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Clin Med 1 - Exam 1 > 4. Angina and PAD > Flashcards

4. Angina and PAD Flashcards

1
Q

Stable angina cause

A

Heart O2 consumption exceeds supply

Atherosclerosis most common cause

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2
Q

Stable angina risk factors

A

Age

Male

White

Smoking, high lipids, HTN, DM, ASCVD, FH

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3
Q

Stable angina symptoms

A

Chest discomfort/pressure with exertion/eating

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4
Q

Stable angina signs

A

Levine sign

Otherwise often none when no exertion/eating

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5
Q

Stable angina diagnostics

A

CCTA = GOLD STANDARD

Stress testing

Coronary artery calcium scan

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6
Q

Stable angina treatment

A

Lifestyle

Beta blockers

Nitros PRN

Aspirin (clopidogrel if allergic)

High intensity statin (atorvastatin, rosuvastatin)

ACE/ARB if DM, CKD, HTN, or EF <40%

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7
Q

Define terms:
Angina
Unstable angina
Stable angina
Typical angina
Atypical angina

A

Angina = chest discomfort due to lack of blood to heart

Unstable angina = angina with no clear pattern or trigger

Stable angina = predictable angina with known trigger

Typical angina = chest/arm/jaw discomfort/pressure

Atypical angina = Epigastric/back/indigestion-like discomfort

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8
Q

Unstable angina cause

A

Angina with no clear pattern or cause, occurs at rest

Impending MI

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9
Q

Compare and contrast unstable angina and vasospastic/prinzmetal angina

A

Unstable angina:
>15 min with abnormal diagnostics

Vasospastic/prinzmetal angina:
<15 min, no lingering dx abnormalities

Both can occur at rest

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10
Q

Myocardial infarction cause

A

Necrosis of heart tissue due to ischemia

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11
Q

MI risk factors

A

Same as stable angina

Age

Male

White

(Smoking, high lipids, HTN, DM, obesity, ASCVD, FH)

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12
Q

MI symptoms

A

DYSPNEA

Heaviness/pressure/tightness in chest

Sweating

Elderly may only have dyspnea, dizziness, or arrythmia

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13
Q

MI signs

A

Dyskinetic apical pulsation on palpation

Rales = CHF

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14
Q

MI diagnostics

A

BEST TEST = high sensitivity TROPONINS (T & I)

Also EKG ASAP

STEMI:
ST elevation
New LBBB

NSTEMI:
ST depression
T-wave inversion

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15
Q

MI treatment

A

Admit all patients with suspected acute MI

BONAS to restore O2:
Beta-blockers
Oxygen >90%
Nitroglycerin
Aspirin
Statin

STEMI = BONAS + PCI = percutaneous coronary intervention (reperfusion)
OR
BONAS + thrombolytics if no bleed risk

NSTEMI = NO THROMBOLYTICS

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16
Q

Post-MI complications

A

MOST COMMON = V Fib

V Tach

A Fib

Mitral regurge

Ventricular septal defects

Myocardial rupture

Stroke

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17
Q

Peripheral atherosclerosis cause

A

Atherosclerosis of peripheral arteries

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18
Q

Most common location of peripheral atherosclerosis is …

A

Femoropopliteal artery

19
Q

Peripheral atherosclerosis risk factors

A

MOST OFTEN AGE 60-70

HYPERHOMOCYSTEINEMIA (amino acid buildup damages vessel walls)

Smoking

DM

High lipids

HTN

Family history

20
Q

Peripheral atherosclerosis symptoms

A

INTERMITTENT CLAUDICATION

Resolves with rest (like stable angina for the legs)

If pain at rest, this is bad!
Rest pain = worse with elevation, better with dangling off the bed

21
Q

Peripheral atherosclerosis signs

A

DESCREASED LEG PULSES

BUERGER TEST = elevate leg and see what happens (color change = bad!)

Ulceration, necrosis, gangrene

Ischemia = hair loss, cool, pallor

Check for sensory and motor loss

22
Q

Peripheral atherosclerosis diagnosis

A

Ankle-brachial index low (<0.9?)

Ultrasound = best in real life

23
Q

Peripheral atherosclerosis treatment

A

Stop smoking

Aspirin

Supervised exercise
- if exercise doesn’t help then give cilostazol or naftiorofuryl (vasodilators)

Lower lipids and BP

Treat DM

Surgery can help

24
Q

Acute arterial occlusion cause

A

MOST COMMON = CARDIAC EMBOLISM

(From LAA)

25
Q

Acute arterial embolism risk factor

A

A Fib

26
Q

Acute arterial occlusion symptoms

A

SUDDEN sever limb pain

Muscle weakness

Parasthesia

27
Q

Acute arterial occlusion signs

A

Loss of pulses

Cool skin

28
Q

Acute arterial occlusion diagnostics

A

Angiography with dye

29
Q

Acute arterial occlusion treatment

A

URGENT revascularization (within 3 hours)

This is an emergency!

30
Q

Another name for atheroembolism is …

A

Cholesterol crystal embolism

31
Q

Atheroembolism cause

A

Friable (fragile) aortic plaque embolizes causing a CHOLESTEROL CRYSTAL SHOWER STORM

32
Q

Atheroembolism risk factors

A

Invasive testing

Trauma

33
Q

Atheroembolism symptoms/signs

A

ALL SHOW UP AT SAME TIME

Transient ischemic attacks

Renal failure

Skin changes (levido reticularis, blue toes)

34
Q

Atheroembolism diagnosis

A

TEE - looking for original plaque

35
Q

Atheroembolism treatment

A

Blockages too small to operate on

Aspirin, statin, HTN meds, treat DM, stop smoking

36
Q

Thromboangiitis obliterans other name

A

Buerger’s disease

37
Q

Thromboangiitis obliterans cause

A

Blood vessels in ARM blocked by INFLAMMATION

Both arterial and venous!

38
Q

Thromboangiitis obliterans risk factors

A

Men age 40-50 who smoke anything

39
Q

Thromboangiitis obliterans symptoms

A

Claudication, rest pain, ulcers in ARMS

40
Q

Thromboangiitis obliterans treatment

A

Stop smoking!

Otherwise amputation

41
Q

Raynaud’s phenomenon cause

A

Episodic vasospastic ischemia of digits in response to cold

Maybe autoimmune

42
Q

Raynaud’s phenomenon risk factor

A

Women

43
Q

Raynaud’s phenomenon symptoms

A

Digital blanching > cyanosis > rubor

44
Q

Raynaud’s phenomenon treatment

A

Gloves, avoid cold

Live with it

If not:
Nifedipine
Prazosin

Clin Med 1 - Exam 1 (8 decks)

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