Cardiac diagnostics and stable angina - nate (incomplete) Flashcards
What is ischemia
imbalance between oxygen supply and demand
what is a phonocardiogram
heart sounds - calves closing
What is NYHA
NY heart association - scoring for heart concerns class 1-4
what is CCS scoring
Canadian cardiac scoring for angina scoring 1-3
What are the 2021 CHEST PAIN guidelines
Chest pain
High-Sensitivity (troponin)
Early Care
Share (share decision making)
Testing (not routinely needed in low-risk patients)
Pathways (clinical decision pathways)
Accompany (women may be more likely to present with accompanying symptoms)
Identify (further testing)
Non-cardiac
Structured (risk assessment should be used)
What is ischemic Heart disease
inadequate supply of blood/O2 to a portion of the myocardium (ie. imbalance of supply and demand)
what is the most common cause of IHD
Atherosclerotic disease of coronary artery
what controls the coronary circulation
hearts requirement for oxygen
coronary vessels can vary in resistance by dilation
What is CK-MB
creatinine Kinase
lab work done at admission, 12 hours and 24 hours
supports diagnosis of myocardial muscle injury/infarct
rises in 4-6 hours after infarct
baseline in 36-48 hours
What is troponin
lab test
cardiac troponin 1 (cTn1) and Cardiac troponin (cTNT @ DH)
more sensitive and specific for MI than CK
elevate sooner - 80% in 3 hours and remain elevated 3-7 days or longer for cTNT
what is the diagnosis for ACS
troponin - also risk stratify unstable angina
what is the preferred biomarker to assess myocardial injury
Cardiac troponin (cTn)
what are other causes of myocardial damage other than MI
sepsis, septic shock, SIRS
PE, HF, preicarditis/myocaradidits
Cardiotoxic meds/chemo, strenuous exercise
infiltrative disorders ie. sarcoid, amyloid
What is a Type 1 MI
small amount of atherosclerotic build up in the artery and a plaque rupture/erosion
what is type 2 MI
oxygen supply and demand imbalance
severe HTN
sustained tachyarrhythmia
what are examples of acute MI
acute heart failure
myocarditis
what are examples of chronic MI
structural heart disease
chronic kidney disease
What is LDH
Lactate Dehydrogenase (elevated if lack of O2)
- not a specific indicator of any one disease or organ injury
What produces C-reactive protein
liver
what is c-reactive protein
acute phase reactant
nonspecific inflammatory marker
not for screening
increase CRP associated with: athero, CV events, recurrent EV events
helps predict mortality
What is the BNP
Brain natriuretic peptide
initially seen in the brain - mostly released in ventricles of the heart
What does BNP correlate to
LV stress - good marker for CHF
when is BNP elevated normally
in women, elderly, renal failure
what is assessed with echocardiography
myocardium, chambers, valves, pericardium, great vessels
EF, valve anatomy and function, LV function, RV function, chamber size
what is the purpose of a doppler
measures velocity of moving blood- noninvasive alternative for hemodynamics
what is the benefit of the 2D surface echo
chamber size, LV function
valve structure, motion
pericardium, masses
when is TTE good for
emergencies - reliable, portable, bedside
What is TTE
transthoracic echocardiogram
what is TEE
transesophageal echocardiogram
What is the difference of TTE vs TEE
TTE always first - can be limited in large pts and severe lung disease
TEE is good for posterior structures - aortic dissection, thrombus, vegetations, 3D reconstructions
What are different types of stress tests
ECG, Echo, Nuclear imaging, cMRI
Exercise vs pharmacological tests
What are the benefits of ECG stress test
cheap, fast, easy
greatest value with moderate to high pre-test probability, normal resting ecg, capable of achieving adequate workload
12 lead before, during and after exercises
What is “double product”
HR and sBP
what is highlighted on a stress test
stenosed artery cannot increase blood flow like normal arterty coronary steal
when are pharmacologic stress tests used
combined with imagine
but used in patients with arthritis, ortho issues, PVD, elderly who cannot exercise much
what is an angiogram
cardiac catheterization
opportunity for diagnosis AND treatment concomitantly (PCI)
what is the gold standard for atherosclerosis
angiograms/cardiac catheterization
What are indications for catheterization
ACS (unstable angina, sSTEMI, STEMI)
SIHD (only after failed GDMT)
pre-op cardiac surgery (sometimes other surgeries)
coronary artery and cardiac hemodynamic evaluation
pHTN
peripheral arterial disease
shock pts - hemodynamic support
electrophysiology studies
what type of medication has a survival benefit post MI
Statin medications - for risk reduction: controls lipidemia
What are medications used for IHD
Nitrates
Beta Blockers
Calcium Channel Blockers
What is MONA for ACS patiens
Morphine, Oxygen, Nitro, Aspirin
