CAD Flashcards
Pain between nose and pubis until proven otherwise
CAD
What is the progression of CAD?
stable angina -> unstable angina -> NSTEMI -> STEMI
What is the leading cause of death for both men and women?
CAD
What is the athelerosclerotic buildup in arteries?
CAD
What determines rupture risk of a plaque?
characteristics, not size
What is caused by rupture?
thrombus formation
What are modifiable risk factors for CAD?
- smoking cessation
- treat sleep apnea
- weight loss
- correct illnesses worsen symptoms
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?
angina pectoris
What groups could have atypical CAD symptoms?
women, DM, elderly, that could have DOE, back pain, neck pain, nausea
What are risk factors for angina pectoris?
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
What causes angina pectoris?
imbalance between myocardial oxygen supply + demand
What could an angina pectoris ecg look like?
normal OR
pathologic Q waves + conduction abnormalities (LBBB, LAFB which can increase CAD odds), ST depression
What is the first line test for angina pectoris?
stress test (physical exercise or meds like dobutamine or adenosine agonists)
When do you get a stress test?
when there is intermediate probability of CAD
What do you do after a stress test?
angiography if positive
What can nuclear isotope testing distinguish?
ischemia from infarction
What can calcium score screening do?
help find calcium (hardened plaques) in arteries, good first step
When do you refer for angina pectoris?
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
What is the management of angina pectoris?
4 drug regimen –
daily aspirin + beta blockers + short acting nitroglycerin PRN + daily statin
If someone is allergic to aspirin what should you use instead?
clopidogrel
What’s second line for angina pectoris?
anti-anginal = add calcium channel blockers or ranolazine
All patients should be on ___ unless clear contraindications
aspirin
How do you treat severe anginal pectoris symptoms?
revascularization for relief of anginal symptoms in patients on optimal management –
1) percutaneous transluminal coronary angioplasty
2) stent deployment
consider CABG!
What does this indicate:
- angina at rest (>20min)
-new onset exertional angina
-preexisting angina that has increased in frequency or duration
-post MI?
unstable angina
What does this indicate:
-same as UA but + myocardial necrosis
-elevation in cardiac enzymes
-no ST elevation?
NSTEMI
What does this indicate:
-ST elevation
-elevation in cardiac enzymes
STEMI
What risk score is used for evaluating 14 day death, recurrent MI, urgent revascularation?
TIMI risk score
What’s the difference between STEMI + NSTEMI?
STEMI = complete occlusion
What can cause plaques to rupture?
inflammation, shear stress, degradation
What is the “catch all” of cardiac enzymes?
troponin
What are cardiac enzymes to look at?
troponin, CPK-MB, LDH, myoglobin (earliest)
What’s the earliest cardiac enzyme?
myoglobin
always treat low risk _______ and moderate-high risk______
conservatively, aggressively
How do you treat unstable angina + NSTEMI?
anti-angina – nitrates, beta blockers, morphine
+ anti-clot antiplatelets
+ anticoagulants (heparin, thrombin inhibs)
+ statins
+ ACE-I/ARB if EF<40%
consider PCI
NO THROMBOLYTICS
How do you treat a STEMI?
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
PCI vs thrombolytics
PCI is preferred - 90 min or less, or 2 hours or less when traveling
If cannot – thrombolytics
MONA BASH in Paris (ACS)
M - morphine
O - oxygen
N - nitrates
A - aspirin + ADP inhibitors
B - beta blockers
A - ACE inhibitors
S - statins
H - heparin/anticoagulants
Is aspirin the only first line agent in MI?
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.
What ADP/P2Y12s are preferred for STEMIs?
ticregalor or prasugrel
What can a dry chronic cough be an ADR of
ACE-I
What’s the catch all cardiac enzyme?
troponin
What may be a sign of angina?
Levine sign—clenched first over the sternum and clenched teeth when describing chest pain
What anti-HTN is renoprotective?
ACE-I
What anti-HTNs should you not use in renal dysfunction?
diuretics
What should you choose in renal dysfunction for HTN?
ACE-I for renal protection and need baseline labs for close monitoring
What should you choose with a patient w gout for HTN?
CCBs, losartan
What would you choose with osteoporisis or elderly + HTN?
diuretics
What would you choose post-MI HTN?
BB or ACE-I
what would you choose for angina or A fib and HTN?
BB or CCB
What anti-HTN do you use with BPH?
alpha blockers
What anti-HTN should you use with DM or CKD?
ACE-I or ARBs
What anti-HTN is reno (nephropathy) and cardioprotective?
ACE-I
