Cardiac Clinical Med 1 (Selby) Flashcards
(44 cards)
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
