CAD, Angina - Johnston Flashcards
Most common cause of CAD/MI
Atherosclerosis
Function of LDL in atherosclerosis
Helps macrophage foam cells produce cytokines that cause vessel wall inflammation
Main way to lower LDL in hyperlipidemia/atherosclerosis
Statin
A patient has MI w/o major chest pain…think what?
Diabetes mellitus
Physical activity amount to recommend?
10-60 min. medium intensity 4-7 days per week
2 components of angina/cardiac blood supply
Supply - oxygen/blood getting to heart tissue
Demand - cardiac workload, stress, emotion, LVH, etc.
Mechanical consequences of myocardial ischemia (3)
- Heart failure
- Angina/M.I.
- Segmental akinesis/dyskinesis
Biochemical consequences of myocardial ischemia (3)
- FA’s can’t be oxidized
- Lactate production
- Decreased pH w/ metabolic acidosis
Electrical consequences of myocardial ischemia (2)
- ST segment displacement (depression or elevation)
- Arrhythmias/electrical instability (tachy, fib)
A posterior wall infarction (transmural) will produce what change on EKG?
Reciprocal ST DEPRESSION in V1-V2
- No leads to directly measure posterior wall
Non-STEMI on EKG
Inverted T waves WITHOUT ST elevation
An S3 heard w/ angina or MI signifies what?
Impending heart failure
During an MI/angina, a systolic murmur over the apex would most likely be what?
INFERIOR M.I. –> Ischemic papillary muscle –> mitral regurg.
What are the NON-chest pain symptoms of chronic ischemic heart disease?
SoB, diaphoresis, fatigue, dizziness, syncope
GI-seeming symptoms that can be suspicious for MI
Heart burn, indigestion, gas
Levine’s sign
Clinched fist on sternum
Anginal equivalent
Elderly, diabetics, women –> ischemia –> elevated LV filling –> pulmonary edema –> dyspnea, fatigue, belching, etc.
Skin risk factors for angina/ischemic heart disease
- Xanthelasma (soft yellow spots on eyelids)
- Xanthomas
- Diabetic skin lesions
- Nicotine stains (tar-stained fingers)
- Pale
4 things that can mimic angina w/o CAD
- Aortic stenosis
- Aortic insufficiency
- Pulmonary hypertension
- Hypertrophic cardiomyopathy
New or worsening chest pain
More severe, prolonged, frequent
Longer than 20 minutes each time
No myocyte necrosis or cardiac enzymes
Unstable angina
Chest pain
Elevated cardiac enzymes
No ST elevation
NSTEMI
Inverted T waves + severe chest pain
M.I.
A stable angina attack can show what on EKG?
ST depression (subendocardial ischemia)
How does EKG relate to unstable angina/M.I.?
Lower (more) ST depression = worse prognosis
5 signs of HIGH RISK for coronary event during stress test
- Positive at low work load
- ST depression greater than 5 minutes after test
- Hypotension during test
- V. tach during test
- Reduced EF during test
Contraindications to stress testing
Any major cardiac issue
Useful test for LBBB, LVH, or digitalis
Nuclear myocardial perfusion imaging
Useful test for detecting wall motion abnormality and EF
Stress echo
Useful test for detecting coronary calcification
Cardiac computer tomographic angiography
Useful test for detecting cardiomegaly, VHD, cardiomyopathy, pericardial effusion
Chest X-ray
GOLD STANDARD test for coronary artery disease
Coronary angiography
A patient being considered for ___ should have coronary angiography done first
CABG (bypass graft)
6 drug types found useful in preventing or reducing MIs and death after MI
- Aspirin
- Beta blocker
- ACE inhibitor
- Statin
- Nitrates
- CCB
When NOT to give a beta blocker?
- Decompensated heart failure
- Hypotension
- Advanced AV block
When TO give a beta blocker?
- Post-MI
- Ischemia
- Compensated heart failure
- Arrhythmia (not a block)
When TO give an ACE inhibitor?
- Diabetics (renal protection)
- LV systolic dysfunction (prevent volume overload)
When TO give nitrates?
Acute ischemia and angina due to vasoconstriction (Prinzmetal)
When do you consider CABG?
- L main vessel disease
When do you consider PCI? (percutaneous coronary intervention)
1 or 2 vessel disease
In Prinzmetal, what are the 2 things to treat with?
Nitrates
Amlodipine (DHP CCB)
Goals for hyperlipidemia treatment
LDL-C 60
TG
2 dietary things that are protective against atherosclerosis
- 2-4 g sodium per day max
- Reduce alcohol
