Clinical Causes of Cardiac Issues
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Questions and Answers

What is the primary concern for patients with severe coronary artery disease?

  • Medication therapy only
  • Monitoring with EKGs
  • PCI treatment
  • CABG surgery may be required (correct)

    • What is typically observed on an ECG for a patient with Wellens' Syndrome?

  • Prolonged PR interval
  • ST segment elevation
  • Biphasic or deeply inverted T waves in V2-3 (correct)
  • Bundle branch block

    • What is the significance of a Type A pattern on an ECG?

  • Benign ECG pattern
  • Indication for thrombolytic therapy
  • Sign of reperfusion (correct)
  • High risk for anterior wall MI

    • What is the significance of a patient's cardiac enzymes being normal or minimally elevated?

    <p>Does not necessarily rule out a cardiac event</p> Signup and view all the answers

    What is the recommended management for patients with Wellens' Syndrome?

    <p>PCI or CABG</p> Signup and view all the answers

    What is the significance of psychological stress in cardiac patients?

    <p>Can cause tachyarrhythmias</p> Signup and view all the answers

    What is the goal of electrical cardioversion?

    <p>To restore a normal heart rhythm</p> Signup and view all the answers

    Why may patients with Wellens' Syndrome be at high risk for anterior wall MI?

    <p>Due to the critical stenosis of the LAD</p> Signup and view all the answers

    What is a potential cause of delayed deterioration in a patient with a myocardial infarction?

    <p>Retroperitoneal hemorrhage</p> Signup and view all the answers

    What is a common investigation performed in the case of delayed deterioration in a patient with a myocardial infarction?

    <p>EKG</p> Signup and view all the answers

    What is a potential diagnosis in a patient with a myocardial infarction and a new murmur?

    <p>Ventricular septal defect</p> Signup and view all the answers

    What is the management of Type I MI in a patient presenting with chest pain?

    <p>Treat medically for MI and pursue prompt catheterization</p> Signup and view all the answers

    What is a complication of myocardial infarction that can cause delayed deterioration?

    <p>Ventricular free wall rupture</p> Signup and view all the answers

    What is a sign of pericarditis on physical examination?

    <p>Pericardial friction rub</p> Signup and view all the answers

    What is a potential cause of delayed deterioration in a patient with a myocardial infarction?

    <p>In-stent thrombosis</p> Signup and view all the answers

    What is a potential diagnosis in a patient with a myocardial infarction and a new murmur?

    <p>Mitral regurgitation</p> Signup and view all the answers

    What is the definition of concordant ST elevation in ECG?

    <p>≥1 mm and proportionally excessive (≥25% of depth of preceding S-wave)</p> Signup and view all the answers

    In which leads is ST elevation typically seen in an anteroseptal myocardial infarction?

    <p>V1-V4</p> Signup and view all the answers

    What is the indication for urgent echocardiography in a patient with LBBB?

    <p>To detect wall motion abnormalities</p> Signup and view all the answers

    What is the target temperature for avoiding hypothermia in trauma patients?

    <p>&gt; 36°C</p> Signup and view all the answers

    What is the goal of 'damage control surgery' in trauma patients?

    <p>To control haemorrhage, decompress, decontaminate, and splint</p> Signup and view all the answers

    What is the indication for performing regular blood gas analysis in trauma patients?

    <p>To monitor base excess</p> Signup and view all the answers

    What is the recommended target for platelet transfusion in trauma patients?

    <p>&gt; 100x10^9/L</p> Signup and view all the answers

    What is the consequence of inappropriate use of vasoconstrictors in trauma patients?

    <p>Doubled mortality</p> Signup and view all the answers

    What is the recommended target for INR in trauma patients?

    <p>&lt; 1.8</p> Signup and view all the answers

    What is the recommended goal for surgery time in trauma patients?

    <p>&lt; 90 minutes</p> Signup and view all the answers

    Study Notes

    Clinical Causes of Delayed Deterioration Post-MI

    • Deterioration post-MI can be caused by Left main coronary artery (LMCA) stenosis, Proximal left anterior descending artery (LAD) stenosis, Severe triple vessel disease, Reinfarction, and Hypoxia or hypotension.
    • Rupture can also cause delayed deterioration, including ventricular free wall rupture, ventricular septal defect (VSD), and mitral valve chordae tendinae rupture.
    • Post-MI Pericarditis and Hemorrhage (e.g., retroperitoneal hemorrhage) can also contribute to delayed deterioration.

    Differential Diagnosis

    • Investigation of delayed deterioration includes review of recent interventions, EKG (new ischemia), Auscultation (new murmur), and Pericardial friction rub.

    Management of Delayed Deterioration

    • Management depends on the clinical context: if Type I MI, treat medically for MI and pursue prompt catheterization; if Type-2 MI, treat the underlying cause of stress and follow EKGs carefully.

    Wellens Syndrome

    • Wellens Syndrome is a clinical syndrome characterized by biphasic or deeply inverted T waves in V2-3, plus a history of recent chest pain now resolved.
    • It is highly specific for critical stenosis of the left anterior descending artery (LAD) and indicates high risk for extensive anterior wall MI.

    Psychological Stress and Tachyarrhythmias

    • Psychological stress can trigger tachyarrhythmias, and dexmedetomidine should be considered.

    Electrical Cardioversion

    • Synchronized cardioversion is recommended, with a dose of 25-50 J/kg.

    Management of Cardiac Arrest

    • Aim to avoid hypothermia, with a target temperature > 36°C.
    • Remove wet clothing and sheets, and use warm blood products, fluids, and warming blankets/mattresses.
    • Perform damage control surgery, including hemorrhage control, decompression, decontamination, and splintage.
    • Aim for surgery time < 90 minutes and conduct regular 'surgical pauses'.

    Metabolic Management

    • Perform regular blood gas analysis, and use base excess to guide resuscitation.
    • If lactate > 5mmol/L or rising, consider stopping surgery, splinting, and transferring to ICU.

    Avoiding Vasoconstrictors

    • Inappropriate use of vasoconstrictors doubles mortality, but may be required in cases of spinal cord or traumatic brain injury.

    Coagulation Management

    • Check clotting regularly and target transfusion, aiming for platelets > 100x10^9/L, INR ≤ 1.8, and fibrinogen > 2g/L.

    Pediatric Doses

    • Pediatric doses are not specified in the text.

    Cardiology

    • Diagnose acute coronary syndrome (ACS) using ECG, clinical symptoms, and biomarkers.

    Thoracic Pain

    • Thoracic pain can be a symptom of ACS.

    Acute Coronary Syndrome (ACS)

    • ACS is defined as a clinical syndrome characterized by symptoms of myocardial ischemia, with or without ST elevation.

    ECG Diagnosis

    • ECG diagnosis includes concordant ST elevation, concordant ST depression, and discordant ST elevation.
    • In cases of LBBB, urgent echocardiography may be useful to detect wall motion abnormalities.
    • Repeat ECG if uncertain.
    • Anatomical localization of ST elevation can help identify the affected coronary artery.

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    Description

    Identify the clinical causes of cardiac issues, including post-MI deterioration, left main coronary artery stenosis, and proximal left anterior descending artery stenosis. Differential diagnosis and investigation methods are also discussed.

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