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FA17 Cardio 2 > CAD 3 > Flashcards

CAD 3 Flashcards

1
Q

myocardial ischemia

A

decreased blood/oxygen supply to heart muscle

suggested on EKG as inverted waves

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2
Q

myocardial injury

A

ischemia sufficiente enough to cause necrosis and release of biomarkers

EKG changes in ST elevation

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3
Q

myocardial infection

A

irreversible injury to myocardium

suggested by EKG changes (ST Elevation and Q waves)

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4
Q

types of MIs

STEMI or NSTEMI +

A
  1. spontenous MI from coronary event
  2. secondary to something else
  4. a = PCI, b- angiography
  5. associated with CABG
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5
Q

unstable angina

A

SUB-endocardial injury

subtotal coronary artery occlusion

anginal chest pain at rest + ECG ST depression and T wave inversion, NEGATIVE cardiac biomarkers

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6
Q

NSTEMI

A

subtotal coronary artery occlusion

anginal chest pain at rest + ECG ST depression or T wave inversion, POSITIVE cardiac biomarkers

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7
Q

STEMI

A

COMPLETE coronary artery occlusion

anginal chest pain

ST elevation/new LBBB

positive cardiac biomarkers

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8
Q

anterior MI: what artery?

A

LAD

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9
Q

Laterial MI: what artery?

A

LCX

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10
Q

Posterior MI: what artery?

A

RCAor LCX

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11
Q

R. ventricle MI: what artery?

A

RCA

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12
Q

atrial MI: what artery?

A

RCA

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13
Q

patients are more likely to get an MI from ___ lesions

A

new

therefore small, recent lesions bc more likely to rupture

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14
Q

HISTORY OF PATIENT WITH ACS

A

ANGINAL PAIN LSTING LONGER THAN 20 MINUTES

LIMITS PHYSICAL ACTIVITY

INCREASES DURATION OR FREQUENCY

DECREASE EXERTION DEEDED TO CAUSE ANDINAL CHEST PAIN

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15
Q

physical exam of MI

A

levine sign

diaphoretic, pale, respiratory distress

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16
Q

initial therapy for suspect ACS

A

MONA

Morphine 2mg
Oxygen 2-4 L
Nitrates
Aspirin (chewed or swallowed once)

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17
Q

MONA might not be good if:

A

Morphoine = avoid unless severe pain

ocygen= may increase vasospasm

nitrates = recent PDE-5

18
Q

diagnosis of an MI (workup)

A

12 lead EKG (and repeat)

usual labs

BNP (heart failure)

CXR
cardiac enzymes (q 6-8 hrs)

CK-MB and Troponin I

19
Q

unstable angina/NSTEMI tx

steps

A
  1. anti-anginal (2)
  2. dual anti platelet therapy (DAPT) (2)
  3. anti-thrombotic therapy (1)
  4. Risk strategy

1-3 are always indicted in NSTEMI/UA

electrolytes and telemetry floor

20
Q

anti-anginal therapy

A

beta blockers (cardioselective BB, doesn’t have HF hemodynamic compromise)

Nitroglycerin

21
Q

DAPT

A

uncoated aspirin

thienopyridine or P2Y12 inhibitor

can use GP IIb/IIIa inhibitor

22
Q

anti-thrombotic therapy

A

1 of 4

  1. unfractionated heparin
  2. LMWH
  3. fonduparinux
  4. IV direct thrombin inhibitors

inhibit further thrombin activation

23
Q

risk stratification in UA/NSTEMI

high risk

A

1+ of, immediate angiogram and revascularizatoin

  • hemodynamic instability or shock
  • severe LV dysfunction of HF
  • persistent resting angina despide meds
  • new or worsening regurge
  • sustained ventricular arrhythmia
24
Q

risk stratification in UA/NSTEMI

stable risk

A

TIMI score used, cath in 24-48 hrs , 3+ is high risk

> 65, 3+ CAD risk factors, known CAD >50% stenosis, Aspirin, severe angina, elevated markers, ST deviation

25
Q

TIMI 5+

A

immediate angiography
unstable patients

add re graph

26
Q

TIMI 3+

A

invasive approach

cardiac cath 4-48 hrs

revascular options est depending on results

27
Q

TIMI 0-2

A

conservative approach

intensify meds

if symptom free, stress test, if not cardiac cath

28
Q

goal of STEMI management

A

total occlusion of large artery SO myself open ASAP to restore perfusion

29
Q

door to balloon time goal? door to needle?

A

to balloon = 90 min (into hospital to time deploy stent)

to needle= 30 min (thrombolytic ASAP)

PCI with angioplasty or stent is preferred if either options are available (CAPBG is not emergent)

30
Q

STEMI with normal coronaries

A

MC in young and women patients

causes: coronary spasm, toxins, collagen, coagulation dz, myocarditis, embolism

31
Q

functional complications of AMI

A

CHF (left ventricle) = ACE

right ventricle failure = fluids, avoid nitro/diuretic

cardiogenic shock

32
Q

mechanical complications of AMI

A

free wall rupture - high mortality, complete heart block

ventricular septal defect

papillary muscle rupture with acute mitral refuge

33
Q

right ventricular infarction

A

coronary occlusion of R a. or branch

inferior MI

clinical triad of: hypotension, clear lungs, jugular venous distention

-backing up in systemic system , LV intact

34
Q

treatment of right ventricular infarction

A

BP depends on preload

STEMI in precordial leads

myst get right sided EKG

avoid vasodilators and diuretics

treat hypotension = givese volume

35
Q

CAD in elderly

A

elderly are more like to have NSTEMI and silent or atypical presentation

more likely to have HF associated with MI

36
Q

medications in secondary prevention

A

beta blocker

aspirin

clopidogrel

ace (HF, LVEF <50%)

staitn

37
Q

Takotsubo cardiomyopathy

A

transient systolic dysfunctional of apical or mid segments of LV that mimics MI

38
Q

cocaine

A

cause CP, coronary artery vasospasm and MI

BB or contraindicated

nitrates and non-DHP CCB are recommend

39
Q

Prinzmetal angina

A

vasospasm of artery

atypical chest pain occurring during rest (MC 12AM -morning)

young smokers, history of coaine use

transient ST elevation

responsive to nitrates, thought to be due to hyperactivity of vascular smooth muscle

40
Q

prinzmetal angina treatment

A

smoking and drug cessation

treatment with non-DHP CCB

avoid beta blockers

41
Q

best way to reduce CAD risk

A

predicting 10 yr risk

starting aggressive and early changes

control of lipids, HTN , DM

FA17 Cardio 2 (10 decks)

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