CAD Flashcards
S2Q2
CAD: Intro
other name, pathology, which side die more, main etiology + example
trend killer + 1>1>1
risks (5)
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
CAD: Angina
other name, etiology (3)
sx - what, where (3), radiate (4)
stable angina - sx duration + otherwise
- 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
CAD: Angina
likely - age, (5)
- > 65y
- DM
- faintness
- fatigue
- eructation (empacho; GI)
- epigastric pain (sinisikmura; don’t just give antacids)
CAD: Angina
fixed threshold - (2)
variable - 1st thing when, 2nd thing (1=1)
mixed - what
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
CAD: Angina
unlikely - (5)
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
CAD: Angina
class 1-4 new york vs. canada
which treatable
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
CAD: Atherosclerosis
pathology (2 + where = 1 = 1)
if inc plaque then what happens (2.1)
stable (1) vs. unstable (1=1=1)
- 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
CAD: Atherosclerosis
timeline - (2.2.2)
— FFIAFL
1st decade
foam cells
fatty streak
2nd decade
intermediate lesion
atheroma
3rd decade
fibrous plaques
lesion
CAD: Atherosclerosis
main triggers (2) - what, what + example
hemodynamic
- sudden inc/dec
prothrombotic
- drugs that cause blood viscosity
- contraceptive pills
CAD: Atherosclerosis
ischemic triggers - (4), pulse pressure what + normal, HR normal, extra (2)
- exercise
- cold exposure
- upright
- smoking
- catecholamine, platelet activation
pulse pressure
- difference between SBP & DBP
- N: 40
HR
- N: 50-70
CAD: Non-Atherosclerotic Cause
(5)
myocardial bridging - normal location (2), what happens (1) (1=1), tx
aortic dissection - etiology, sx, tx
- 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
CAD: Non-Atherosclerotic Cause
transient (3) - associated + sx, where, where
vasospasm
- raynaud’s phenomenon
- episodic
embolus
- elsewhere
thrombus
- heart/same origin
CAD: Non-Atherosclerotic Cause
degree (2) - sx
exercise x vessel
50% stenosis of epicardial artery
- angina in strenuous
80% stenosis
- angina at rest
exercise can form new blood vessels but long time
CAD: Risk Factors
sex + why, race, 3 conditions
family Hx death age
psych - trend, (2)
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
CAD: Syndromes
chronic stable angina - etiology, hx, prognosis
- eti: atherosclerotic plaque
- existed before, progressive
CAD: Syndromes
ACS - associated, WHO criteria (1.2.1=1) + how many
sx (10) + if what artery affected then prognosis
- 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
CAD: MI
2 types + tx
criteria (2G) - (3.0)
- 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
CAD: Unstable Angina
pathology (2), when sx (2), duration, ECG & biomarker, onset, sx (2) + how many need
- 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
CAD: Unstable Angina
NSTEMI - pathology, what, ECG & biomarkers (4)
STEMI - pathology (2), ECG, biomarkers
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
CAD
ST elevation significance
ventricular septal defect - patho
septum - 1=1
no ST elevation = not total
ST elevation = complete obstruction
ventricular septal defect
- blood flow LV –> RV
septum
- excessive necrosis = rupture
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
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
CAD: Mx
dobutamine - when, for, effect
revascularization - via (3), for
stenting - other name, purpose + uses
balloon - what
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
CAD: Mx
phase 1-4
phase 1: hospital
phase 2: discharge
phase 3: immediate OP
phase 4: long term maintenance
CAD: New Classification
type 1-5
chronic coronary syndrome - which angina, when (2)
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
