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Clinical Medicine II > CAD > Flashcards

CAD Flashcards

1
Q

Pain between nose and pubis until proven otherwise

A

CAD

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2
Q

What is the progression of CAD?

A

stable angina -> unstable angina -> NSTEMI -> STEMI

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3
Q

What is the leading cause of death for both men and women?

A

CAD

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4
Q

What is the athelerosclerotic buildup in arteries?

A

CAD

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5
Q

What determines rupture risk of a plaque?

A

characteristics, not size

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6
Q

What is caused by rupture?

A

thrombus formation

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7
Q

What are modifiable risk factors for CAD?

A
  • smoking cessation
  • treat sleep apnea
  • weight loss
  • correct illnesses worsen symptoms
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8
Q

What does this define:
- reproducible angina symptoms of at least 2 months (CP, pressure, tightness, gripping, radiating to upper arms, neck, jaw, face) ass w/ SOB, diaphoresis, palpitations, pre-syncope
- precipitated by exertion or emotional stress
- relieved by rest or nitroglycerin?

A

angina pectoris

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9
Q

What groups could have atypical CAD symptoms?

A

women, DM, elderly, that could have DOE, back pain, neck pain, nausea

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10
Q

What are risk factors for angina pectoris?

A

older age, male, post-menopausal females, hyperlipidemia, smoking, HTN, DM, obesity, family Hx
high triglycerides, small LDL, high homocysteine, stress, depression, inflammatory markers
lipoprotein, chlamydia pneumoniae

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11
Q

What causes angina pectoris?

A

imbalance between myocardial oxygen supply + demand

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12
Q

What could an angina pectoris ecg look like?

A

normal OR
pathologic Q waves + conduction abnormalities (LBBB, LAFB which can increase CAD odds), ST depression

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13
Q

What is the first line test for angina pectoris?

A

stress test (physical exercise or meds like dobutamine or adenosine agonists)

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14
Q

When do you get a stress test?

A

when there is intermediate probability of CAD

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15
Q

What do you do after a stress test?

A

angiography if positive

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16
Q

What can nuclear isotope testing distinguish?

A

ischemia from infarction

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17
Q

What can calcium score screening do?

A

help find calcium (hardened plaques) in arteries, good first step

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18
Q

When do you refer for angina pectoris?

A

1) need to confirm or exclude CAD
2) medical therapy fails to relieve anginal symptoms
3) history and noninvasive testing suggests high-risk coronary anatomy

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19
Q

What is the management of angina pectoris?

A

4 drug regimen –
daily aspirin + beta blockers + short acting nitroglycerin PRN + daily statin

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20
Q

If someone is allergic to aspirin what should you use instead?

A

clopidogrel

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21
Q

What’s second line for angina pectoris?

A

anti-anginal = add calcium channel blockers or ranolazine

22
Q

All patients should be on ___ unless clear contraindications

A

aspirin

23
Q

How do you treat severe anginal pectoris symptoms?

A

revascularization for relief of anginal symptoms in patients on optimal management –
1) percutaneous transluminal coronary angioplasty
2) stent deployment

consider CABG!

24
Q

What does this indicate:
- angina at rest (>20min)
-new onset exertional angina
-preexisting angina that has increased in frequency or duration
-post MI?

A

unstable angina

25
Q

What does this indicate:
-same as UA but + myocardial necrosis
-elevation in cardiac enzymes
-no ST elevation?

A

NSTEMI

26
Q

What does this indicate:
-ST elevation
-elevation in cardiac enzymes

A

STEMI

27
Q

What risk score is used for evaluating 14 day death, recurrent MI, urgent revascularation?

A

TIMI risk score

28
Q

What’s the difference between STEMI + NSTEMI?

A

STEMI = complete occlusion

29
Q

What can cause plaques to rupture?

A

inflammation, shear stress, degradation

30
Q

What is the “catch all” of cardiac enzymes?

A

troponin

31
Q

What are cardiac enzymes to look at?

A

troponin, CPK-MB, LDH, myoglobin (earliest)

32
Q

What’s the earliest cardiac enzyme?

A

myoglobin

33
Q

always treat low risk _______ and moderate-high risk______

A

conservatively, aggressively

34
Q

How do you treat unstable angina + NSTEMI?

A

anti-angina – nitrates, beta blockers, morphine
+ anti-clot antiplatelets
+ anticoagulants (heparin, thrombin inhibs)
+ statins
+ ACE-I/ARB if EF<40%
consider PCI
NO THROMBOLYTICS

35
Q

How do you treat a STEMI?

A

anti-angina – nitrates, beta blockers, morphine
+ anti-clot antiplatelets
+ anticoagulants (heparin, thrombin inhibs)
+ statins
+ ACE-I/ARB if EF<40%
PCI is PREFERRED method!
thrombolytic therapy

36
Q

PCI vs thrombolytics

A

PCI is preferred - 90 min or less, or 2 hours or less when traveling
If cannot – thrombolytics

37
Q

MONA BASH in Paris (ACS)

A

M - morphine
O - oxygen
N - nitrates
A - aspirin + ADP inhibitors

B - beta blockers
A - ACE inhibitors
S - statins
H - heparin/anticoagulants

38
Q

Is aspirin the only first line agent in MI?

A

No, guidelines call for a P2Y12 inhibitor to be added to aspirin for all patients with STEMI, regardless of whether reperfusion is given, and continued for at least 14 days, and generally for 1 year.

39
Q

What ADP/P2Y12s are preferred for STEMIs?

A

ticregalor or prasugrel

40
Q

What can a dry chronic cough be an ADR of

A

ACE-I

41
Q

What’s the catch all cardiac enzyme?

A

troponin

42
Q

What may be a sign of angina?

A

Levine sign—clenched first over the sternum and clenched teeth when describing chest pain

43
Q

What anti-HTN is renoprotective?

A

ACE-I

44
Q

What anti-HTNs should you not use in renal dysfunction?

A

diuretics

45
Q

What should you choose in renal dysfunction for HTN?

A

ACE-I for renal protection and need baseline labs for close monitoring

46
Q

What should you choose with a patient w gout for HTN?

A

CCBs, losartan

47
Q

What would you choose with osteoporisis or elderly + HTN?

A

diuretics

48
Q

What would you choose post-MI HTN?

A

BB or ACE-I

49
Q

what would you choose for angina or A fib and HTN?

A

BB or CCB

50
Q

What anti-HTN do you use with BPH?

A

alpha blockers

51
Q

What anti-HTN should you use with DM or CKD?

A

ACE-I or ARBs

52
Q

What anti-HTN is reno (nephropathy) and cardioprotective?

A

ACE-I

Clinical Medicine II (15 decks)

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