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clin med > cardio day 2 PP1 > Flashcards

cardio day 2 PP1 Flashcards

1
Q

metabolic system need 3+ of the following

A

high wait circ. , high trigly, high bp, high fasting glucose, red HDL

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2
Q

angina cause

A

Anything that makes the heart muscle need more O2 such as cold weather, exercise, large meals, stress, abnormal heart rhythms, anemia, valvular disease, heart failure, hyperthyroidism

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3
Q

angina sx

A

Central tight pressure to squeezing, radiates to the arm or jaw, relieved with rest
Dyspnea on exertion, SOB, NV, weakness/fatigue, epigastric pain, indigestion, change in mental status

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4
Q

Leading cause of death in industrialized countries

A

ischemic heart disease

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5
Q

ischemic heart disease?

A

Ischemia (less blood supply) to the heart muscle caused by CAD and narrowing/hardening of the arteries

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6
Q

ischemic heart disease dx

A

Coronary angiogram
Lab tests
ECG
Stress test, nuc med test, exercise stress
Echo
Coronary CT angiogram, electoral beam CT (EBCT), cardiac MRI

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7
Q

Ranexa

A

for microvascular and chronic angina

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8
Q

goals stable angina

A

Prevent MI and death

Improve QOL

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9
Q

stable angina is resolves with

A

rest or nitroglucerin

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10
Q

Prinzmetal’s Angina?

A

Vasospasm induced angina that occurs in cycles, mainly at night

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11
Q

Prinzmetal’s Angina cause

A

Vasospasm- contractions of smooth muscle

NO CAD

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12
Q

Prinzmetal’s Angina dx

A

Inject coronaries with Ergonovine- vasospasm should occur and is diagnostic
ECG- ST elevation

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13
Q

Prinzmetal’s Angina trmt

A

Vasodilation with nitrate or CCB

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14
Q

cocaine use trmt

A

Benzodiazepines, nitrates, CCB

NO beta blockers, they cause alpha mediated vasoconstriction

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15
Q

cocaine use dx

A

stress test or cardiac cath

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16
Q

Syndrome X aka microvascular angina

A

Angina with dec blood flow to the heart
Vasospasm and/or small vessel disease with more pain perception
Coronary arteries look normal

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17
Q

dx Syndrome X aka microvascular angina

A

MRI may help confirm

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18
Q

trmt Syndrome X aka microvascular angina

A

beta blockers or nitrates

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19
Q

pathogenesis acs

A

Inflammation
Endothelial activation and fibrous cap is formed
Plaque and fibrous cap rupture causing prothrombin and thrombin to activate which obstructs blood flow
Platelets aggregate to form a thrombus

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20
Q

unstable angina dx

A

EKG changes

Normal cardiac markers

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21
Q

NSTEMI dx

A

High cardiac biomarkers- CK, CK-MB, myoglobin, troponin I

ECG- ST depression and T wave inversion

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22
Q

this acs has the highest mortality

A

stemi

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23
Q

TIMI risk score

A

stemi

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24
Q

stemi sx

A

May have LHF with hypoxia- dyspnea, hypoxemia, pulmonary edema, respiratory compromise
Ventricular arrhythmias- treat immediately

25
Q

dx stemi

A

EKG- ST and J point elevation and hyperacute T waves

26
Q

stemi statin trmt

A

atorvastatin 40 to 80 mg; Rosuvastatin 20-40 mg (know)

27
Q

FFR-

A

fractional flow reserve

28
Q

Bare metal stent (BMS)-

A

ASA lifelong and (DAPT) dual antiplatelet therapy minimum 3 months

29
Q

Drug eluting stent (DES)-

A

ASA lifelong and (DAPT) dual antiplatelet therapy 12 months +

30
Q

Antiplatelet therapy-

A

plavix, brilinta, effient

31
Q

when should you do fibrinolysis in stemi

A

after pci

32
Q

IABP- intra aortic counter pulsation

A

Percutaneous impella implant

Increases coronary filling and decreases afterload

33
Q

Spontaneous coronary dissection

A

Tear in layers of coronary artery causing hematoma or dissection flap to obstruct blood flow

34
Q

Spontaneous coronary dissection mechanism

A

unknown

35
Q

dx Spontaneous coronary dissection

A

Coronary angiogram

IV US

36
Q

trmt Spontaneous coronary dissection

A

Risk factor modification
PCI- stent, CABG
Not musch bc usually dx after death

37
Q

cardiac troponins

A

Troponin C, I and T

38
Q

high levels of cardiac troponins indicate

A

cardiac muscle cell death

39
Q

tropinin 1

A

Raises 3-12 hours after onset of ischemia
Peaks 12-24 hrs
Lasts 7-14 days
Must raise to a certain amount for it to be considered myocardial injury
Minimally elevated levels suggest type 2 MI/“demand ischemia”

40
Q

Heart score for chest pain pts in the ED

A

0-3 discharge
4-6 admit for observation
7-10 early invasive strategies

41
Q

CARDIOGENIC SHOCK

A

Ventricles fail and blood does not perfuse organs

Less oxygen, vasoconstriction, hypotension

42
Q

sx cardiogenic shock

A

Cold extremities, oliguria, change in LOC, weak pulse, mottled skin, hyperventilation, pulmonary edema, JVD

43
Q

90% MI pts get this

A

Post infarction arrhythmias

44
Q

Post infarction arrhythmias ?

A

Electrical conduction is affected after the MI
Enhanced sympathetic activity, inc catecholamines, autonomic imbalance
Arrhythmia depends on the area affected

45
Q

Types: supraventricular arrhythmias, accelerated junctional rhythms, av blocks, IV blocks, ventricular arrhythmias, reperfusion arrhythmias, junctional bradycardia

A

Post infarction arrhythmias

46
Q

Accelerated junctional arrhythmias

A

usually inferior MI

47
Q

Sinus bradycardia

A

Inferior or posterior MI

1.2 hrs after the MI

48
Q

Sinus bradycardia trmt

A

IV atropine, dopamine, epi

Transcutaneous or transvenous pacer

49
Q

AV blocks

A

1st and 2nd degree

Mobitz type 2 has the highest risk for a complete heart block

50
Q

av block trmt

A

pacer

51
Q

intraventricular blocks

A

HIS bundle

Usually anterior MI

52
Q

Not treated with antiarrhythmic therapy

A

pvc

53
Q

Risk of hemodynamic collapse

A

nonsustained vt

54
Q

sustained vt

A

Amiodarone- antiarrhythmic drug

Electrolytes- K and Mg

55
Q

post MI with revasc. when to give ICD?

A

wait 90 days

56
Q

post MI without revasc. when to give ICD?

A

wait 40 days

57
Q

highest risk in 1st 90 days after MI

A

scd

58
Q

VF

A

Usually 1st hr after MI

After 48 hrs its usually associated with pump failure and cardiogenic shock

clin med (35 decks)

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