CARDIO-CAD Flashcards

1
Q

What is the #1 risk factor for Cardiac dz?

A

**Prior coronary event
MI
Stents
bypass surgery

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2
Q

What are some non cardiac risk factors?

A

​Non-cardiac atherosclerosis ​- PAD legs, carotid artery, AAA/in heart to*

​DM- pts die from heart attack and stroke

Dyslipidemia​ - if LDL >190

Family History

​Cigarette smoking​

Sedentary lifestyle

Obesity-

​Age

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3
Q

What is major risk factor for coronary disease, and heart failure?

A

Hypertension​

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4
Q

What happens to person if coronary artery has FIXED blocked l/t dec. ability of blood flow to increase with ​increased demand​ of the heart muscle for oxygen.

A

Stable angina - FIXED**

blood flow is normal at rest when demand is not high

Exercise- myocardial oxygen consumption shoots up. INC in coronary artery blood flow is needed. If blockage is 70-90%, then you can’t meet hearts demand.

Angina/CP= heart becomes ischemic lacks oxygen, hurts

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5
Q

What trigger/ precipitative factors on stable angina?

A

Exercise
Eating
Anxiety
Cold weather

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6
Q

Ms. Angina has CP, but has been manageable with medical or revascularization therapy. Her pain is predictabl eand ​reproducible​ during exercise and relieved with rest or nitroglycerin​? What is this?

A

Stable Angina- RELIEVED W/ REST

PMH of ischemic heart disease will experience angina as part of the clinical manifestations of the disease.

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7
Q

Mrs. Angina has CP, but has been manageable with medical or revascularization therapy. What are steps in TX?

A
STABLE ANGINA
**Beta blockers​- initial treatment of symptoms​.
​Calcium channel blockers​ and ​nitrates:  ONLY if  BB contraindicated or ADEs ​
Regular exercise​
Aspirin 
Statin, 
**Tobacco cessation, 
control BP
DEC excess weight, 
management of diabetes. 
 stress reduction
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8
Q

What gives difference on Labs btwn ST elevation and NST elevation?

A
Troponin- HEART damage in ST elev
Elevated in:
MI
Sepsis
Afib
Aflutter
Marathon runners
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9
Q

What is definition of infarction?

A

Chest pain WITH troponin

5% ED w/ CP pts- MI
EKG-ST elevation, QRT deplorization and Troponin to diagnosis

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10
Q

What are hallmarks of Chest Pain.

A

Midline
Pain w/ exertion relieve w/ rest= CAD until proven NOT
Lower jaw pain-MC**, upper rare
Women- exertion SOB
MEN-classic CP
SOB, upper L CP w/ walking- stress test!!!
RARE L upper chest pain as angin

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11
Q

What is an acute coronary syndrome that is defined by the absence of biochemical evidence of myocardial damage.

Clinical findings:

  1. prolonged >20 mins angina at rest, lower in threshold
  2. new onset of severe/subtle angina w/in 2wks
  3. angina that is increasing in frequency/severity of stable angina
  4. angina that occurs after a recent episode of MI.
  5. New onset of resting/nocturnal chest pain
A

Unstable angina- AT REST

Other- SOB/DOE
N/V
Diaphoresis
Syncope

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12
Q

What is ABRUPT DEC in coronary arteries blood flow without increase in myocardial oxygen demand. vs. stable angina​ an inadequate flow when the demand goes up

A

Acute coronary syndrome/unstable angina

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13
Q

What is causative issue of unstable angina?

A

Coronary thrombus

result to acute coronary syndrome/unstable

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14
Q

What deposits occurs between the INTIMA/wall of lumen and the MEDIA/smooth muscle in wall of vessel?

A
● CHOLESTEROL DEPOSIST- CAUSE Endothelial dysfunction 2/2 to:
○ High Cholesterol (LDL cholesterol)
○ HTN
○ Tobacco- little paper cuts
○ DM
○ Ventricular wall stress ​(pounding of blood on the wall at a bend in the artery)
○ Sedentary Lifestyle
* Inflammation weakens plaque breaks off
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15
Q

In a cross section of the coronary artery, what are signs of endothelia dysfunction?

A

1st fatty streaks pools of lipids near bend of artery
Starts b4 symptoms in person
1.Lipid pools injure endothelium
2. Endo cell turn to fibroblasts
3. Fibroblast coat endo-Fibrous cap over lipid pool
4. Fatty MAC/monocytes eat fat cells
5. Signals cytokines to help
6. **MACs release protease- dissolve fibrous capsule, cap thins

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16
Q

What is problem when fibrous cap thins?

A

RUPTURE-exposure of lipid pool into blood stream
→ ​activates platelets​ and causes them to ​aggregate
​→ release ​clotting factors​ that leads to fibrin
→ fibrin traps red cells
→ clots occlude the vessel

○ The bigger the vessel, the longer/wider the total occlusion, the sicker the pt is, the bigger the infarction is

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17
Q

When platlets aggregate after exposure of lipid in blood , and fibrin is released. what is formed?

A

White Thrombus- platetes (INC inflammation)

Red Thrombus- RBC

18
Q

After RED thrombus what is occurs? What is ideal management?

A

Acute ST elevation myocardial infarction (STEMI)=
TOTAL​ OCCLUSION- PLATELETS, RBC, FIBRIN

EMERGENTManagement- Angioplasty cath lab/STENTS ​within 90 minutes

19
Q

What does ST segment depression and ongoing chest pain with troponin positive indicate? Next management

A

Acute Non-ST elevation myocardial infarction (NSTEMI):
P​ARTIAL​ OCCLUSION

Manage- Angioplasty cath lab ​within 24-72 hours
TX: 
beta-blocker,
Heparin- grels.
aspirin,
oxygen
20
Q

What if PT has Resting/Accelerating Angina/Unstable Angina, what this type of occlusion?

A

TRANSIENT​ OCCLUSION
●W/ or W/O M.I. with resting angina benefit from angioplasty

● Positive troponin- stay ​ in the ED
● Negative troponin​- home and get a stress test within 1 week​.

21
Q

Ms. Smith has PMH of CVD, 52yo. gets an echo, then walks, repeats echo to get idea of their exercise capacity. What is this test?

A
Treadmill stress echo
AVOID- STEMI, unstable angina, Severe HTN
Aortic Stenosis- DEC CO, syncope
Ventricular paceing
Ednocoarditis, PE, DVT
22
Q

Ms. Smith lies there and gets infusion of dobutamine (NE/epi) →makes heart beat faster and harder

A

Dobutamine stress echo

EKG states not able to walk

23
Q

Ms. Dollar, uses a lot of radiation do a rest image → see if dye is taken up by heart muscle. Then if during exercise you see a “cold” spot = area of ischemia

A

Nuclear stress testing

Inability to walk- DVT, PE, MI, hip surgery

24
Q

Ms. Dollor heart is vasodilate; shunts blood away from occluded area. see normal perfusion at rest but after the adenosine, see cold spots which indicates ischemia

A

Adenosine nuclear stress test​

25
What is given in acute coronary syndromes for life-prolonging?
Aspirin | ○ Aspirin (50-100 mg)
26
What prevent further negative remodeling
Beta-Blocker​ atenolol, metoprolol, carvedilol ACEI-Lisinopril ARB
27
What non RX modifers to treat CAD
Wt reduction-low fat Aerobic+some resistance, no ISOs NO Tobacco
28
What are cardiac DDX for angina/CP?
``` CAD Pericardiits/Myocardiits Aortic Dissection- trauma ED Tachy arrythmis- VT, SVT, PVS Catecholmaine excess- NE, E, SNS from adrenal medulla ```
29
What are non organ related DDX for angina?
Stress Anemia Trauma Exercise
30
What are GI related DDX for angina?
GERD PUD Esophageal spasm rupture Gallbladder, Pancreatic Dz
31
What are pulmonary condtion related to DDx for angina?
``` Influenza, INfx PE Pneumothorax Asthma Pleurisy ```
32
What are MSK condition related to DDX for chest pain?
Costochondritis Cervical radiculopathy MSK strain
33
What determines hard and soft plague?
Calcium scores + means hard plague, body protecting itself. BUT DX CAD - no DX, no statins needed, but consider PMH Not covered by INS.
34
What is used to DX mural thrombus? What is a mural thrmobus
Transthoracic esophageal echocardiogram MURAL TE- platelet and some fibrin MC in unstable angina/non Q wave MI
35
Which marker is elevated 1st with MI?
Tropoinin w/in 4hr Peak 10-24hr Last 10days
36
Where is Creatine Phosophokinase?
enzyme in brain, MSK, heart Elevated 4-6h, Pk 12-24 2-3 days normalizes
37
Which marker found in cardiac injury has three forms?
CK-MB- 1. CK-MM- <1% in MSK, 2. CK-BB brain 3. CK-MB- both 60% Elevated 4-6h, Pk 12-24 2-3 days normalizes
38
Ms. Cad has PMH of stable angina but no heart attack, no CAD. What is goal
``` PRIMARY prevention of CAD prevent heart and blood vessel dz Min stress lower salt, fat diet Inc exercise NO smoking BP reg Cholesterol Qyr- LDL<120, <100 for moderate risk Controll chronic illness ```
39
Mr. Cad is obese, w/ PMH of CAD and MI. What is goal?
``` SECONDARY prevention of CAD BP <130, <90 NO smoking Statin<70 LDL SIG DEC OF MI ANTI PLATE "-GRELS" WT REDUCE DM Control Flu vaccine** Cardiac rehab ```
40
Ms. Vessel is 72 has been stressed w/ CP waking her up at night. EKG shows ST Elevation, but goes normal w/ NO Q waves. Echo show no s/s of artery damage. Hx of smoking spouse. What is tX
``` Coronary Vasospasm NOT a blockage 1. Sublingal/IV nitrates during spasm OR 2. CCB verapamil ```