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COMAT - IM > CAD/ACS > Flashcards

CAD/ACS Flashcards

1
Q

What are the indications for a CABG?

A
  • LAD is affected
  • 3 vessel disease
  • 2 vessel disease if a diabetic
  • Symptomatic despite maximal therapy
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2
Q

What is the physiology behind angina?

A

Oxygen supply cannot meet the demand of the heart!

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3
Q

Describe how stable angina will present?

A

Exertion/stress
–> Chest pain
–> Relieved by rest or nitrates

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4
Q

Describe how stable angina will present?

A

Exertion/stress
–> Chest pain
–> Relieved by rest or nitrates

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5
Q

Can you have other symptoms such as diaphoresis, SOB, dizziness, N/V with stable angina?

A

YES

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6
Q

What will the results of the EKG and Cardiac Enzymes be with Stable Angina? Unstable Angina?

A

NEGATIVE

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7
Q

What defines Unstable Angina?

A
  • Chest pain now occurring at rest
  • Chest pain that is worsening in nature, such that is occurs easier, lasts longer, etc.
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8
Q

What defines Unstable Angina?

A
  • Chest pain now occurring at rest
  • Chest pain that is worsening in nature, such that it occurs easier, lasts longer, etc.
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9
Q

Besides EKG and Cardiac Enzymes, what are 2 other tests that can be done to assess coronary vasculature?

A
  1. Stress testing
  2. Coronary angiography
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10
Q

With stress testing is is either with exertion or?

A

Medication such as Dobutamine

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11
Q

With stress testing with medications, how does that work?

A

Diseased vessels are already maximally dilated so change will be seen in the non-diseased vessels

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12
Q

Prior to a stress test, what medications should be held for at least 48 hours? (3)

A

Beta blockers
CCBs
Nitrates

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13
Q

What is the mainstay of treatment for Stable Angina?

A

Aspirin
Beta blockers
+/- Nitroglycerin

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14
Q

What causes Prinzmetal Angina?

A

Coronary vessel vasospasm

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15
Q

How will Prinzmetal Angina present? In who?

A

Young women with chest pain that occurs at rest and often in the morning

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16
Q

How will Prinzmetal Angina present? In who?

A

Young women with chest pain that occurs at rest and often in the morning

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17
Q

What is the best treatment for Prinzmetal Angina?

A

CCBs!

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18
Q

Results of the EKG and Cardiac Enzymes for a NSTEMI?

A

EKG = normal
Cardiac enzymes = (+)

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19
Q

What is the full treatment for ACS?

A

MONA-B(ASH)
- Morphine
- O2
- Nitrates
- Aspirin + other Anti-platelets
- Beta blocker
- ACEi
- Statin
- Heparin

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20
Q

What is the full treatment for ACS?

A

MONA-BASH
- Morphine
- O2
- Nitrate
- Aspirin + Antiplatelet therapies
- Beta-blocker
- ACEi
- Statin
- Heparin

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21
Q

With a STEMI what can show up on an EKG? (4)

A

ST elevations
NEW LBBB
+/- Q waves and T wave inversions

22
Q

When do Troponins and CK-MB peak?

A

Troponins = 24-48 hours
CK-MB = Within 24 hours

23
Q

In what leads will an Inferior MI present? Vessel?

A

Leads II, III, AVF
= Right Coronary A.

24
Q

What medications should you avoid if you suspect an Inferior MI and why?

A

Nitrates because it will drop the BP since the RV is affected

25
Q

In what leads will an Anterior MI present? Vessel?

A

V1 - V4
= Left Anterior Descending

26
Q

In what leads will a Lateral MI present? Vessel?

A

Leads I, AVL, V5, V6
= Left Circumflex A.

27
Q

In what leads will a Posterior MI present? What will you see?

A

ST depression in V1 and V2

28
Q

IF PCI cannot be performed in less than ____ and theres no contraindications, administer _____

A

< 120 mins
Give Thrombolytics = tPa, reteplase, streptokinase…

29
Q

Day 1 following an MI, what are you worried about?

A

Heart failure

30
Q

Days 2-4 following an MI, what are you worried about? (2)

A

Arrhythmias
Pericarditis

31
Q

Days 2-4 following an MI, what are you worried about? (2)

A

Arrhythmias
Pericarditis

32
Q

Days 5-10 following an MI, what are you worried about (3)?

A

LV wall rupture
Papillary muscle rupture
Septal rupture

33
Q

Days 5-10 following an MI, what are you worried about? (3)

A

LV wall rupture
Papillary muscle rupture
Septal rupture

34
Q

If LV wall ruptures, how will that present?

A

Like cardiac tamponade!

35
Q

If a papillary muscle ruptures, how will that present?

A

Pulmonary edema
Mitral regurgitation

36
Q

If the septum ruptures, how will that present?

A

Increased oxygen in the RV

37
Q

In the weeks to months following an MI, what are you worried about?

A

Ventricular aneurysm

38
Q

In the weeks to months following an MI, what are you worried about?

A

Ventricular aneurysm

39
Q

For Peripheral Arterial Disease, what are 3 mainstays of treatment not including Cilostazol?

A

Aspirin
Statin
Exercise therapy

40
Q

How does Cardiac Tamponade arise?

A
  • Fluid in pericardial sac
  • Increases the intracardial pressure
  • Decreased filling of the heart
    = Decreased CO
41
Q

What will be present with Cardiac Tamponade?

A

JVD
Distant heart sounds
Hypotension
Pulsus Paradoxus

42
Q

What will be seen on EKG with Cardiac Tamponade?

A

Electrical alternans

43
Q

What will be seen on Echo with Cardiac Tamponade?

A

RA and RV collapse

44
Q

What virus commonly causes Pericarditis?

A

Coxsackie B

45
Q

If Pericarditis occurs following an MI, what is the likely cause?

A

Autoimmune = Dressler syndrome

46
Q

How will Pericarditis present?

A

Pleuritic chest pain and dyspnea
+/- cough and fever

47
Q

What will make the pain BETTER with Pericarditis?

A

Sitting up and bending forward

48
Q

What may you hear on Auscultation with Pericarditis?

A

Friction rub throughout heart sounds

49
Q

what will be seen on EKG with Pericarditis? (2 options)?

A

DIFFUSE ST elevation
DIFFUSE PR depression

50
Q

What is the treatment for Pericarditis?

A

Aspirin/NSAIDs + Colchicine
+/- Steroids

COMAT - IM (17 decks)

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