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SUMMED2 > CARDIO-CAD > Flashcards

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
Q

What is given in acute coronary syndromes for life-prolonging?

A

Aspirin

○ Aspirin (50-100 mg)

26
Q

What prevent further negative remodeling

A

Beta-Blocker​
atenolol,
metoprolol,
carvedilol

ACEI-Lisinopril
ARB

27
Q

What non RX modifers to treat CAD

A

Wt reduction-low fat
Aerobic+some resistance, no ISOs
NO Tobacco

28
Q

What are cardiac DDX for angina/CP?

A 
CAD
Pericardiits/Myocardiits
Aortic Dissection- trauma ED
Tachy arrythmis- VT, SVT, PVS
Catecholmaine excess- NE, E, SNS from adrenal medulla
29
Q

What are non organ related DDX for angina?

A

Stress
Anemia
Trauma
Exercise

30
Q

What are GI related DDX for angina?

A

GERD
PUD
Esophageal spasm rupture
Gallbladder, Pancreatic Dz

31
Q

What are pulmonary condtion related to DDx for angina?

A 
Influenza, INfx
PE
Pneumothorax
Asthma
Pleurisy
32
Q

What are MSK condition related to DDX for chest pain?

A

Costochondritis
Cervical radiculopathy
MSK strain

33
Q

What determines hard and soft plague?

A

Calcium scores
+ means hard plague, body protecting itself. BUT DX CAD
- no DX, no statins needed, but consider PMH
Not covered by INS.

34
Q

What is used to DX mural thrombus? What is a mural thrmobus

A

Transthoracic esophageal echocardiogram
MURAL TE- platelet and some fibrin
MC in unstable angina/non Q wave MI

35
Q

Which marker is elevated 1st with MI?

A

Tropoinin
w/in 4hr
Peak 10-24hr
Last 10days

36
Q

Where is Creatine Phosophokinase?

A

enzyme in brain, MSK, heart
Elevated 4-6h, Pk 12-24
2-3 days normalizes

37
Q

Which marker found in cardiac injury has three forms?

A

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
Q

Ms. Cad has PMH of stable angina but no heart attack, no CAD. What is goal

A 
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
Q

Mr. Cad is obese, w/ PMH of CAD and MI. What is goal?

A 
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
Q

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

A 
Coronary Vasospasm
NOT a blockage
1. Sublingal/IV nitrates during spasm
OR
2. CCB verapamil

SUMMED2 (38 decks)

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