6. Ischemic Heart Disease Flashcards
prevalence of ischemic heart disease
30% of periop pts
ischemic heart disease risk factors
genetic
high fat diet
male
smoking
elderly
obesity
diabetes
HTN
sedentary
hypercholesterolemia
ischemia balances
O2 delivery and O2 consumption
angina diagnosis
retrosternal chest discomfort
crescendo-decrescendo pain over several minutes
angina dermatomes
C8-T4
chest wall movement pain indicates
costochondritis
stable angina
chest pain that doesnt change over 2+ months
stable angina pathophys
mild partial occlusion
atherosclerosis
most common cause of stable angina
atherosclerosis
stable angina diagnosis
stress test
EKG may be normal
chemical stress test
atropine
dobutamine
cardiac pacing
adenosine
coronary steal drugs
adenosie
dipyridamole
gold standard for angina diagnosis
coronary angiography
catheter placement in coronary antiography
femoral artery
acute coronary suyndrome
worsening O2 demand/supply imbalance
most common reason for ACS
focal disruption of atheromatous plaque
STEMI pathoploy
CRP and fibrinogen increased
STEMI diagnosis
EKG changes
troponin level
troponins elevate within
3 hrs of MI
troponin 1
> 40 ng/L
troponin T
men: > 22 ng/mL
women: > 14 ng/mL
when do you not need an echo for MI
if you have EKG evidence
STEMi treatment
beta blockers
referfusion (30 mins/12 hrs)
PCI (90 mins/12 hrs)
chronic NSETMI treatment
stabilize w/statins
acute NSTEMI treatment
betal blockers
antithombotics
supp O2
drug eluting stent reduces
neointimal hyperplasia
issues with stents
thrombosis
bleeding
how long does it take to reendothelialize
2-3 weeks
bare metal reendothelialise
12 weeks
drug eluting stent reendothelialize
up to 1 year
DAT
aspirin
+
P2Y12 inhibitor (plavix)
without stent wait for surgery
2-4 weeks
BMS wait for surgery
30 days-12 weeks
CABG wait for surgery
6 -12 weeks
DES wait for surgery
6-12 months
MAC risk 4 weeks post PCI
10%
MACE risk 90 days post PCI
4%
MACE risk > 90 days post PCI
3%
apiring increase bleading risk
1.5times
plavix + aspirin increases bleeding risk
2.25x
stop clopidogrel/ticagrelor
5 days
stop prasugrel
7 days
surgeries you must stop antiplt therapy
neuro
aorti aneurysm
prostatectomy
(high bleeding risk)
continue DAPT after angioplasty
2 weeks
continue DAPT after BMS
6 weeks
continue DAPT after DES
12 months
when can you give plts after last clopidogrel dose
4 hrs
when is plt transfusion most effective
24 hours after clopidogrel dose
predictors of major cardiac complications
high risk surgery
MI
CHF
stroke/TIA
IDDM
Cr>2.0mg/dl
wait _____ days after MI for surgery
60+ days
which is better TIVA or VA
no difference
when do you treat ST segment change
> 1mm
normal/elevated BP
give NTG
HR elevated
normal/high BP
give esmolol
