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Clin Med - Cardio Exam #2 > CAD > Flashcards

CAD Flashcards

1
Q

What is the Most Common cause of death in high income countries?

A

CAD

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2
Q

Usual onset of CAD for Females vs. Males

A

F 55

M 45

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3
Q

Define Coronary Artery Disease

A

Narrowing or blockage of the arteries and vessels that provide oxygen and nutrients to the heart

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4
Q

Define Cardiovascular Disease

A

Broader category that includes CAD, arrhythmias, stroke, and heart valve d/o

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5
Q

Define atherosclerosis

A

buildup of plaque within blood vessels

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6
Q

Define angina pectoris

A

Myocardial 02 demand exceeds supply

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7
Q

define MI (myocardial infarction)

A

Heart attack which can be further differentiated into STEMI, or NSTEMI

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8
Q

What are the risk factors included in the Framingham Risk Score?

A 
Age 
Sex 
Elevated BP
Cholesterol 
Cigarette smoking
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9
Q

What are the most important risk factors for predicting possible cardiac event.?

A

Early CAD

Family hx

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10
Q

What factors are unique to women and put them at risk of Cardiac event?

A

Smaller coronary arteries
Loss of estrogen-elevated inflammatory state
Lower baseline HDL
Vague symptoms are the norm
Less symptom relief with tx, and poorer outcomes from CABG
Higher rates of post MI heart failure

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11
Q

Stop smoking for 1 year and you decrease the risk of MI by _____ %?

A

50

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12
Q

What is the number 1 most preventable cause of death and illness in the US?

A

Smoking

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13
Q

What is the summary - pathological reason behind why smoking raises the risk of CVD?

A

Increased demand
decreased O2 to tissues
Hyper coagulable state
damaged endothelium

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14
Q

What effect can LDL have on contributing to the risk of CVD?

A

Main component of atherosclerotic plaques

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15
Q

What effect can TG have on contributing to the risk of CVD?

A

Lipid made from converting foods high in carbohydrates or fat. Also a component of plaques

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16
Q

What effect can HDL cholesterol have on contributing to the risk of CVD?

A

Absorbs other cholesterol and carries it back to the liver.
“good” cholesterol-reduces risk of CVD

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17
Q

Why does DM contribute to the risk of CVD?

A
  • Tends to lower HDL and raise TG and LDL
  • contributes to Hypercoag state
  • Nephropathy leads to cardio-renal syndrome
  • Neuropathy allows multi vessel atherosclerosis to develop before ischemic symptoms occur resulting in Cardiomyopathy
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18
Q

How does HTN contribute to the risk of CVD?

A
  • causes microscopic tears in artery walls allowing for assume. of atherosclerosis
  • Causes decreased elasticity of arteries, increased after load, more strain on heart leading to cardiomyopathy
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19
Q

How does Sleep Apnea contribute to the risk of CVD?

A

Paused shallow breathing while sleeping

  • Increased neg. intrathoracic pressure increases after-load results in increased demand in an already hypoxic state
  • pro-inflammatory promotes atherosclerosis
  • Increased platelet activity, reduced fibrinogen, promotes thrombus
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20
Q

What can be done to dx a pt with possible sleep apnea?

A

Sleep study

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21
Q

What aggravating factors may a pt report on Hx?

A

Symptoms aggravated by:

  • exertion (less than before)
  • Supine
  • emotional
  • AM symptoms
  • Post prandial
  • Cold exposure
  • intercourse
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22
Q

What might a patient report as an alleviating factor for their symptoms?

A

Cessation of activity (less than 3 min)

NTG

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23
Q

What is important to ask the patient about their alleviating factors? (2 questions)

A

How long after cessation of activity do their symptoms resolve?

How often do they use their NTG?

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24
Q

What descriptors might a patient c/o?

A 
Tightness
Squeezing
Burning
pressing
choking
aching
gas
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25
Q

What are the descriptors “bursting” or “tearing” usually associated with?

A

thoracic aneurysm

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26
Q

What information might a patient give in regards to the location of their symptoms?

A

Clenched fist over chest “levine sign”
substernal/left sided
Radiates to shoulder, arm, neck, jaw, back or abdomen

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27
Q

What should be looked for on physical exam?

A

Murmur
DM (retinopathy, neuropathy)
Hypercholesterolemia (xanthelasmas)
Hypothyroid (myxedema, cardiomegaly, fluid retention
Peripheral artery dz: (claudication, diminished pulses)
Active Angina!!! (htn, gallop, tachy-arrhythmia, mital regurg

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28
Q

DDX for cardiovascular dz (CARDIAC)

A

Angina/MI
Pericarditis
Myocarditis
TAA

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29
Q

Work up for CAD

A

Risk stratification (QRISK2, Framingham, HEART, ASCVD)
Labs
EKG
CXR

30
Q

What labs would be drawn for CAD?

A 
CBC
Chem 7
Lipid panel
A1C
Cardiac enzymes for active pain
CRP-inflammatory marker
31
Q

What might be seen on EKG in the presence of CAD

A

Normal, LVH. ST elevation/depressions, T inversions during pain

32
Q

What might be seen in CXR in the presence of CAD?

A

Normal or cardiomegaly, assess for non-cardiac etiology

33
Q

What non-cardiac DDX are possible?

A 
Derm-Zoster
MSK-chostochondritis, CA
Lung-PE, Pna, Ca
GI-GERD, ulcer
Psych-drug/attention, anxiety
34
Q

How many stages does the Canadian Cardiovascular Society have for Angina Pectoris?

A

I-IV

35
Q

What is the difference between stage 1 and 4?

A

Stage 1 is least effected

Stage 4 is most effected

36
Q

Workup for CAD?

A

Stress test
Exercise or Dobutamine, stress Echo-adds US
Sestamibi (nuclear) (myocardial perfusion sinctography)
MUGA (radionuclide angiography)
CTA

37
Q

What are contraindications for stress test?

A

Pain at rest of with minimal activity, aortic stenosis

38
Q

What would a positive result on a Stress test be?

A

1mm horizontal or downsloping ST depression measured 80msec past the J point

39
Q

Indications for sestamibi?

A 
Resting ST-segment depression 
Complete LBBB
Ventricular paced rhythm
ventricular pre-excitation syndrome
Prior revascularization with PCI or CABG
Inability to exercise
Renal or allergic patients unable to have dye
40
Q

What is the benefit of a sestamibi?

A

Provides simultaneous assessment of myocardial perfusion and function in one study

41
Q

What is MUGA best used for?

A 
Evaluates Ventricle contractility
monitor cardiotoxic (chemotherapy) drug effects during tx.
42
Q

Is it safe to do MUGA on a renal pt?

A

Yes-MUGA is safe in renal pt’s nucleotide excreted via liver to GI

43
Q

What can be determined with CT angio?

A

Coronary artery stenosis
Stent and bypass graft patency
venous anatomy
calcified and non-calcified plaque burden

44
Q

Is CTA contraindicated in renal failure?

A

YES-this is a dye study—not good for those with renal dz

45
Q

What test might be ordered for a pt with unstable angina who requires further work-up after positive stress test, and requires a final r/o after other causes of pain have been excluded and stress negative?

A

Cardiac Catheterization (with or without angioplasty)

46
Q

What general medical management must be done for a pt with CAD?

A

BP control
DM Control
Lifestyle changes (smoking, diet, exercise)

47
Q

What medications are suggested for pt’s with CAD?

A 
Platelet inhibitors (ASA)
NTG
B-Blockers
Ranolazine
Statin
48
Q

Define MI?

A

Blockage of flow to one or more coronary arteries not relieved by decreased demand. Results in damage to myocardium.

49
Q

Define STEMI

A

Acute occlusion of an atherosclerotic area resulting in FULL THICKNESS necrosis of myocardium

50
Q

Etiology of STEMI

A 
Thrombus or plaque rupture most common
Vasospasm
Hypotension
Coronary artery dissection
Cocaine
51
Q

HX of STEMI

A 
same as Angina
Increased severity of angina
diaphoresis
nausea
dyspnea
arrhythmia
sudden death
1/3rd may be completely asymptomatic/have vague symptoms
52
Q

PE of pt with STEMI

A 
anxious 
uncomfortable
Brady/tachy/arrhythmia
HS WNL
gallops or mitral regurg possible
JVD possible with large infarct
53
Q

What cardiac lab is the most specific to MI

A

Troponin

54
Q

What will be seen on EKG in the event of an STEMI

A

-ST segment elevation
Greater than 1 mm in 2 or more precordial leads or adjacent limb leads
OR
-New or presumed L bundle branch block

Pathologic Q waves

-Hyperacute T-waves

55
Q

What can “hide” an MI on EKG?

A

A new or presumed L bundle branch block

56
Q

What must be done in the event of a STEMI?

A 
Emergent percutaneous coronary intervention (PCI)
While waiting for this.....
Oxygen
ASA 325
NTG
Morphine
Hemparin
B-blocker
Fibrinolytic
After the event......
lifestyle mods and meds
57
Q

Define NSTEMI

A

Acute occlusion of an atherosclerotic area resulting in PARTIAL THICKNESS necrosis of myocardium

58
Q

What is the most reliable way to diagnose NSTEMI?

A

Cardiac enzymes

59
Q

What may appear on EKG in the event of an NSTEMI

A

Normal or subtle change possible
ST-stement depression 0.5mm or greater OR
Dynamic T wave inversion with pain or discomfort/transient ST elevation of 0.5mm or greater for less than 20 minutes

60
Q

Tx for NSTEMI

A 
Oxygen
ASA 325
NTG
Morphine 
GIIb/IIIa inhibitor
Anticoag (heparin, fondaparinux)
Cath lab if unable to get pt pain free
Post event-lifestyle mods and meds
61
Q

Define Printzmetal angina

A

Coronary artery spasm generally in the setting of clean coronary arteries. More common in younger pt/s and women and generally occurs in early AM.

62
Q

Etiology of Printzmetal angina?

A 
Cold
stress
cocaine
smoking
 vasconstricitng meds (B-blocker, antihistamine, decongestant, ADHD stims)
63
Q

What might the EKG of Printzmetal Angina look like on EKG?

A

STemi

64
Q

Work up for Printz. angina?

A

Cardiac cath (usually comes back clean but has to be done to rule out STEMI).

65
Q

tx for Printz. Angina?

A

Generally responds well to NTG,

Prophylax with CCB’s/long acting nitrates

66
Q

MI complications (4)

A

Cardiogenic shock
Heart failure
Dressler’s syndrome
Arryhthmias

67
Q

Define Cardiogenic shock

A

Large L vent infarct leads to significant decrease of contractility. This leads to very low BP and inadequate systemic perfusion

68
Q

Define Dressler’s syndrome?

A

Fever
Pleuritis
Pericarditis
Caused by autoimmune reaction to damaged heart muscle

69
Q

When can Dressler’s syndrome occur?

A

weeks-months after an MI

70
Q

What surgical options exist for a pt who can’t be catheterized?

A

CABG

Clin Med - Cardio Exam #2 (12 decks)

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