Cardiovascular Emergencies Overview

Cardiovascular Emergencies

Avoid nitrates in RCA infarcts (preload dependence). Remember RCA, V1-4, LAD, V5-V6, 1, and avL for the LCX.
Ventricular fibrillation (VFib) is a common cause of death surrounding a myocardial infarction (MI).
Papillary muscle rupture presents with a holosystolic murmur best heard at the apex, radiating to the axilla.
Ventricular free wall rupture presents with Beck's triad (Jugular venous distension, hypotension, and distant heart sounds) and rapid decompensation.
Interventricular septal rupture presents with a holosystolic murmur at the Left Lower Sternal Border (LLSB) accompanied by pressure equalization between heart chambers, detectable with cardiac catheterization or bubble study.
Echocardiogram is crucial for diagnosing endocarditis and most valvular disorders. Transthoracic echocardiogram (TTE) is usually performed first, followed by transesophageal echocardiogram (TEE). Blood cultures are also necessary.

Lower Extremity Pain

Leg pain better at night with "shiny" extremities: Varicose veins.
Leg pain worse at night in a smoker: Peripheral arterial disease (PAD).
Leg pain relieved with leg elevation: Varicose veins.
Underlying cause of varicose veins: Incompetent valves.
Leg pain with activity: Ankle brachial index (ABI) measurement.
Leg pain relieved with leg elevation: Doppler ultrasonography.
Leg pain (no erections), buttock/thigh/calf pain: Aorta and its branches (iliac arteries; Leriche syndrome).
Upper calf pain with activity: Superficial femoral artery.
Lower calf pain with activity: Popliteal artery.
Calf pain, fullness behind the knee: Baker’s cyst (ruptured).
Sudden onset calf pain with atrial fibrillation (Afib): Heparin therapy.
Shiny skin with no hair above the medial malleolus: Stasis dermatitis from varicose veins.
Ulcer beneath toes, no sensation, CKD: Ulcers secondary to diabetic neuropathy.
Painful ulcer beneath toes, smoker: Ulcers secondary to PAD.
Painless ulcer above the medial malleolus, 70 yo female: Ulcers secondary to venous incompetence.
ABI 1.5 with foot ulcer: Diabetes (calcified vessels).
Leg pain relieved with rest: Supervised walking program.
Medication to improve walking distance in PAD: Cilostazol (PDE inhibitor).
PAD in a young Japanese female with high BP and elevated ESR/CRP: Takayasu arteritis.
Varicose veins treatment: Leg elevation and compression stockings.
Tortuous, palpable "cord" in leg pain: Superficial thrombophlebitis (NSAIDs, warm compresses; no heparin).
Unilateral leg swelling and tenderness in pregnant women, those on oral contraceptives, or truck drivers: Deep vein thrombosis (DVT).

Urological Conditions

Testicular pain, unsure if epididymitis or torsion: Testicular ultrasound is necessary to rule out torsion.
Epididymitis treatment: Ceftriaxone and doxycycline.
AAA repair, anemia, positive FOBT: Aortoenteric fistula.

Renal Conditions

Renal cell carcinoma: Abdominal CT scan.

Other Medical Conditions

Risk factor for most atherosclerotic vascular disease: Cigarette smoking.
Strongest risk factor for aortic dissection and strokes: Hypertension.
Aortic dissection management: IV beta blocker (like labetalol).
Stanford A dissection: Ascending aortic involvement treated with beta blockers and surgery.
Stanford B dissection: Primarily treated with medical therapy.
Radial nerve injury: Inability to extend the wrist, sensory loss on the back of the forearm and back of the first three digits + midshaft humeral fracture.
Ulnar nerve injury: Inability to spread fingers, claw hand, sensory loss on the front and back of the 4th and 5th digits + recent elbow dislocation.
Median nerve injury: Inability to pronate the hand or oppose thumbs, sensory loss on the palmar surface of the hand involving the first three digits + carpal tunnel syndrome, supracondylar humeral fractures.
Axillary nerve injury: Inability to abduct the shoulder, sensory loss on the lateral shoulder + anterior shoulder dislocation, upper humeral dislocation.
Peroneal nerve injury: Inability to dorsiflex or evert the foot, loss of sensation on the dorsal surface of the foot and lateral leg + recent knee dislocation, fracture of the fibula.
Scaphoid fracture: Fall on outstretched hand; pain and paresthesia in the “anatomic snuff box,” even with a negative X-ray, a thumb spica cast is used for 6 weeks.
Obturator nerve injury: Weakness of thigh adduction.
Lateral femoral cutaneous nerve injury: Anesthesia over the lateral thigh.
Appendicitis: Periumbilical pain radiating to halfway between the umbilicus and the Anterior Superior Iliac Spine (ASIS), McBurney's point tenderness. Passive internal rotation of the hip in flexion (Obturator sign), Passive extension of the hip (Psoas sign), RLQ pain from LLQ palpation (Rovsing sign), Ultrasounds for pregnant patients, CT scans for general patients.
Urinary tract symptoms and abdominal pain (e.g., fever, WBC count): Abdominal/pelvic CT with intravenous contrast (e.g., diverticulitis).
Common cause of lower GI bleeding in the elderly: Barium enema (diverticulosis.)
Recurrent LLQ pain, gas/feces in the urine: Abdominal/pelvic CT with oral/rectal contrast (colovesical fistula).
Appendicitis in pregnant: Ultrasound.
Appendicitis in others: Abdominal CT Scan.
Signs of hemorrhagic pancreatitis: Periumbilical ecchymosis, flank ecchymosis.
Sigmoid volvulus: Omega sign in a patient with nausea and vomiting.
Duodenal atresia: Double bubble sign on abdominal X-ray.
Intussusception: Target sign in a 7-month-old on abdominal ultrasound in the right lower quadrant.
Murphy's sign: Patient holds their breath in mid-inspiration with right upper quadrant palpation.
Ascending cholangitis (Reynold's pentad): Fever, right upper quadrant pain, jaundice, altered mental status, and hypotension. Charcot's triad is fever, RUQ pain and Jaundice.
Psoas sign: RLQ pain with hip extension in an anorexic patient with nausea and vomiting.
Obturator sign: RLQ pain with internal rotation of a flexed hip.
Rovsing sign: RLQ pain with LLQ palpation.
Kehr's sign: Referred pain to the left shoulder in a patient with a history of mononucleosis).
McBurney's sign: RLQ pain halfway between the umbilicus and the ASIS.
Acute bowel infarction: Abdominal pain in a patient with CAD, X-ray reveals “thumbprinting” in the bowel.
Cervical rib: Impingement on nerves/blood vessels supplying the arm, causing symptoms of upper extremity paresthesias and possible subclavian steal syndrome.
Breast masses (30–50 years): Fibrocystic change, (teens/20s): Fibroadenoma.
Cystic breast mass: Fine needle aspiration (FNA) as next step; if fluid is serous, stop here, if blood, proceed to biopsy.
Burn patients: Prophylactic use of proton pump inhibitors (PPIs) for stress ulcers.
Umbilical hernias: Common in infants and possibly associated with neonatal hypothyroidism.
Post-operative fever causes : Infection, Pain, Dehydration, Medications, Water, Wound complications, and medications.
Cushing's triad: Hypertension, bradycardia, and irregular respirations (possible elevated ICP).
Elevated ICP treatment: Hyperventilation (pCO2 of 25-30), position the patient (right Trendelenberg), and administration of mannitol).
Anterior spinal artery syndrome: Loss of pain and temperature, incontinence, and LE paralysis in conjunction with AAA repair.
Syringomyelia: Loss of pain and temperature in a cape-like distribution).

Additional Conditions (Page 7&8)

A comprehensive list of various medical conditions and their associated symptoms, diagnostic tests, and treatments is displayed. These encompass a wide range of organ systems. Specific examples include endocrine disorders (thyroid), musculoskeletal conditions, neoplastic diseases, and more. A large number of diagnostic steps, including imaging (CT, ultrasound, X-rays), blood tests, and potentially surgical interventions are noted.