Cardiac Diagnostics and Stable Angina Flashcards
The first clinical manifestation of coronary artery disease maybe _______, it is mandatory to identify high risk patients.
Death
What are some possible underlying etiologies of heart defects/disease?
Is the disease congenital?
Hypertensive?
Ischemic?
Inflammatory?
Other?
If you hear a grade 3 murmur or higher what should you order for a work-up?
Echocardiogram
What is the mneumonic that can help remember the approach to chest pain?
CHEST PAINS
Chest pain means more than just chest pain
High-Sensitivity - order troponin
Early care for acute symptoms
Share - shared decision making
Testing - not usually needed in low-risk patients
What is the most common cause of ischemic heart disease?
Atherosclerotic disease of the coronary artery
What is stable angina?
Episodic clinical syndrome due to transient myocardial ischemia
What is the basic explanation of what is occurring in ischemic heart disease?
Inadequate supply of blood/O2 to a portion of the myocardium (imbalance of supply and demand)
Coronary circulation is controlled by what
By the hearts requirement for oxygen, coronary vessels can vary in resistance by dilation
What is going to occur if there is a higher demand for O2 in the setting of blood flow limitations?
Ischemia
Creatinine Kinase (CK-MB) supports what diagnosis
Diagnosis of myocardial muscle injury/infarct
Can hep quantify timing, degree of MI
A CK-MB will rise how long after an infarct?
4-6 hours
What test is more sensitive and specific than a CK?
Troponin
Does an elevated troponin only occur in an MI?
No, there are other possible causes for troponin to be elevated
What are some of the other causes of an increased troponin level besides an MI?
Sepsis, shock
PE, HF, pericarditis/myocarditis
Cardiotoxic meds/chemo, strenuous exercise
Infiltrative disorders
What patients are you likely to order a lactate dehydrogenase?
Critically ill patients, shock patients
Brain natriuretic peptide (BNP) is continuously released, but rate of release is increased to regulate
Cardiac output
BNP’s are usually elevated with what symptom
dyspnea
Are BNP’s normally elevated in women, elderly, and renal failure?
Yes
What is a normal EF?
55 to 65
What are clinical indications to use a 2D ECHO?
Evaluate Cardiac chambers and valves
Effusion/tamponade
Masses
Great vessels
What are clinical indications to use a stress ECHO?
Ischemia
Viable myocardium
What are clinical indications to use a TEE?
Inadequate TTE
Aortic disease
Ineffective endocarditis
Embolism source
Valve prosthesis
Intraoperative
A stress test is used to evaluate
risk of ischemic heart disease and to identify regions of myocardial viability
What medication does a pharm stress test use?
Vasodilator (dipyridamole)
or positive inotropes (dobutamine)
