope needs to be considered in elderly Pts w/ repeat syncope and negative cardiac work ups

? d/o is MC mistaken for syncope

What are the San Fran Syncope rules for features suggesting adverse events and may need admission

Answer 15

Carotid sinus hypersenitivity

Seizures

Abnormal EKG
SOB
SBP <90 
HcT <30%
>45y/o
CHF/Ventricular dysrhythmia