Cardiac Clinical Med 1 (Selby) Flashcards
What is defined as stable angina?
- Chest pain or pressure for at least 2 months duration that is precipitated by exertion or emotional stress
What is defined as unstable angina?
- New onset angina, angina with minimal exertion, angina at rest, or angina accelerating in frequency or severity
What is defined as an NSTEMI?
- ST segment depression and/or T wave inversions with abnormal cardiac enzymes
What is defined as a STEMI?
- ST segment elevation with abnormal cardiac enzymes or new LBBB or posterior MI
What are some modifiable risk factors of CAD?
- HTN
- Hyperlipidemia
- DM
- Obesity
- Smoking
- Inactivity
- Unhealthy diet
- Stress
What are some non-modifiable risk factors of CAD?
- Male
- Age
- Family Hx
- Ethnicity (AA, Hispanics, Southeast Asians)
What are some non-traditional risk factors of CAD?
- CKD
- Proteinuria
- Inflammatory status (HIV, RA, Psoriasis)
What is the clinical presentation of CAD?
- Typical chest pain or discomfort (radiate to neck, jaw, arms, epigastrium)
- Dyspnea
- Nausea or vomiting
- Diaphoresis
- Fatigue
Who is more likely to present with atypical symptoms in CAD?
- Elderly
- Women
- Diabetics
What are the three classical components of angina pectoris?
- Substernal chest pain or discomfort
- Provoked by exertion or emotional stress
- Relieved by rest and/or nitroglycerin
What does the number of classical components with angina tell us about the chest pain?
- All three components means typical angina CP
- Two components means atypical angina CP
- One or none of the components means non-angina CP
What are some ways to diagnose stable angina?
- Resting ECG
- Cardiac stress testing
- Invasive coronary angiography
What are some examples of cardiac stress testing?
- Exercise stress ECG
- Exercise or dobutamine stress ECHO
- Myocardial perfusion imaging (MPI)
How can we pharmacologically stress the heart?
- Use vasodilators to stimulate the vasodilation seen in exercise
- Inotropes and chronotropes to increase the myocardial oxygen demand by increasing HR and contractility
What does a stress ECG look at?
- 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
What does a stress ECHO look at?
- Regional wall motion abnormalities or LV dilation
What does a stress myocardial perfusion imaging look at?
- Looks at perfusion defects between rest and stress, cardiac viability, and LV systolic function (uses a nuclear radioisotope)
What does the dobutamine stress ECHO help show us?
- Contractility of heart
- Regional wall motion abnormalities
What is considered significant stenosis when doing a coronary angiography?
- > 70%
How do we diagnose ACS (acute coronary syndrome)?
- Resting ECG
- Cardiac biomarkers
- Invasive coronary angiography
What is the general rule when it comes to using ST elevation to diagnose a STEMI?
- ST segment elevations needs to be > 2mm
What is the NSTEMI ECG criteria?
- New ST depression >0.5mm in two leads OR
- T-wave inversion >1 mm in two leads with prominent R waves
What does a STEMI typically result from?
- Complete occlusion of blood flow in a coronary vessel
What does a NSTEMI typically result from?
- Partial occlusion of blood flow in a coronary vessel or presence of complete occlusion of blood flow but in the presence of collateral circulation
What is the generalized treatment plan for stable angina?
- Lifestyle modification
- Aspirin
- Statins
- Anti-anginal drugs
What are some anti-anginal drugs?
- B-blockers
- CCBs
- Long acting nitrates
- Ranolazine
What is the mnemonic for initial management of all ACS patients? What does it stand for?
- “MONA”
- Morphine
- Oxygen
- Nitrates
- Aspirin
What is the generalized treatment plan for unstable angina?
- Antiplatelet therapy
- Anticoagulants
- Revascularization therapy
- Thrombolytics
What do you do for a STEMI when at a non-PCI capable hospital?
- Transfer to PCI hospital within <120 minutes OR
- Start thrombolytics <30 minutes and then transfer to PCI hospital
What ECG leads are used to look at the RCA? What is the anatomic locations?
- II, III, aVF
- Inferior
What ECG leads are used to look at the LAD? What is the anatomic locations?
- V1-V4
- Septal and Anterior
What ECG leads are used to look at the LCx? What is the anatomic locartions?
- V5-6 or I, aVL
- Lateral
What are the two classification systems of thoracic aortic dissection?
- Debakey
- Stanford
What are some risk factors for aortic dissection?
- Long term HTN
- Smoking
- Dyslipidemia
- Cocaine
- Marfan syndrome
- Bicuspid aortic valvular disease
- Giant cell arteritis
- Takayasu arteritis
- Syphilis
- Deceleration trauma
What are some risk factors of aortic dissection in younger patients?
- CT disorders (marfan)
- Syphilis
- Cocaine/meth use
- Trauma
What is the clinical presentation of aortic dissection?
- Sudden onset chest pain described as a “ripping” or tearing which radiates to the back
- HTN
What are some other cardiac signs that are seen in aortic dissection?
- Myocardial infarction
- Aortic regurgitation
- BP asymmetry between arms
- Cardiac tamponade
- Syncope
- Aortic rupture with exsanguination and death
What are some other neurologic signs that are seen in aortic dissection?
- Stroke or TIA
- Ischemic neuropathy
- Paraplegia
- Horner syndrome
What are some GI signs seen with aortic dissection?
- Mesenteric ischemia
- GI bleeding
What are some pulmonary signs that are seen with aortic dissection?
- Hemothorax
What are some renal signs that are seen in aortic dissection?
- Acute renal failure
What are some limb signs that are seen in aortic dissection?
- Pulse deficit (weak peripheral pulse)
How do you diagnose an aortic dissection?
- ECG and cardiac biomarkers
- Chest X-ray
- CT Angiography
- Transesophageal ECHO
What is the treatment and management for aortic dissection?
- Anti-impulse therapy which lowers HR and the force of LV ejection (IV B-blockers)
- Surgical management (open surgery)
