2) Cardiology (Part 1) Flashcards
Non-modifiable coronary heart disease risk factors
- Age
- Male sex
- Family history
Modifiable coronary heart disease risk factors
- Hyperlipidemia
- Hypertension
- Diabetes mellitus
- Metabolic syndrome
- Cigarette smoking
- Obesity
- Sedentary lifestyle
- Heavy alcohol intake
Markers for CHD
- Elevated lipoprotein (a)
- Hyperhomocysteinemia
- Elevated high-sensitivity C-reactive protein (hsCRP)
- Coronary arterial calcification detected by CT (CAC)
Atherosclerosis
- Pathological process in which coronary arteries become narrowed by the buildup of fatty material in their walls
Atherosclerotic plaques
- Lead to narrowing of the artery lumen
- Decrease blood flow and oxygen delivery to the coronary arteries
CAD diagnosis
- Cardiac catheterization (often after an abnormal cardiac stress test)
Or
- CT angiography
CAD treatment
- Treat Modifiable Risk Factors (Hyperlipidemia, Hypertension, Diabetes mellitus, Metabolic Syndrome, Cigarette Smoking, Obesity, Sedentary Lifestyle, Heavy Alcohol Intake)
- Low-dose aspirin 75-100mg/daily for secondary prevention
Primary prevention (preventing 1st heart attack)
- Mostly don’t prescribe low-dose aspirin
- Sometimes used in select adults aged 40-70 years who have a higher risk of developing ischemic heart disease but not an increased bleeding risk
Angina
- Limitation of Coronary Blood Flow
- Decreased Oxygen supply to the heart muscle
- Pt. develops chest pain
Classic history of angina
- Chest discomfort, usually described as “heaviness” “pressure” “squeezing” “smothering” or “choking”
Levine’s sign (pt making fist over sternum describing pressure)
- Can radiate to either shoulder and to both arms (especially the ulnar surfaces of the forearm and hand)
- Can arise in or radiate to the back, interscapular region, root of the neck, jaw, teeth, and epigastrium
- Angina is rarely localized below the umbilicus or above the mandible
Anginal “equivalents” symptoms
- Dyspnea
- Nausea
- Fatigue
- Faintness
- More common in elderly and diabetic patients
Types of angina
- Prinzmetal’s Variant Angina/Vasospastic Angina
- Stable Angina
- Unstable Angina
Prinzmetal’s Variant Angina
- Caused by coronary artery vasospasm resulting in transmural ischemia
- Severe ischemic pain that usually occurs at rest and is associated with transient ST-segment elevation
- Diagnosed with coronary angiography demonstrating transient coronary spasm
Stable angina
- Transient myocardial ischemia
- Caused by exertion typically is relieved in 1–5 min by slowing or ceasing activities and even more rapidly by rest and sublingual nitroglycerin
Unstable angina
- Part of “Acute Coronary Syndrome”
- Has at least one of three symptoms
- Can have ECG changes, but has negative troponins
Symptoms indicative of unstable angina
- Ooccurrence at rest (or with minimal exertion) lasting >10 min (usually more than 20 min)
- Relatively recent onset (i.e., within the prior 2 weeks)
- Crescendo pattern (i.e., distinctly more severe, prolonged, or frequent than previous episodes)
Stable angina Tx
- Treat modifiable risk factors
- Nitrates
- Beta or Calcium Channel Blockers, Ranolazine
Prinzmetal’s Variant Angina Tx
- Nitrates
- Calcium channel blockers
Unstable angina Tx
- Admission
- Dual antiplatelet therapy + glycoprotein IIb/IIIa inhibitor + anticoagulation with heparin +/- statin +/- cardiac cath
Unstable Angina (UA) ischemic symptoms
- Rest angina usually more than 20 minutes, new onset angina that limits physical activity, increasing angina that is more frequent, longer, and occurs with less exertion than previously
- With or without EKG changes in contiguous leads (ie T wave inversions, ST segment depressions)
- NO elevation of troponin
Non-STEMI ACS symptoms
- Same as unstable angina, but troponin is elevated
STEMI ACS symptoms
- ST segment elevations of 1 mm (0.1 mV) in 2 anatomically contiguous leads or 2 mm (0.2 mV) in 2 contiguous precordial leads
- OR new left bundle branch block and presentation consistent with ACS