CARD 46- Clinical Presentation and Evaluation of Ischemic Heart Disease Flashcards
What is Percutaneous Coronary Intervention (PCI)?
Describe the Treatment of Stable Angina
- Treatment of aggravating symptoms
- Adaption of activity
- Treatment of risk factors
- Beta-Blockers
Describe the ECG progression in STEMI
Describe the common PTs who have Silent Ischemia/Asymptomatic Ischemia
More common in women later decades
More common in diabetics
Describe the Physical Exam for IHD
- BP and Pulse
- New Murmurs
- Aortic Stenosis can be associated with angina and syncope
- Carotid bruit
- S4 can be associated with IHD (nonspecific)
What are the differences in NSTEMI vs STEMI
- EKG ST elevation (STEMI)
- Enzymes elevated
- Occasional develop Q wave
- Tx antiplatelet, heparin, admission (NSTEMI)
- Tx Reperfusion (STEMI)
How do CCBs relate to Stable Angina?
Second line if Beta-Blockers are not tolerated
How do NSAIDs relate to Stable Angina?
Small but finite increased risk of myocardial infarction and mortality
Describe the Exercise Stress Test
- Reach 85% of max HR
- 12 ECG and BP monitoring
- ST depression 2mm
- Ventricular Tachyarrhythmia
- Limitations: abnormal ECG baseline, cannot exercise
Describe an Inferior STEMI
Relate Unstable Angina and NSTEMI
EKG may show ST depression
Angiogram - partial obstruction
ENZYMES ELEVATED - only NSTEMI
What are the Ischemic Heart Disease Risk Factors?
- FmHx premature CAD 1st degree relative
- male < 55 female < 65
- Tobacco products
- Diabetics 2-4 times the risk
What is Acute Coronary Syndrome (ACS)?
What are the Tests for IHD?
- Exercise Stress Test
- Stress Echo
- Stress Radionuclide Myocardial Perfusion Scan
- CT for Calcium scoring
- Angiography (CT or Coronary)
What are the Anginal Equivalents and what is Atypical Presentation?
- Indigestion
- Nausea
- SOB
- Diaphoresis
- Dizziness
- Syncope
- Fatigue
Describe a Lateral Wall MI
Describe an Angiography
Visualizing vessel lumen
Contrast agent with XR, CT or MRI
Describe Unstable Angina
- increased intensity or frequency, does not go away with demand reduction, or occurs at rest
- ST depression or Normal ECG
Describe the relationship between Women and Heart Disease
- More likely atypical presentation
- 5-10 years older at time of presentation
- Higher incidence of vasospastic heart disease
- Less likely to undergo procedures
Describe what a Coronary Angiography is
- Catheter placed in arterial circulation and advanced to coronary arteries both right and left
- Injection of contrast
- Measure EF (ventriculogram)
- 70% obstruction considered significant
What is Revascularization?
CABG and PCI (percutaneous coronary intervention)
What is a Stress Radionuclide Myocardial Perfusion Scan?
Compares Rest and Exercise images
Inability to dilate shows less uptake of radioactive tracer
What is a Stress Echocardiogram?
- Ischemia presents as wall motion abnormality (US)
- Dobutamine and Adenosine for pt who cannot exercise
Describe the relationship between Antiplatelets and Stable Angina
- Aspirin
- P2Y12 Inhibitors (ADP receptor antagonists)
- Clopidogrel
Describe an Anterior STEMI
Describe the relationship between Nitrates and Stable Angina
- Systemic venodilation
- Dilation of coronary vessels and collateral
- Short acting - NTG spray/tablets
- Long acting - Transdermal paste/patches
- Tablets - isosorbide dinitrate
Describe what a Coronary Artery Bypass Graft (CABG) is
- Bypass portion of artery with segment of donor artery or vein
- Left internal mammary artery is preferred over saphenous vein
- Artery > Vein
How do you dx an MI?
