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Cardiovascular 2 > CAD, Angina - Johnston > Flashcards

CAD, Angina - Johnston Flashcards

1
Q

Most common cause of CAD/MI

A

Atherosclerosis

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2
Q

Function of LDL in atherosclerosis

A

Helps macrophage foam cells produce cytokines that cause vessel wall inflammation

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3
Q

Main way to lower LDL in hyperlipidemia/atherosclerosis

A

Statin

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4
Q

A patient has MI w/o major chest pain…think what?

A

Diabetes mellitus

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5
Q

Physical activity amount to recommend?

A

10-60 min. medium intensity 4-7 days per week

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6
Q

2 components of angina/cardiac blood supply

A

Supply - oxygen/blood getting to heart tissue

Demand - cardiac workload, stress, emotion, LVH, etc.

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7
Q

Mechanical consequences of myocardial ischemia (3)

A
  • Heart failure
  • Angina/M.I.
  • Segmental akinesis/dyskinesis
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8
Q

Biochemical consequences of myocardial ischemia (3)

A
  • FA’s can’t be oxidized
  • Lactate production
  • Decreased pH w/ metabolic acidosis
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9
Q

Electrical consequences of myocardial ischemia (2)

A
  • ST segment displacement (depression or elevation)

- Arrhythmias/electrical instability (tachy, fib)

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10
Q

A posterior wall infarction (transmural) will produce what change on EKG?

A

Reciprocal ST DEPRESSION in V1-V2

- No leads to directly measure posterior wall

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11
Q

Non-STEMI on EKG

A

Inverted T waves WITHOUT ST elevation

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12
Q

An S3 heard w/ angina or MI signifies what?

A

Impending heart failure

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13
Q

During an MI/angina, a systolic murmur over the apex would most likely be what?

A

INFERIOR M.I. –> Ischemic papillary muscle –> mitral regurg.

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14
Q

What are the NON-chest pain symptoms of chronic ischemic heart disease?

A

SoB, diaphoresis, fatigue, dizziness, syncope

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15
Q

GI-seeming symptoms that can be suspicious for MI

A

Heart burn, indigestion, gas

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16
Q

Levine’s sign

A

Clinched fist on sternum

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17
Q

Anginal equivalent

A

Elderly, diabetics, women –> ischemia –> elevated LV filling –> pulmonary edema –> dyspnea, fatigue, belching, etc.

18
Q

Skin risk factors for angina/ischemic heart disease

A
  • Xanthelasma (soft yellow spots on eyelids)
  • Xanthomas
  • Diabetic skin lesions
  • Nicotine stains (tar-stained fingers)
  • Pale
19
Q

4 things that can mimic angina w/o CAD

A
  • Aortic stenosis
  • Aortic insufficiency
  • Pulmonary hypertension
  • Hypertrophic cardiomyopathy
20
Q

New or worsening chest pain
More severe, prolonged, frequent
Longer than 20 minutes each time
No myocyte necrosis or cardiac enzymes

A

Unstable angina

21
Q

Chest pain
Elevated cardiac enzymes
No ST elevation

A

NSTEMI

22
Q

Inverted T waves + severe chest pain

A

M.I.

23
Q

A stable angina attack can show what on EKG?

A

ST depression (subendocardial ischemia)

24
Q

How does EKG relate to unstable angina/M.I.?

A

Lower (more) ST depression = worse prognosis

25
Q

5 signs of HIGH RISK for coronary event during stress test

A
  • Positive at low work load
  • ST depression greater than 5 minutes after test
  • Hypotension during test
  • V. tach during test
  • Reduced EF during test
26
Q

Contraindications to stress testing

A

Any major cardiac issue

27
Q

Useful test for LBBB, LVH, or digitalis

A

Nuclear myocardial perfusion imaging

28
Q

Useful test for detecting wall motion abnormality and EF

A

Stress echo

29
Q

Useful test for detecting coronary calcification

A

Cardiac computer tomographic angiography

30
Q

Useful test for detecting cardiomegaly, VHD, cardiomyopathy, pericardial effusion

A

Chest X-ray

31
Q

GOLD STANDARD test for coronary artery disease

A

Coronary angiography

32
Q

A patient being considered for ___ should have coronary angiography done first

A

CABG (bypass graft)

33
Q

6 drug types found useful in preventing or reducing MIs and death after MI

A
  • Aspirin
  • Beta blocker
  • ACE inhibitor
  • Statin
  • Nitrates
  • CCB
34
Q

When NOT to give a beta blocker?

A
  • Decompensated heart failure
  • Hypotension
  • Advanced AV block
35
Q

When TO give a beta blocker?

A
  • Post-MI
  • Ischemia
  • Compensated heart failure
  • Arrhythmia (not a block)
36
Q

When TO give an ACE inhibitor?

A
  • Diabetics (renal protection)

- LV systolic dysfunction (prevent volume overload)

37
Q

When TO give nitrates?

A

Acute ischemia and angina due to vasoconstriction (Prinzmetal)

38
Q

When do you consider CABG?

A
  • L main vessel disease
39
Q

When do you consider PCI? (percutaneous coronary intervention)

A

1 or 2 vessel disease

40
Q

In Prinzmetal, what are the 2 things to treat with?

A

Nitrates

Amlodipine (DHP CCB)

41
Q

Goals for hyperlipidemia treatment

A

LDL-C 60

TG

42
Q

2 dietary things that are protective against atherosclerosis

A
  • 2-4 g sodium per day max

- Reduce alcohol

Cardiovascular 2 (20 decks)

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