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Clin Med-Cardio pt 1 > Atherosclerosis/ PVD/ CHD > Flashcards

Atherosclerosis/ PVD/ CHD Flashcards

1
Q

Characterized by lipid deposition, fibrosis, calcification and plaque formation in large and medium vessels

A

Atherosclerosis

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2
Q

Atherosclerotic heart disease is the most common cause of..

A

Cardiovascular death and disability

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3
Q

Men are more affected by atherosclerosis 4:1 until age….

A

70, where the ratio becomes 1:1

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4
Q

Smoking and elevated cholesterol levels (greater than 200) due to diet or familiar dyslipidemias…

A

RISK FACTORS** for atherosclerosis

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5
Q

CRP level with atherosclerosis

A

Increased!

Inflammation thought to play a role*

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6
Q

Managent of ______ and _______ are essential to the control of vascular disease

A

Blood glucose

Blood pressure

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7
Q

Smoking cessation!!**
Control of HTN, tx of diabetes, tx of dyslipidemia
Low BMI, regular exercise
Modified diet..low saturated, low fat, low cholesterol

A

Treatment for atherosclerosis

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8
Q

characterized by insufficient oxygen supply to cardiac muscle, most commonly caused by atherosclerotic narrowing

A

Ischemic heart disease

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9
Q

Risk factors: HTN, diabetes, increased age, tobacco use, family hx (CV dz in males under 55, females under 65), physical inactivity, obesity, dyslipidemias, ETOH

A

Ischemic heart disease

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10
Q 
Abdominal obesity
Triglycerides above 150
HDL less than 40 (men) or 50 (women)
Fasting glucose higher than 110
HTN
A

If a pt has at least 3 of these, MAJOR CONTRIBUTOR TO CORONARY HEART DISEASE***

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11
Q 
Pts with...
Cerebrovascular disease
Peripheral artery disease
Abdominal aorta aneurysm
Chornic/end stage renal dz
Diabetes
A

**HIGH RISK! for coronary heart disease

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12
Q

_____ use is associated with MI and infarction secondary to vasospasm. Pts often much younger than typical cardiac patients

A

Cocaine

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13
Q

What causes angina pectoris?

A

Ischemia

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14
Q

characterized by paroxysmal chest “squeezing” or pressure, often accompanied by a sensation of smothering and fear of impending death

A

Angina

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15
Q

Predictably exacerbated by physical activity and relieved by rest

A

Stable angina

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16
Q

Caused by vasospasm at rest, with preservation of exercise capacity

A

Prinzmetal (variant) angina

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17
Q

Closely related to non-ST segment elevation myocardial infarction (NSTEMI) and is a common manifestation of cardiovascular disease

A

Unstable angina

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18
Q
  1. angina at rest
  2. new onset of angina symptoms
  3. increasing pattern of pain in previously stable patients
A

Common presentations of unstable angina

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19
Q

What is the most common presentation of unstable angina?

A

REST PAIN (ANGINA)

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20
Q

What should you suspect when the patients pain is less responsive to Nitro, lasts longer and occurs at rest or with less exertion than previous episodes of angina?

A

Unstable angina

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21
Q

_______ sign, which is a clenched fist over the sternum and clenched teeth when describing chest pain, may be seen in patients with ischemia

A

Levine

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22
Q

Midsternal but may radiate to jaw, shoulders, arms, wrists, back of neck or any combo of these

A

Angina

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23
Q

Who presents more with right shoulder and back pain radiation?

A

Women

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24
Q

Stable angina usually lasts less than..

A

3 minutes

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25
Q

Angina pectoris lasting longer than 30 minutes suggest….

A

Unstable angina, MI, or another diagnosis

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26
Q

The pain of stable angina can be significantly relieved by..

A

Sublingual nitro

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27
Q

How often can you use sublingual nitro?

A

Every 5 minutes up to 3 times

if pain is not completely relieved after these 3 doses, unstable angina, MI or other diagnosis likely!!!!!**

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28
Q

Horizontal or downsloping ST segment depression on ECG is amon the most sensitive clinical signs of..

A

An anginal attack

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29
Q

ECG will normal in about ____% of patients with angina

A

25

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30
Q

What is he most useful and cost effective, non invasive test to look at angina?

A

Exercise stress testing

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31
Q

An ST segment depression of 1 mm (0.1 mV) during an exercise stress test…

A

POSITIVE result!

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32
Q

If a person cannot exercise, what is an alternative way of stress testing?

A

Pharmacologic stress testing

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33
Q

Myocardial perfusion scintigraphy, radionuclide angiography, and stress echocardiography can help determine…

A

Extent and location of ischemia

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34
Q

What is the definitive diagnostic procedure to diagnose ischemic heart disease (but should be used selectively because of cost and invasiveness)**

A

Coronary angiography!***

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35
Q

Long acting nitrate should include a daily _________ hour treatment free interval to prevent drug tolerance

A

8-10 hr

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36
Q

Headache, nausea, light headedness, hypotension

A

ADVERSE effects of Nitro

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37
Q

This class of drugs prolongs life in patients with coronary disease and are FIRST LINE THERAPY** FOR CHRONIC ANGINA..they are indicated for treatment of ischemic symptoms

A

Beta blockers

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38
Q

This class of drug are useful in the treatment of UNSTABLE ANGINA, particularly with patients who have symptoms of heart failure

A

ACE inhibitors

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39
Q

This class of drug decreases cardiac muscle oxygen demand but are considered alternative therapy. They re indicated for treatment of ischemic symptoms in patients for whom Beta-blockers are contraindicated or have been maximized

A

Ca channel blockers

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40
Q

Diagnosis of acute MI is based on evolution of..

A

Cardiac biomarkers

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41
Q

1/5 of patients with acute MI will die, usually from..

A

Ventricular fibrillation

before reaching a hospital

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42
Q

Non traumatic chest pain is the most common presenting factor in

A

Acute coronary syndrome

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43
Q

Crushing retrosternal pain or pressure; heaviness or tightness; unexplained indigestion; epigastric pain

A

MI

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44
Q

Denotes formation of fibro-fatty lesions in the intimal lining of large and medium sized arteries

A

Atherosclerosis

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45
Q

Oxidized LDL within a macrophage helps make up..

A

Atherosclerosis

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46
Q

if the plaque ruptures or fissures…circulating blood gets exposed to contents of the plaque (ie collagen), which is very ….

A

Thrombogenic

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47
Q

a HUGE risk factor for large, medium and SMALL vessels

A

Diabetes

if small vessels involved, arteriosclerosis

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48
Q 
Total cholesterol, LDL, HDL, triglycerides
Hypertension
Cigarette smoking
Diabetes****
Fam hx in first degree relative (male under 55, female under 65)
Male gender
Age (men over 45, women 55)
Hypoestrogenemia
Physical inactivity
CENTRAL OBESITY
Elevated plasma homocysteine levels
Elevated CRP
A

Risk factors for Atherosclerosis**

49
Q

CRP under 1 mcg/ml

A

low risk for atherosclerosis

50
Q

CRP 1-3 mcg/ml

A

intermediate risk for atherosclerosis

51
Q

CRP over 3 mcg/ml

A

high risk for atherosclerosis

52
Q

made by the endothelial cells and is PROTECTIVE: vasodilator with anti-atherosclerotic properties

A

Nitric oxid (NO)

53
Q

What does smoking do to NO levels

A

Decreased or absent production of NO in smoking (HTN and diabetes also)

54
Q

Risk factor modification- smoking cessation, antihypertensive rx, treatment of dyslipidemia, estrogen replacement, glucose regulation, regular exercise, aspirin prophylaxis

(NO HX OF DISEASE!!)

A

Primary prevention of atherosclerosis

55
Q

Delay or abort disease progression in patients with documented CHD; risk factor modification

(DO have HX of dz, now trying to slow progression!)

A

Secondary prevention

56
Q

if we lower lipids, we can prevent

A

Atherosclerosis

57
Q

What drug is ALWAYS used in secondary prevention. If you have atherosclerosis, you WILL be on this (unless contraindicated)

A

Aspirin

58
Q

Increased LDL increases risk of…

A

CAD
PAD
Stroke

59
Q

How long without oxygen until cells begin to die?

A

10-20 minutes

60
Q

Temporary reduction of blood flow to an organ, potentially reversible

A

Ischemia

61
Q

A significant ________ ________ can lead to an in imbalance between blood supply and demand. The reduction in blood flow limits the normal increase in perfusion when there is increased demand (activity, exercise)

A

Coronary stenosis

62
Q

Significant left ventricular hypertrophy
Aortic stenosis
Tachyarrhythmias

All increase O2 demand, putting patient at higher risk of….

A

Myocardial Ischemia

63
Q

False negative stress tests are common in what group of people?

A

Women

bc they are more likely to have single vessel dz, which may not show up on stress test

64
Q

Chest discomfort- heaviness, tightness, pressure, squeezing, burning, aching or choking; may not be described as “pain”. Classic symptoms of…

A

Reversible myocardial ischemia

65
Q

Precipitating factors include..Exertion, exercise, emotional duress, cold weather, sexual activity, cigarette smoke, large meals.
*reproducible with activity

A

Stable angina

66
Q

Xanthelasma, xanthomas- hyperlipidemia.
Funduscopic abnormalities: A-V nicking, hypertensive, diabetic changes

May be seen in PE in patients with..

A

Angina

67
Q

sharply demarcated yellowish deposit of fat underneath the skin, usually on or around the eyelids. While they are neither harmful nor painful, these minor growths may be disfiguring and can be removed.

A

Xanthelasma

68
Q

an irregular yellow patch or nodule on the skin, caused by deposition of lipids.

A

Xanthoma

69
Q

ST segment depression and/or T wave changes are characteristic of..

A

Ischemic changes

70
Q

Most useful non invasive test for pt with angina?

A

Exercise stress test

71
Q

What is the GOLD STANDARD** for assessing severity of coronary artery disease?

A

Coronary angiography

used in conjunction with patients symptoms and extent of ischemia, via stress testing

72
Q

Which vessels do Nitro effect?

A

Healthy veins!..healthy vessels will dilate because nitro relaxes smooth muscle

**nitro will not dilate diseased vessels

73
Q

Venodilates, reducing LV volume (preload), which decreases oxygen consumption

A

Nitro

74
Q 
This class of drug prevents angina by decreasing myocardial consumption of oxygen, decreases HR, contractility and BP
*improves exercise tolerance and reduces symptoms
A

Beta receptor blockers

75
Q

Reduce mortality rate post MI

Reduce mortality rate in patients with heart failure

A

Beta blockers

76
Q

Decrease myocardial O2 requirements by dilating peripheral arteries/arterioles, reducing BP, LV wall stress and after load!
*result is a lower myocardial O2 consumption

A

Calcium channel blockers

77
Q

Do we use long or short term acting calcium channel blockers?

A

LONG!

short term can cause significant swings in BP

78
Q

Dihydropyridine
Diltiazem
Verapamil
Ranolazine

A

Ca channel blockers

79
Q

Which is the weakest vasodilator of all Ca channel blockers?

A

Verapamil

80
Q

Avoid calcium channel blockers in which type of people?

A

THOSE WITH HEART FAILURE!**

these drugs decrease contractility

81
Q

Has unique MOA of decreasing late Na current, decreasing intracellular Ca.

*increased QT interval without causing arrhythmias

A

Ranolazine

82
Q

**ALL PATIENTS WITH CHD SHOULD BE ON….

A

Anti platelet drugs

decreases incidence of subsequent MI, cardiac death

83
Q

Inhibits ADP-induced platelet aggregation; option if ASA is contraindicated

A

Clopidogrel

84
Q

Patients with unacceptable symptoms in spit of optimal medical treatment

A

Revascularization

85
Q

3 vessel CAD, especially w LV dysfunction
Left main or left main equivalent dz

Pt may be candidate for…

A

CABG

86
Q

Indicated primarily for single or 2 vessel disease

*low morbidity, mortality and rapid recovery

A

Angioplasty

87
Q

Metal scaffolding devices that prevent elastic recoil

A

Stents

88
Q

Saphenous veins and internal mammary arteries are commonly used in…

A

Coronary bypass surgery

89
Q

Which surgical procedure has the best long term results of potency and flow

A

Coronary artery bypass

90
Q

Often induced by exposure to cold, emotional stress, meds, drugs
**chest discomfort AT REST accompanied by ST segment elevation and arrhythmias

A

Coronary vasospasm

may progress to MI if spasm does not resolve

91
Q

2 drugs that can prevent spasm or reverse spasm

A

Ca channel blockers

Nitrates

92
Q

Coronary ischemia as a result of vasospasm
Symptoms at rest, esp in early AM
Women>men..AKA variant angina
Coronary arteriography often identifies normal appearing vessels- vasospasm can be induced pharmacologically in cardiac cath lab.

A

Prinzmetal’s Angina

93
Q

There is considerable overlap between unstable angina and _____. The pathology is nearly identical.

A

NSTEMI

94
Q

Difference between NSTEMI and unstable angina (UA)?

A

NSTEMI has abnormal cardiac markers (CK MB or troponins) that indicate cell necrosis

(NO CELL NECROSIS HAS OCCURRED YET IN UNSTABLE ANGINA)

95
Q

Pathology: complex coronary lesions- stenosis with placque rupture, hemorrhage, thrombus.
Prognosis (untreated): High risk of developing MI in following days/weeks.

A

Unstable angina

96
Q

Tx: full anticoagulation and anti platelet therapy

A

Unstable angina

97
Q

Prolonged ischemia resulting from inadequate tissue perfusion leading to tissue necrosis and myocardial cell death.

A

Myocardial infarction

98
Q

Atypical presentations of MIs (often painless infarcts) in…

A

Elderly
Diabetics
Women

99
Q
  • Pulse and BP variable and change frequently; hemodynamic instability common.
  • Irregularities in pulse may represent arrhythmias.
  • Lungs usually clear unless heart failure present.
A

MI

100
Q
  • S4 gallop in most; S3 unusual unless CHF.
  • Transient apical mitral regurgitant murmurs usually represent papillary muscle dysfunction.
  • Extremities: cyanosis/cold indicate low CO.
A

MI

101
Q
  • S4 gallop in most; S3 unusual unless CHF.
  • Transient apical mitral regurgitant murmurs usually represent papillary muscle dysfunction.
  • Extremities: cyanosis/cold indicate low CO.
A

MI

102
Q

If ischemia to papillary muscle during MI, what may happen?

A

Mitral regurg

103
Q

enzyme released from damaged skeletal muscle and heart. Always elevated with MI.

A

CK (creatine kinase)

104
Q

Cardiac specific troponin will rise within about..

A

4-6 hours

peak in 8-12!

105
Q

CKMB levels increase with..

A

Myocardial damage

106
Q

Pts with ST segment depression are initially considered to have either…

A

Unstable angina OR

NSTEMI

107
Q

If deciding between NSTEMI or unstable angina…and cardiac biomarkers become elevated. What is your dx?

A

NSTEMI

108
Q

ST elevation of greater or equal to 1 mm in 2 contagious leads
**must be readily identified!!

A

STEMI

109
Q

All patients with acute coronary syndrome with ongoing discomfort should receive…

A

IV fluids
Oxygen
Nitro

110
Q

An oral ________ should be initiated within the first 24 hours for all patients with ACS, in the absence of contraindications (heart failure, bradycardia, heart block)

A

Beta blocker

111
Q

If a patient has heart failure and cannot take a beta blocker, which medication should he/she go on within the first 24 hours of ACS

A

ACE inhibitor

112
Q

Acute STEMI patients need to undergo immediate thrombolytic therapy to promote re-perfusion. Which drugs can you give?

A

tPA
Aspirin
Clopidogrel

113
Q

Thrombolytic therapy within the first __ hours of the onset of pain reduces mortality and limits size of infarction

A

3

114
Q

What is the time limit goal of opening the artery after presenting to the hospital?

A

90 minute “door to balloon time”

115
Q

You want to open the artery how many hours after onset of symptoms

A

3 hours

116
Q

Infarcts characterized by by prolonged ischemia, small elevations of cardiac markers and EKG changes showing ST depression and/or T wave inversions.

A

NSTEMI

117
Q

Considered “incomplete infarcts” with lower initial mortality but high risk of re-infarction and with high mortality.

A

NSTEMI

118
Q

WHICH CLASS OF DRUGS DO YOU ALWAYS AVOID AFTER AN MI???****

A

NSAIDs

associated with re-infarction, hinders healing***

Clin Med-Cardio pt 1 (10 decks)

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