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Medicine II > CAD > Flashcards

CAD Flashcards

1
Q

greatest risk factors for CAD

A 
a.     Prior coronary event
B.	Non-cardiac atherosclerosis
C.	Diabetes mellitus
D.	Dyslipidemia
E.	Hypertension
F.	Family History
G.	Cigarette smoking
H.	Sedentary lifestyle
I.	Obesity
J.	Age
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2
Q

strongest familial predictor of CAD

A

sibling

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3
Q

what is the correlation b/w DM and CAD

A

Small vessel dz

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4
Q

how does dyslipidemia

A

increase deposition of LDL into intima space –> reducing endothelial fxn

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5
Q

what age is a greater predictor of CAD than cigarette smopke

A

> 70

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6
Q

MCC of CAD

A

atherosclerosis

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7
Q

common underlying physiological process that leads to CAD

A

endothelial dysfunction of the vessels

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8
Q

lipid deposition in the wbc leads to smooth muscle proliferation known as

A

fatty streak

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9
Q

precipitated angina, caused by exertion and external factors

A

stable angina

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10
Q

acute coronary syndromes

A

acute coronary syndromes

ST elevation MI
Non ST elevation MI
Unstable angina
noncardiac chest pain

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11
Q

any condition brought on by a sudden reduction or blockage of blood flow to the heart - most often caused by plaque rupture or clot formation in the coronary arteries

A

Acute Coronary Syndrome

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12
Q

Endothelial dysfunction results in lipid (cholesterol) deposition btwn INTIMA and MEDIA. Dysfunction results from…

A 
"	HTN
"	↑ LDL
"	Smoking
"	DM
"	Stress factors
"	Sedentary lifestyle
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13
Q

Endothelial dysfunction results in lipid (cholesterol) deposition btwn _____ and ____.

A

Endothelial dysfunction results in lipid (cholesterol) deposition btwn INTIMA and MEDIA.

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14
Q

precipitating external factors of stable angina

A

exercise
eating
anxiety or stress
cold environment

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15
Q

etiology of unstable angina

A

1) Atherosclerosis - MCC of MI –> caused by plaque rupture
2) Coronary artery spasm
3) REDUCTION in flow in the coronary artery
* acute coronary syndrome that is defined by the ABSENCE of biochemical evidence of myocardial damage

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16
Q

pathophysiology of unstable angina

A

TRANSIENT occlusion

Abrupt ↓ in coronary BF w/o ↑ in myocardial O2 demand.

Results from coronary thrombus 2˚ atherosclerosis

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17
Q

New onset chest pain w/i 2 wks is a classic manifestation of

A

stable angina

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18
Q

long term DOC for prevention of the progression of stable angina

A

Long term tx

DOC: Aspirin

reduces incidence of stroke and MI

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19
Q

classic outpatient regimen of stable chronic angina

A

aspirin, sublingual nitroglycerin as needed, and daily beta blocker and stain

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20
Q

cardioselective B1 beta blockers

A

metoprolol

atenolol

21
Q

nonselective beta blockers

A

propranalol

nadolol

22
Q

these three drugs have been show to reduce the risk of adverse cardiovascular events

A

Statins, ezetimibe, and PCSK9 inhibitors have been shown to reduce the risk of adverse cardiovascular events.

23
Q

for pts with established atherosclerotic CVD what is the go to platelet tx

A

For patients with established and stable atherosclerotic CVD, we recommend long-term aspirin therapy. Long-term antiplatelet therapy with aspirin reduces the risk of subsequent myocardial infarction (MI), stroke, and cardiovascular death among patients with a wide range of manifestations of occlusive CVD.

24
Q

for pts that can’t take aspirin b/c of risk of GIB what is the go to for anti platelet tx of CVD

A

ADP inhibitors: Clopidogrel (Plavix) for 1yr íASA allergies

25
Q

if you have chest pain for more than 30 minutes what diagnostic marker would you expect to see

A

traponin

diagnostic tests to evaluate:

” ECG: ST depression &/or T wave inversion
“ Neg cardiac enzymes

26
Q

_____ are effective at reducing the severity and frequency of anginal attacks in patients with stable ischemic heart disease and should be used for this purpose.

A

Beta blockers are effective at reducing the severity and frequency of anginal attacks in patients with stable ischemic heart disease and should be used for this purpose.

27
Q

80% of pts benefit from this form of CVD tx that can be indicated for lowering bp or tx of acute myocardial infarction, hf, or EF <40

A

About 80 percent of patients with established cardiovascular disease will benefit from angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARBs) therapy.

The most common indications range from attainment of goal blood pressure to the treatment of acute myocardial infarction, heart failure or left ventricular ejection fraction below 40 percent, diabetes, and proteinuric kidney disease.

28
Q

Certain focal areas under the___ become sites of LIPID POOLS

A

intima

full of fatty material that become covered in fibrous caps

29
Q

Body wants to “clean up” lipid pools —> WBC leave circulation, the dissolve the fibrous cap via enzymes which can have what complication…

A

Body wants to “clean up” lipid pools –> WBC leave circulation & enter pool “eating” the lipids

can lead to rupture

30
Q

following the rupture of fibrous caps what occurs

A

exposes the thrombogenic lipid pool to the circulation triggering clotting factors

Circulating platelets aggregate & a platelet thrombus is formed - aka white thrombus

31
Q

difference between white thrombus and red thrombus

A

first Circulating platelets aggregate & a platelet thrombus is formed –> white thrombus

Fibrin thrombus then forms trapping RBC in the large fibrin clot (red thrombus) & partially or totally occludes the coronary artery

32
Q

acute tx of unstable angina

A

Acute tx
“ Stress test
“ Cardiac cath: angio if indicated

33
Q

long term tx of unstable angina

A

Long term tx
“ DOC: Aspirin
“ ADP inhibitors: Clopidogrel (Plavix) for 1yr –>ASA allergies
“ Adj tx: B-blockers, NTG, CCB
“ Lifestyle changes (↓ wt, daily exercise)
“ HTN, lipid control (consider Statins)
“ Low MW heparin
“ Unfractionated heparin: given w/ ACS, EKG changes, + cardiac marker

34
Q

STEMI and non STEMI

what distinguishes them from people with MI

A

troponin

35
Q

how to dx MI

A

MI dx:

1) Chest pain
2) Troponin
* Do serial troponin

Positive cardiac enzymes:
“ CK/CK-MB: appears 4-6 hr, peaks 12-24 hr and returns to baseline 3-4 d
“ Troponin I&T: appears 4-8hr, peaks 12-24 hr, returns to baseline 7-10day “ MOST SENSITIVE & SPECIFIC

ECG:
“ STdepression, +/- T wave inversion = can be normal looking

36
Q

what is the immediate tx goal of NSTEMI

A

” Urgent angioplasty 1-3d after admisssion

37
Q

what is the immediate tx goal of a STEMI

A

the goal is a door to balloon time (angioplasty) of less than an hour and half

Reperfusion!

Percutaneous coronary intervention - best w/i 3 hrs of sx onset

May need CABG if 3 vessel dz
TPA

38
Q

anti-throm tx and adj tx following STEMI

A

Anti-throm tx: ASA, heparin, GP IIB/IIIA inhibitor

Adj tx: Bblockers, ACE-I, NTG, Morphine, Statin

39
Q

ASA dose that prolongs like for individuals with ACS

A

75-100MG

decreases GIB without decreasing thrombotic risk

40
Q

PTCA

what is it and when is it indicated

A

percutaneous transluminal coronary angioplasty
indicated with 1 or 2 vessel dz not involving LAD in whom ventricular function is near normal

restoneosis can be reduced with stents

41
Q

calcium scores, CAC (coronary artery calcium)

A

seen in almost everyone over 65 so really only indicated in pts under 50

42
Q

pain under the left axilla

A

is virtually never cardiac pain

43
Q

pain under the left breast that doesn’t start at the sternum is _____ to be cardiac

A

unlikely

44
Q

diagnostic gold for stable angina

A

coronary angiogram

45
Q

medical tx for stable angina

A

BB
statin
ASA

nitro for acute sublingual NTG PRN

46
Q

tx for unstable angina

A

agioplasty if indicated

anti-platlets : ASA
anticoagulants: heparin

maybe CCB of BB

47
Q

NSTEMI tx

A

angiplasty 1-3 days after admission

48
Q

STEMI

A

emergency angio

Medicine II (21 decks)

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