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Clinical Medicine III > Block I: ischemic disease > Flashcards

Block I: ischemic disease Flashcards

1
Q

[] is a major cause of vascular disability and death in the US

A

CAD

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2
Q

[] can cause overall diminished coronary artery perfusion relative to myocardial oxygen demand

A

CAD, can cause ischemic heart disease

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3
Q

[] is a fibro-fatty plaque which is the basic lesion of CAD

A

artheroma

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4
Q

describe an atheroma

A

a fibro-fatty plaque, that is the basic lesion of CAD

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5
Q

[] is a raided, focal plaque within the tunica interna of the coronary artery

A

artheroma

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6
Q

describe the composition of an artheroma

A

core of lipid (mainly cholesterol and cholesterol esters) with a fibrous cap

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7
Q

what are the four key risk factors of CAD

A
  1. hyperlipidemia
  2. HTN
  3. cigarette smoking
  4. DM
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8
Q

what are the HDL:LDL ratios that correlate to a person’s risk for CAD

A

LDL:HDL < 3 low risk
LDL:HDL > 5 high risk

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9
Q

LDL:HDL < 3 is [] risk for CAD

A

low

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10
Q

LDL:HDL > 5 is [] risk for CAD

A

high

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11
Q

diabetics usually have high [] which can be a contributing factor to CAD

A

triglycerides

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12
Q

what three syndrome related to ACS

A
  1. unstable angina
  2. NSTEMI
  3. STEMI
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13
Q

what is the pathophysiology of ACS

A
  1. endothelial damage (smoking, dyslipidemia, HTN, insulinemia)
  2. black formation
  3. rupture of unstable plaque
  4. platelet activation and plugging
  5. coronary thrombosis
  6. complete or partial vessel occlusion
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14
Q

there is a [] correlation between clinical symptoms and extent of ACS

A

modest

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15
Q

[] is caused by a fixed obsructive CAD i.e. stable plaque

A

stable/typical angina

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16
Q

a stable angina usuallly requires []% stenosis to be symptomatic

A

50

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17
Q

patient presents with

  1. substernal pain/discomfort
  2. provoked by exertion/emotional distress
  3. subsides with rest
  4. some SOA

what is your suspicion?

A

stable angina

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18
Q

what are some anginal equivalents?

A
  1. nausea
  2. lightheaddedness
  3. generalized weakness
  4. acute changes in mental status
  5. diaphoresis
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19
Q

[] is caused by ischemic events due to vaoconstriction or vasospasm. i.e. cold exposure, drug use (cocaine) or can be spontaneous

A

variant angina

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20
Q

how can cocaine cause ischemic coronary events?

A
  1. causes coronary artery vasospasm and vasoconstriction by increasing myocardial energy requirements
  2. also increases platelet aggregation
  3. chronic use significantly accelerates progression of artherosclerotic disease
    - higher risk acute MI
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21
Q

[] clinical syndrome in which episodic chest discomfort occurs at rest without a usual precipitating factor

A

prinzmetal’s angina

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22
Q

what EKG changes are assoc. with prinzmetal’s angina

A

ST segment elevation changes, returns to normal once angina subsides

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23
Q

when does prinzmetal’s angina usually occur?

A

early in the morning, waking patients from sleep.

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24
Q

how is printzmetal’s angina treated?

A

responds well the nitrates or CCBs

-which can be used prophylactically

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25
Q

what is known as a pre-infarction angina

A

unstable angina

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26
Q

[] changing pattern of previously stable angina, or new onset or more severe angina

A

unstable angina

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27
Q

patient comes in with

  1. crescendo pattern of pain
  2. occured while resting
  3. has lasted 40 minutes, and has not been helped by the NTG that was given her in the ambulance
A

unstable angina

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28
Q

[] is characterized as a severe, fixed, obstructive disease with 90% stenosis

A

unstable angina

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29
Q

unstable angina usually consists of []% stenosis

A

90

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30
Q

patients EKG shows

  1. ST segment depression
  2. T wave inversion

what is your suspicion?

A

unstable angina

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31
Q

how can you tell a pre-infarction angina from an MI in lab?

A

usually troponins, which are released upon myocardial cell death. indicative of necrosis

*not end all be all

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32
Q

[] is ischemia of anterior myocardial wall segments, from a result of occlusion of LAD

A

anterior wall MI

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33
Q

ST elevations in leads V1, V2, V3, V4 are indicative

A

anterior wall MI

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34
Q

ST elevations must be present in at least [] conescutive leads to dx STEMI

A

2

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35
Q

what coronary artery is most likely to be affected by an anterior wall mi?

A

LAD

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36
Q

motion pattern of ischemic myocardial segments revels [] motion compared to other normally contractile segments

A

hypo or akinetic motion

specifically anterior

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37
Q

ischemia of inferior myocardial wall generally causes by occlusion of posterior descending artery OR distal part of left circumflex is called []

A

inferior wall MI

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38
Q

what arteries are usually assoc. with inferior wall MI

A
  1. posterior descending artery

2. distal part of left circumflex

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39
Q

changes in EKG leads II, III, aVF are usually indicative of []

A

inferior wall MI

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40
Q

what is important to note about inferior wall MIs

A

they usually present with hypotension therefore DO NOT GIVE NTG

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41
Q

why do inferior wall MIs cause hypotension?

A

they induce parasympathetic stimulation -> bradycardia, hypotension

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42
Q

ischemia of lateral wall generally causes by occlusion of LAD or L circumflex is []

A

lateral wall MI

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43
Q

what coronary arteries are involved in lateral wall MI

A

LAD or L circumflex

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44
Q

what EKG leads reveal changes in lateral MI?

A

I, aVL, V5, V6

45
Q

ischemia of septal wall caused by occludion of LAD is [] MI

A

septal MI

46
Q

what arteries are involved in a septal MI

A

LAD

47
Q

what leads are involved in a septal MI

A

1, 2

48
Q

what leads are involved in a posterior wall MI

A

1, 2, 6

49
Q

what arteries are involved in a posterior wall MI

A
  1. R coronary

2. Left circumflex

50
Q

[] is a symptom of myocardial ischemia that occurs most commonly during activity and relieved by resting

A

angina pectoris

51
Q

who may present with atypical symptoms of MI

A
  1. women
  2. elderly
  3. diabetics
52
Q

what are some uncommon presentations of MI

A
  1. nausea
  2. epigastric pain
  3. tooth pain
  4. dull body or arm aches
53
Q

ischemic pain is classically felt []

A

retrosternally

54
Q

what is levine’s sign

A

clenched fist over the heart

55
Q

if a patient has had a heart attack before, what should their symptoms look like?

A

a duplicate of whatever occured with their first one

56
Q

radiation of pain to arms or neck is more likely to characterize []

A

myocardial ischemia

57
Q

what are the most common signs for myocardial ischemia pain radiation

A
  1. L shoulder
  2. upper arm
  3. inner aspect arm to elbow
  4. forearm
  5. wrist
  6. 4th or 5th fingers

*sometime jaw or neck or intrascapular

58
Q

a patient presents with retro- sternal pain, what may you conclude about their condition

A

ischemic in nature

59
Q

anginal pain lasts [] minutes

A

3-15 and subsides complete with not residual pain

60
Q

substernal pain for 10 minutes with complete revocery may indicate []

A

anginal pain

61
Q

chest discomfort for a few seconds is UNlikely to be []

A

ischemic

62
Q

anginal pain lasting over [] minutes suggests unsatable angina, MI, alt. dx

A

20

63
Q

anginal pain lasting ocer 20 minutes may suggest []

A
  1. unatsble angina
  2. MI
  3. other dx
64
Q

what common precipitating factors for anginal pain?

A
  1. meals
  2. cold
  3. emotional distress
  4. exercise
65
Q

what are some alleviating factors of anginal pain

A
  1. rest

2. NTG

66
Q

what are some symptoms that should INCREASE the likelyhood of MI

A
  1. nausea
  2. diaphoresis
  3. vomiting
  4. syncope
  5. SOA
67
Q

what are the most telling signs of an MI patient

A
  1. pale
  2. anxious
  3. diaphoretic

*cannot fake this

68
Q

in early anterior infarctions the [] nervous system takes over and leads to []

A

sympathetic

tachycardia, hypertension

69
Q

in inferior infarctions the [] nervous system takes over and leads to []

A

parasympathetic

hypotension, bradycardia

70
Q

what is important to monitor on pts. neck if your suspect MI

A

JVD

71
Q

what murmumr is most common with inferior wall MI

A

acute mitral valve regurgitation

72
Q

are murmurs always indicative of MI

A

no, but NEW ones should raise suspicions

73
Q

[] is the most common cause of acute mitral valve regurgitation

A

inferior wall MI

74
Q

a new systolic murmur may signify []

A

papillary muscle dysfunction or rupture

or

herald ventricular septal rupture

75
Q

a PMI abnormality may point to

A

dyskinetic infarcted area

76
Q

what are important things to look for in cardiac exam if you suspect a patient has MI

A
  1. murmurs
  2. heart sounds
  3. PMI
77
Q

what rectal check should you perform if you suspect a patient has an MI?

A

occult blood on stool

esp. if youre going to give anticoag- want to ensure pt. isnt having a bleed

78
Q

list some diagnostic tests you would perform if you suspect MI

A
  1. EKG
  2. Troponin
  3. CBC/CMP
  4. PT/PTT/INR
  5. BNP
  6. D-Dimer
  7. CTA
  8. exercise electrocardio
  9. echo
  10. coronary angiography
79
Q

myocardial ischemia delays [] in heart which can lead to EKG changes

A

process of repolarization

80
Q

what EKG segments are most commonly affected by MI

A
  1. ST T wave
81
Q

ST elevation indicates

A

STEMI, highly pathological

82
Q

what, pathophysiologically, is happening when an ST segment is elevated

A

depolarizes incompletely and remains electrically more positive than uninjured area surrounding it

present in leads facing affected areas

83
Q

ST depression is indicative of

A

angina

84
Q

a horizontal ST is indicative

A

angina

85
Q

what does an inverted t wave represent

A

angina where full thickness of myocardium is involved

if it is new its concerning

86
Q

what does troponin represent

A

it is released from dead myocardial cells, indicative of MI

87
Q

[] diagnostic test is most useful, non invasive procedure for evaluating a patient with angina

A

exercise electrocardiograph

88
Q

if troponin is normal, what should be your next diagnostic test?

A

exercise electrocardiograph

89
Q

what is a 2D doppler with various roles such as

evaluating valvular heart disease, L ventricular dysfunction, pericardial problems

A

echo

90
Q

[] definitive diasnostic procedure for CAD

A

coronary angiography

91
Q

[] visualizes location and severity of stenosis

A

coronary angiography

92
Q

narrowing of []% viewd on coronary angiography is cliniclaly sig.

A

50

93
Q

most lesions that produce ischemia are []% stenotic

A

70

94
Q

[] shows whether obstructions are amenable to percutaneous transluminal coronary angioplasty or bypass

A

coronary angiography

95
Q

what is the DOC for anginal pain

A

NTG

96
Q

what is the MOA of NTG

A

relaxes cardiovascular smooth muscle and alters venous vessels

increases subendocardial perfusion to ischemic and non ischemic areas

**decrease in pre load

97
Q

what anti-anginal causes a decrease in pre load

A

NTG

98
Q

do not admin NTG if BP is less than []

A

90 mmHG

*also dont admin if markedly bradycardic or tachycardic

99
Q

if pain doesn’t subside with NTG what should be on your radar

A

evolving infarction may be present

req. imm. attention

100
Q

what are common side effects of NTG

A
  1. nausea
  2. HA
  3. dizziness
  4. hypotension
101
Q

MOA BB

A

prevent angina by reducing myocardial oxygen requirements during exertion and stress

reduce HR, contractility, BP

102
Q

[] is the only anti-anginal therapy proven to prolong life in patients wiht CAD and post MI

A

BB

103
Q

[] is given as a f/u to MI, NOT during acute MI

A

BB

given 12 hours after they are stable or discharged once home

104
Q

[] should be rxed for all patients with angina indefinitley

A

ASA

105
Q

role ASA in treatment

A

anti-platelet

keep plateletls from being activated and sticking together- keeps them from forming fibrous clot

106
Q

what are some other antiplatelets

A
  1. ticlopidine
  2. ticagrelor
  3. clopidogrel
107
Q

[] should be started with unstable angina

A

hepratin IV

low molecular weight, becoming standard of care

  • safer, more convenient
  • PTT not risk
108
Q

what is an absolute indication for thrombolytic therapy

A
  1. ST seg elevation w hx unstable angina

Clinical Medicine III (5 decks)

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