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What are the classic sx of chest pain?
- Crushing substernal pain or abdominal pain
- N/V/diaphoresis/SOB
- Sx last longer than 15-20 minutes
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What are important PMH to know with a pt presenting with CP?
- HTN, DM, Cholesterol, Tobacco, Obesity, Drugs use/abuse
- Family history
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What are clinical findings on PE for CP?
- Dyspnea
- Diaphoresis
- JVD
- Pulmonary Edema
- New murmor
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What are the three kinds of angina discussed?
- Rest angina - Pain >20 mins
- New Onset - severe pain within 2 months of presentation. Marked decrease in PE
- Increasing - Previously dx angina which is worsening
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What is the DDx for CP?
- Cardiac
- vascular
- pulmonary
- MS
- GI
- Derm
- Connective Tissue
- Psych
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What are the DEADLY SIX?
- Aortic Dissection
- PE
- AMI/ACS
- Arrythmia
- Pericarditis
- Tamponade
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What are the serum markers in CP?
- Myoglobin - from muscle
- CK-MB - from death of muscle
- Troponin - from myocardial injury
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What are the most common presenting sx for AMI?
- 26% - initial Cxr
- 54% - SOB
- 14% Abdominal Pain
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How do we treat an AMI?
- 100% ASA
- 100% low flow O2
- B-Blocker
- Nitro
- Antiplatlet therapy
- Heparin, LMW Heparin, Clopidogrel
- Invaisive
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Complications of AMI
- Dysrhythmia
- Diastolic dysfunction - pulmonary congestion --> shock
- Systolic dysfunction - diminished cardiac output -->shock
- Mechanial Complications (wall rupture, pericarditis, thrombus)
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How do we treat Pulmonary Edema?
- UNLOADME
- U-upright
- N-nitro
- L-Lasix
- O-O2
- A-Apsirin/ACE
- D-Dopamine/Dobutamine
- M-Morphine
- E-Endotracheal Intubation
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How do we classify aortic dissections?
- Standford A/Debakey I-II - surgical
- Standford B/Debakey III - Medical
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What will find on exam with a pneumothorax?
- Decreased breath sounds
- JVD
- Tachypnea
- Decreased BP
- Trach Deviation
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What will we find on an EKG with a PE?
- S1, Q3, T3
- most common ST, R-Axis deviation
- RBBB
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What hallmarks can we see on CXR with PE?
- Westermark - cutoff Pulmonary Artery
- Hamptons Hump - Pleural based wedge
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What is the gold standard for Dx of PE?
Arteriogram
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What is a classic presentation of Pericarditis?
- sharp, pleuritic pain
- most severe in supine position
- better when patient sits or leans forward
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What will pericarditis look like on EKG?
- Diffuse ST elevations
- PR depression
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