CAD Flashcards

S2Q2

1
Q

CAD: Intro

other name, pathology, which side die more, main etiology + example

trend killer + 1>1>1

risks (5)

A

ischemic heart disease
- narrowing of epicardial arteries
- L die more in circulation
- d/t atherosclerosis (reuse oil)

  • CVD as #1 killer
  • ischemic heart disease > stroke > cardiovascular

risks
- diet, smoking, alcohol, sedentary, pollution

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2
Q

CAD: Angina

other name, etiology (3)

sx - what, where (3), radiate (4)

stable angina - sx duration + otherwise

A
  • chest pain
  • deep visceral squeezing pain on substernal, back, epigastric
  • radiate to: jaw, neck, shoulder, arm
  • eti: exertion, emotional upset, anything that inc demand on myocardium

STABLE ANGINA
- transient, 2-30 mins
- if >30 mins = heart attack

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3
Q

CAD: Angina

likely - age, (5)

A
  • > 65y
  • DM
  • faintness
  • fatigue
  • eructation (empacho; GI)
  • epigastric pain (sinisikmura; don’t just give antacids)
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4
Q

CAD: Angina

fixed threshold - (2)

variable - 1st thing when, 2nd thing (1=1)

mixed - what

A

fixed threshold
- constant level of activity
- pt can predict at what level will cause

variable threshold
- circadian: usually AM, inc catecholamine during sleep = inc HR BP when wake up
- postprandial = more carbohydrates = splanchnic steal blood from heart
- has good & bad days

mixed threshold
- can’t be defined

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5
Q

CAD: Angina

unlikely - (5)

A

pleuritic pain
- sharp/knife pain in inhalation & exhalation
- can pinpoint

pain primarily in middle/lower abdomen

reproduced when press chest or movement

last few secs or longer

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6
Q

CAD: Angina

class 1-4 new york vs. canada

which treatable

A

CLASS I

CLASS II
- new york: slight limit in physical activity
- canada: slight limit in ordinary

CLASS III
- new york: slight limit in ordinary
- canada: marked limit
- walk 1-2 blocks

CLASS IV
- can’t carry out d/t sx even at rest

  • don’t treat class 3-4
  • ADL limits: class III & II
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7
Q

CAD: Atherosclerosis

pathology (2 + where = 1 = 1)

if inc plaque then what happens (2.1)

stable (1) vs. unstable (1=1=1)

A
  • LDL (cholesterol plaques) & monocytes get stored in endothelium of intima = clot = obstruct lumen
  • inc plaque = arterial wall thicken & harden, smooth muscle multiply
  • stable: won’t easily rupture
  • unstable: rupture = wound that bleeds = clot
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8
Q

CAD: Atherosclerosis

timeline - (2.2.2)

— FFIAFL

A

1st decade
foam cells
fatty streak

2nd decade
intermediate lesion
atheroma

3rd decade
fibrous plaques
lesion

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9
Q

CAD: Atherosclerosis

main triggers (2) - what, what + example

A

hemodynamic
- sudden inc/dec

prothrombotic
- drugs that cause blood viscosity
- contraceptive pills

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10
Q

CAD: Atherosclerosis

ischemic triggers - (4), pulse pressure what + normal, HR normal, extra (2)

A
  • exercise
  • cold exposure
  • upright
  • smoking
  • catecholamine, platelet activation

pulse pressure
- difference between SBP & DBP
- N: 40

HR
- N: 50-70

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11
Q

CAD: Non-Atherosclerotic Cause

(5)

myocardial bridging - normal location (2), what happens (1) (1=1), tx

aortic dissection - etiology, sx, tx

A
  • congenital anomaly, granuloma, tumor, scar from trauma, radiation from cancer tx

myocardial bridging
- coronary artery should be epicardial (on top of heart & outside epicaridum)
- cross bridging
- embed into muscle = impingement
- tx: nothing

aortic dissection
- high BP = torn = chest pain = emergency or death

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12
Q

CAD: Non-Atherosclerotic Cause

transient (3) - associated + sx, where, where

A

vasospasm
- raynaud’s phenomenon
- episodic

embolus
- elsewhere

thrombus
- heart/same origin

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13
Q

CAD: Non-Atherosclerotic Cause

degree (2) - sx

exercise x vessel

A

50% stenosis of epicardial artery
- angina in strenuous

80% stenosis
- angina at rest

exercise can form new blood vessels but long time

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14
Q

CAD: Risk Factors

sex + why, race, 3 conditions

family Hx death age

psych - trend, (2)

A

sex
- male d/t testosterone
- female protected by progesterone & estrogen til menopause

race
- black, southeast asian

  • DM: walking time bomb
  • dyslipidemia: high LDL
  • abdominal obesity: DM
  • family Hx of CAD: genetic, die by 50y
  • psych: leading cause d/t stress & depression
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15
Q

CAD: Syndromes

chronic stable angina - etiology, hx, prognosis

A
  • eti: atherosclerotic plaque
  • existed before, progressive
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16
Q

CAD: Syndromes

ACS - associated, WHO criteria (1.2.1=1) + how many

sx (10) + if what artery affected then prognosis

A
  • associated: MI

WHO criteria (>2)
- ischemic discomfort: >30 mins
- ECG: PQRST wave, non-ST elevation MI
- rise/fall of biomarkers: troponin elevation = heart attack

  • angina: 15-30 mins or more
  • diaphoresis, pale, cold skin
  • sinus tachycardia, 3rd/4th heart sound, crackles
  • basilar rates
  • pulmonary edema
  • hypotension: if (L) coronary artery affected = worse prognosis
17
Q

CAD: MI

2 types + tx

criteria (2G) - (3.0)

A
  • total obstruction: emergency
  • partial: manageable

criteria (either)
- typical rise/fall of biomarkers for myocardium necrosis: ischemic discomfort, pathologic Q wave, abnormal myocardium/wall
- pathologic finding of MI

18
Q

CAD: Unstable Angina

pathology (2), when sx (2), duration, ECG & biomarker, onset, sx (2) + how many need

A
  • patho: less severe ischemia & myocardial changes
  • when: rest or after minimal
  • duration: >10 mins
  • ECG & biomarkers: none detected
  • onset: new (4-6w)

signs/sx (>1)
- crescendo pattern (progressive)
- pain gr. 5-8

19
Q

CAD: Unstable Angina

NSTEMI - pathology, what, ECG & biomarkers (4)

STEMI - pathology (2), ECG, biomarkers

A

NSTEMI
- patho: more severe
- clinical feature of UA

ECG/bio
- myocardial necrosis
- troponin I present
- inverted T wave
- non-ST elevation

STEMI
- most severe
- complete occlusion of epicardial artery

ECG/bio
- elevated, ST elevation

20
Q

CAD

ST elevation significance

ventricular septal defect - patho

septum - 1=1

A

no ST elevation = not total

ST elevation = complete obstruction

ventricular septal defect
- blood flow LV –> RV

septum
- excessive necrosis = rupture

21
Q

CAD: Mx

MPI - other name, use (2), when, result (1=1)

CT angio - see (2), result (1=1)

US - see (1)

coronary angio - see (4), where

which standard

A

myocardial perfusion imaging / nuclear scintigraphy
- use nuclear substance (thallium & systamine) during exercise
- if not light up = obstruction

CT angiography
- see: coronary artery, Ca
- higher Ca score = more blockage

intravascular US
- see: amount of atheroma

coronary angiography
- standard for CAD
- see: chambers, valves, lumen, vessels
- femoral artery

22
Q

CAD: Mx

dobutamine - when, for, effect

revascularization - via (3), for

stenting - other name, purpose + uses

balloon - what

A

dobutamine
- given during stress test if pt can’t walk
- elevate HR

revascularization
- melt clot fibrinolysis, PCI, bypass
- for severe c 2-3 vessels

stenting/angioplasty
- fix obstruction using graft from LE

balloon angioplasty
- no longer done

23
Q

CAD: Mx

phase 1-4

A

phase 1: hospital
phase 2: discharge
phase 3: immediate OP
phase 4: long term maintenance

24
Q

CAD: New Classification

type 1-5

chronic coronary syndrome - which angina, when (2)

A

type I: atherosclerotic CAD
type II: oxygen demand
type III: differentiation from sudden cardiac death
type IV: demand for percutaneous coronary intervention (PCI)
type V: CABG

chronic coronary syndrome
- stable agina
- <1y p ACS & revascularization