cardio day 2 PP1

Question 1

metabolic system need 3+ of the following

Answer 1

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

Question 2

angina cause

Answer 2

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

Question 3

angina sx

Answer 3

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

Question 4

Leading cause of death in industrialized countries

Answer 4

ischemic heart disease

Question 5

ischemic heart disease?

Answer 5

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

Question 6

ischemic heart disease dx

Answer 6

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

Question 7

Ranexa

Answer 7

for microvascular and chronic angina

Question 8

goals stable angina

Answer 8

Prevent MI and death

Improve QOL

Question 9

stable angina is resolves with

Answer 9

rest or nitroglucerin

Question 10

Prinzmetal’s Angina?

Answer 10

Vasospasm induced angina that occurs in cycles, mainly at night

Question 11

Prinzmetal’s Angina cause

Answer 11

Vasospasm- contractions of smooth muscle

NO CAD

Question 12

Prinzmetal’s Angina dx

Answer 12

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

Question 13

Prinzmetal’s Angina trmt

Answer 13

Vasodilation with nitrate or CCB

Question 14

cocaine use trmt

Answer 14

Benzodiazepines, nitrates, CCB

NO beta blockers, they cause alpha mediated vasoconstriction

Question 15

cocaine use dx

Answer 15

stress test or cardiac cath

Question 16

Syndrome X aka microvascular angina

Answer 16

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

Question 17

dx Syndrome X aka microvascular angina

Answer 17

MRI may help confirm

Question 18

trmt Syndrome X aka microvascular angina

Answer 18

beta blockers or nitrates

Question 19

pathogenesis acs

Answer 19

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

Question 20

unstable angina dx

Answer 20

EKG changes

Normal cardiac markers

Question 21

NSTEMI dx

Answer 21

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

ECG- ST depression and T wave inversion

Question 22

this acs has the highest mortality

Answer 22

stemi

Question 23

TIMI risk score

Answer 23

stemi

Question 24

stemi sx

Answer 24

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

Question 25

dx stemi

Answer 25

EKG- ST and J point elevation and hyperacute T waves

Question 26

stemi statin trmt

Answer 26

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

Question 27

FFR-

Answer 27

fractional flow reserve

Question 28

Bare metal stent (BMS)-

Answer 28

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

Question 29

Drug eluting stent (DES)-

Answer 29

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

Question 30

Antiplatelet therapy-

Answer 30

plavix, brilinta, effient

Question 31

when should you do fibrinolysis in stemi

Answer 31

after pci

Question 32

IABP- intra aortic counter pulsation

Answer 32

Percutaneous impella implant | Increases coronary filling and decreases afterload

Question 33

Spontaneous coronary dissection

Answer 33

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

Question 34

Spontaneous coronary dissection mechanism

Answer 34

unknown

Question 35

dx Spontaneous coronary dissection

Answer 35

Coronary angiogram | IV US

Question 36

trmt Spontaneous coronary dissection

Answer 36

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

Question 37

cardiac troponins

Answer 37

Troponin C, I and T

Question 38

high levels of cardiac troponins indicate

Answer 38

cardiac muscle cell death

Question 39

tropinin 1

Answer 39

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”

Question 40

Heart score for chest pain pts in the ED

Answer 40

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

Question 41

CARDIOGENIC SHOCK

Answer 41

Ventricles fail and blood does not perfuse organs | Less oxygen, vasoconstriction, hypotension

Question 42

sx cardiogenic shock

Answer 42

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

Question 43

90% MI pts get this

Answer 43

Post infarction arrhythmias

Question 44

Post infarction arrhythmias ?

Answer 44

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

Question 45

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

Answer 45

Post infarction arrhythmias

Question 46

Accelerated junctional arrhythmias

Answer 46

usually inferior MI

Question 47

Sinus bradycardia

Answer 47

Inferior or posterior MI | 1.2 hrs after the MI

Question 48

Sinus bradycardia trmt

Answer 48

IV atropine, dopamine, epi | Transcutaneous or transvenous pacer

Question 49

AV blocks

Answer 49

1st and 2nd degree | Mobitz type 2 has the highest risk for a complete heart block

Question 50

av block trmt

Answer 50

pacer

Question 51

intraventricular blocks

Answer 51

HIS bundle | Usually anterior MI

Question 52

Not treated with antiarrhythmic therapy

Answer 52

pvc

Question 53

Risk of hemodynamic collapse

Answer 53

nonsustained vt

Question 54

sustained vt

Answer 54

Amiodarone- antiarrhythmic drug | Electrolytes- K and Mg

Question 55

post MI with revasc. when to give ICD?

Answer 55

wait 90 days

Question 56

post MI without revasc. when to give ICD?

Answer 56

wait 40 days

Question 57

highest risk in 1st 90 days after MI

Answer 57

scd

Question 58

VF

Answer 58

Usually 1st hr after MI | After 48 hrs its usually associated with pump failure and cardiogenic shock