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Cardio > ACS, Stable Angina and Aortic Dissection > Flashcards

ACS, Stable Angina and Aortic Dissection Flashcards

1
Q

Definition of acute coronary syndrome

A

Unstable angina, NSTEMI or STEMI

*NOT stable angina

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2
Q

New onset angina at rest or minimal exertion
Angina accelerating in frequency or severity
Normal ECG or ST depression, T-wave inversion
Normal cardiac enzymes

A

Unstable angina

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3
Q

ST depression and/or T-wave inversion

Abnormal cardiac enzymes

A

NSTEMI

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4
Q

ST elevation
Abnormal cardiac enzymes
or
New LBBB or posterior MI

A

STEMI

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5
Q

Most common cause of death in the united states

A

CAD

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6
Q

Atherogenic risk factors

A
  • Low HDL (<40 mg/dL)
  • High LDL
  • High VLDL
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7
Q

Who are silent (painless) AMIs more common in?

A

Elderly, women, diabetics

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8
Q

Classic components of angina pectoris (3)

*actually memorize

A
  1. Substernal chest pain/discomfort
  2. Provoked by exertion or emotional distress
  3. Relieved by rest or nitroglycerin
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9
Q

Typical angina presents with how many of the following components?

  1. Substernal chest pain/discomfort
  2. Provoked by exertion or emotional distress
  3. Relieved by rest or nitroglycerin
A

3/3

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10
Q

Atypical angina presents with how many of the following components?

  1. Substernal chest pain/discomfort
  2. Provoked by exertion or emotional distress
  3. Relieved by rest or nitroglycerin
A

2/3

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11
Q

Non-angina chest pain presents with how many of the following components?

  1. Substernal chest pain/discomfort
  2. Provoked by exertion or emotional distress
  3. Relieved by rest or nitroglycerin
A

1-0/3

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12
Q

Evaluates contractility of the heart

Assesses regional wall motion abnormalities (RWA) as hypokinesis, akinesis, dyskinesis, or normal

A

Dobutamine Stress ECHO

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13
Q

Test used to asses for how much of a coronary artery is occluded

A

Coronary angiography

*>70% = significant stenosis

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14
Q

STEMI ECG criteria

A

ST elevation > 2mm in continuous leads or new LBBB

*Can not diagnose STEMI when there is known/old LBBB

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15
Q

Differences in blood flow in STEMI vs NSTEMI

A

STEMI = complete occlusion of blood flow

NSTEMI = partial occlusion of blood flow, or complete occlusion in presence of collateral circulation

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16
Q

Initial treatment and management of stable angina

A

Aspirin, B blocker, nitroglycerin, statin

17
Q

If stable angina is no relieved by initial treatment (Aspirin, B blocker, nitroglycerin, statin) then what?

A

add Ca channel blocker or long acting nitrate

18
Q

If stable angina is not relieved by Aspirin, B blocker, nitroglycerin, statin; and the addition of a Ca blocker or long acting nitrate, then what?

A

Consider ranolazine, refer for coronary angiography

19
Q

Coronary artery bypass graft (CABG) indications

A
  • 3 vessel disease >70% stenosis
  • Left sided (primarily)
  • LV dysfunction
20
Q

Initial management for all patients presenting with ACS

A

MONA (morphine, oxygen, nitrates, aspirin)

21
Q

In a patient presenting with ACS, what else can be done in addition to MONA?

A

Dual anti-platelet therapy (DAPT)

ASA and P2Y12 inhibitor (clopidogrel, ticagrelor)

22
Q

Drugs shown to improve mortality in MI (3)

A

ASA, B blockers, ACEi

23
Q

Treatment and management of STEMI

A

PCI (percutaneous coronary intervention aka stent) <90 min

  • or transfer to PCI capable hospital in <120 min
  • or administer thrombolytics <30 min then transfer to PCI capable hospital
24
Q

In the event of unstable angina or NSTEMI,

This score system predicts risk of 14 day death, recurrent MI, or urgent revascularization

A

TIMI score

25
Q

ECG leads showing ST elevations
Coronary artery involved

Inferior MI

A

II, III, aVF

RCA

26
Q

ECG leads showing ST elevations
Coronary artery involved

Septal MI

A

V1-V2

LAD

27
Q

ECG leads showing ST elevations
Coronary artery involved

Anterior MI

A

V2, V3, V4

LAD

28
Q

ECG leads showing ST elevations
Coronary artery involved

Lateral MI

A

V5, V6 or I, aVL

LCX

29
Q

ECG leads showing ST elevations
Coronary artery involved

Posterior MI

A

Tall R waves and ST depression in V1, V2, V3
RCA in right dominant
LCX in left dominant

30
Q

Complication of MI that presents as pericarditis

A

Dressler syndrome

  • weeks to months later
  • autoimmune
31
Q

Classification systems for aortic dissection (2)

A

Debakey, Stanford

32
Q

The following are risk factors for what diagnosis?

Long term HTN
Smoking
Dyslipidemia
Marfan
Bicuspid aortic valve
Giant cell arteritis
Takayasu arteritis
Syphilis
Deceleration trauma
A

Aortic dissection

33
Q

Pathogenesis of aortic dissection

A

Intimal tear allows blood to penetrate the vessel wall and dissect the intima away, creating an intimal flap

*creates a false lumen within the tunica media for blood to flow into

34
Q

Imaging study used to diagnose aortic dissection

A

CT angiography

35
Q

Treatment and management for aortic dissection

A
  • Anti-impulse therapy: B blockers and vasodilators to lower BP and HR
  • Opiates for pain control
  • Refer to surgery
36
Q

Type A aortic dissection mortality vs management type (medical intervention vs surgery)

A

Surgical management = higher survivability in type A

*Type A for Ascending aorta

37
Q

Type B aortic dissection mortality vs management type (medical intervention vs surgery)

A

Medical management = higher survivability in type B

  • Type B for descending aorta
  • Type B also has higher survival rate overall

Cardio (18 decks)

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