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CPR Exam 1 > Cardiac Clinical Med 1 (Selby) > Flashcards

Cardiac Clinical Med 1 (Selby) Flashcards

1
Q

What is defined as stable angina?

A
  • Chest pain or pressure for at least 2 months duration that is precipitated by exertion or emotional stress
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2
Q

What is defined as unstable angina?

A
  • New onset angina, angina with minimal exertion, angina at rest, or angina accelerating in frequency or severity
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3
Q

What is defined as an NSTEMI?

A
  • ST segment depression and/or T wave inversions with abnormal cardiac enzymes
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4
Q

What is defined as a STEMI?

A
  • ST segment elevation with abnormal cardiac enzymes or new LBBB or posterior MI
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5
Q

What are some modifiable risk factors of CAD?

A
  • HTN
  • Hyperlipidemia
  • DM
  • Obesity
  • Smoking
  • Inactivity
  • Unhealthy diet
  • Stress
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6
Q

What are some non-modifiable risk factors of CAD?

A
  • Male
  • Age
  • Family Hx
  • Ethnicity (AA, Hispanics, Southeast Asians)
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7
Q

What are some non-traditional risk factors of CAD?

A
  • CKD
  • Proteinuria
  • Inflammatory status (HIV, RA, Psoriasis)
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8
Q

What is the clinical presentation of CAD?

A
  • Typical chest pain or discomfort (radiate to neck, jaw, arms, epigastrium)
  • Dyspnea
  • Nausea or vomiting
  • Diaphoresis
  • Fatigue
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9
Q

Who is more likely to present with atypical symptoms in CAD?

A
  • Elderly
  • Women
  • Diabetics
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10
Q

What are the three classical components of angina pectoris?

A
  • Substernal chest pain or discomfort
  • Provoked by exertion or emotional stress
  • Relieved by rest and/or nitroglycerin
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11
Q

What does the number of classical components with angina tell us about the chest pain?

A
  • All three components means typical angina CP
  • Two components means atypical angina CP
  • One or none of the components means non-angina CP
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12
Q

What are some ways to diagnose stable angina?

A
  • Resting ECG
  • Cardiac stress testing
  • Invasive coronary angiography
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13
Q

What are some examples of cardiac stress testing?

A
  • Exercise stress ECG
  • Exercise or dobutamine stress ECHO
  • Myocardial perfusion imaging (MPI)
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14
Q

How can we pharmacologically stress the heart?

A
  • Use vasodilators to stimulate the vasodilation seen in exercise
  • Inotropes and chronotropes to increase the myocardial oxygen demand by increasing HR and contractility
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15
Q

What does a stress ECG look at?

A
  • Looking for ST segment depression, new LBBB, new AV block, VT, VF, increasing number of PVCs
  • Not to be used in people with abnormal baseline ECGs
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16
Q

What does a stress ECHO look at?

A
  • Regional wall motion abnormalities or LV dilation
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17
Q

What does a stress myocardial perfusion imaging look at?

A
  • Looks at perfusion defects between rest and stress, cardiac viability, and LV systolic function (uses a nuclear radioisotope)
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18
Q

What does the dobutamine stress ECHO help show us?

A
  • Contractility of heart

- Regional wall motion abnormalities

19
Q

What is considered significant stenosis when doing a coronary angiography?

A
  • > 70%
20
Q

How do we diagnose ACS (acute coronary syndrome)?

A
  • Resting ECG
  • Cardiac biomarkers
  • Invasive coronary angiography
21
Q

What is the general rule when it comes to using ST elevation to diagnose a STEMI?

A
  • ST segment elevations needs to be > 2mm
22
Q

What is the NSTEMI ECG criteria?

A
  • New ST depression >0.5mm in two leads OR

- T-wave inversion >1 mm in two leads with prominent R waves

23
Q

What does a STEMI typically result from?

A
  • Complete occlusion of blood flow in a coronary vessel
24
Q

What does a NSTEMI typically result from?

A
  • Partial occlusion of blood flow in a coronary vessel or presence of complete occlusion of blood flow but in the presence of collateral circulation
25
Q

What is the generalized treatment plan for stable angina?

A
  • Lifestyle modification
  • Aspirin
  • Statins
  • Anti-anginal drugs
26
Q

What are some anti-anginal drugs?

A
  • B-blockers
  • CCBs
  • Long acting nitrates
  • Ranolazine
27
Q

What is the mnemonic for initial management of all ACS patients? What does it stand for?

A
  • “MONA”
  • Morphine
  • Oxygen
  • Nitrates
  • Aspirin
28
Q

What is the generalized treatment plan for unstable angina?

A
  • Antiplatelet therapy
  • Anticoagulants
  • Revascularization therapy
  • Thrombolytics
29
Q

What do you do for a STEMI when at a non-PCI capable hospital?

A
  • Transfer to PCI hospital within <120 minutes OR

- Start thrombolytics <30 minutes and then transfer to PCI hospital

30
Q

What ECG leads are used to look at the RCA? What is the anatomic locations?

A
  • II, III, aVF

- Inferior

31
Q

What ECG leads are used to look at the LAD? What is the anatomic locations?

A
  • V1-V4

- Septal and Anterior

32
Q

What ECG leads are used to look at the LCx? What is the anatomic locartions?

A
  • V5-6 or I, aVL

- Lateral

33
Q

What are the two classification systems of thoracic aortic dissection?

A
  • Debakey

- Stanford

34
Q

What are some risk factors for aortic dissection?

A
  • Long term HTN
  • Smoking
  • Dyslipidemia
  • Cocaine
  • Marfan syndrome
  • Bicuspid aortic valvular disease
  • Giant cell arteritis
  • Takayasu arteritis
  • Syphilis
  • Deceleration trauma
35
Q

What are some risk factors of aortic dissection in younger patients?

A
  • CT disorders (marfan)
  • Syphilis
  • Cocaine/meth use
  • Trauma
36
Q

What is the clinical presentation of aortic dissection?

A
  • Sudden onset chest pain described as a “ripping” or tearing which radiates to the back
  • HTN
37
Q

What are some other cardiac signs that are seen in aortic dissection?

A
  • Myocardial infarction
  • Aortic regurgitation
  • BP asymmetry between arms
  • Cardiac tamponade
  • Syncope
  • Aortic rupture with exsanguination and death
38
Q

What are some other neurologic signs that are seen in aortic dissection?

A
  • Stroke or TIA
  • Ischemic neuropathy
  • Paraplegia
  • Horner syndrome
39
Q

What are some GI signs seen with aortic dissection?

A
  • Mesenteric ischemia

- GI bleeding

40
Q

What are some pulmonary signs that are seen with aortic dissection?

A
  • Hemothorax
41
Q

What are some renal signs that are seen in aortic dissection?

A
  • Acute renal failure
42
Q

What are some limb signs that are seen in aortic dissection?

A
  • Pulse deficit (weak peripheral pulse)
43
Q

How do you diagnose an aortic dissection?

A
  • ECG and cardiac biomarkers
  • Chest X-ray
  • CT Angiography
  • Transesophageal ECHO
44
Q

What is the treatment and management for aortic dissection?

A
  • Anti-impulse therapy which lowers HR and the force of LV ejection (IV B-blockers)
  • Surgical management (open surgery)

CPR Exam 1 (21 decks)

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