Cardiology - CAD, infective, CHF, myopathy, HTN Flashcards
Define Preload?
this is from the left atrium contracting, thus pushing blood into the LV and causing to stretch and have a stronger contraction
Define Afterload?
another way of saying BP, or pressure that holds the aortic valve closed (generally the systolic number) - resistance against which the heart contracts
Define Contractility?
strength of LV muscle
What drug increases contractility?
digoxin
What drug reduces contractility?
verapamil (blocks Ca++)
Define Systole?
blood leaves the LV to body
Define diastole?
Ventricle fills (passive and active)
Normal Ejection Fraction is what %?
55%
Ejection Fraction of post MI?
25%
What is coronary artery disease?
inflammatory process involving the arteries in the body. Starts with deposition of lipids (causes inflammation and narrowing), constant remodeling
What are non-modifiable risk factors for CAD?
age, sex, genetic, ethnicity
What are modifiable risk factors for CAD?
high cholesterol, HTN, DM, smoking, obesity, physical inactivity, ETOH, stress
What are some key preventions for CAD?
DASH diet exercise proper weight control DM, HTN, cholesterol stop smoking
Atypical Presentation of CAD…Elderly, DM, women?
Elderly - syncope
DM - silent ischemia (no pain), SOB
Women - often mistaken for abdominal pain
Examples of non-cardiac pain?
pleuritic pain (sharp related to respiratory movement); lower abdomen, localized with one finger; reproduced by movement or palpation; constant pain lasting for days
Typical MI signs and symptoms?
substernal chest pain/pressure crushing radiation to neck or left arm grey color diaphoresis anxiety feeling impending doom HTN, hypotension
Atypical MI signs and symptoms?
nausea, epigastric pain, back pain, fatigue, no symptoms
What is Acute Coronary Syndrome (3)?
- CHEST PAIN consistent with cardiac cause of pain
- EKG changes consistent with ischemia (ST elevation, depression, flipped T wave)
- elevated cardiac enzymes
(ranges from unstable angina to MI {NSTEMI/STEMI})
Define Stable Angina?
patient with predicable pattern of angina with activities
- exertional CP is relieved by rest or 2 nitroglycerin tablets
- get stress test
Define Unstable Angina?
new chest pain due to partial occlusion of coronary artery lasting <30 min
-get cardiac cath
Treatment for Stable Angina?
ACEI, BB, ASA, Nitroglycerin sublingual, Statin
Prinzmetal or Variant Angina… define and treatment?
Wakes from sleep or occurs at rest
-ST elevations during active vasospasm (if no vasospasm they can exert themselves and no CP)
TX = CCB
What is the most sensitive cardiac enzyme?
Troponin T (detected for 3 days)
Describe Chest Pain story suggestive of MI?
>30 min pressure, heavy, band like or squeezing levine sign (make fist over sternum) worse with exertion radiate to jaw or left arm (associated = SOB, nausea, diaphoresis)
Treatment for NSTEMI?
- antiplatelet (aspirin, clopidogrel)
- anticoag (unfractionated heparin, enoxaprin, fondoparinux)
- BB (if no contraindications - heart failure, bradycardia, heart block) = then give CCB
{MONA B CASHPAD, elective cardiac cath}
Treatment for STEMI?
- Aspirin
- clopidogrel
- IMMEDIATE (90 min) CATH - coronary angiography
- thrombolytic (alteplase, reteplase)
{MONA B CASHPAD + urgent cardiac cath}
What are contraindications for thrombolytics?
previous hemorrhagic stroke, any stoke in last year, intracranial neoplasm, active internal bleed, suspect aortic dissection
trauma within 2-4 weeks, bleeding, major surgery within 3 weeks, pregnancy, PUD, anticoagulants, BP >180/110
What does MONA B CASHPAD stand for?
Morphine, oxygen, nitroglycerin, aspirin
BB
CCB, ACEI, Statin, Heparin (stemi) or Lovenox (nstemi/angina), plavix, amiodarone, dopamine/dobutamine/diuretics
4 Key BB?
Metoprolol - use if EF >40
Carvedilol - use if EF <40%
Esmolol - rate control agent
Labetalol - HTN drug of choice
When do you use amiodarone… ADR?
for VT/VF or any arrhythmia
ADR: pulmonary HTN, elevated LFT, hypo/hyperthyroid, iodine allergy
Get PFT, LFT, thyroid before starting
What are cardiac catheterization criteria?
- within 90 minutes of arrival
- access via femoral or brachial artery
- bare metal (plavix for 30 days)
- drug eluting (plavix x1 year)
What do you do if cardiac catheterization is not available within 90 minutes?
thrombolytics
or meets criteria: persistent ST elevation + chest pain; hypotension, CHF, arrhythmia - VT/VF
What are indications for thrombolytic therapy?
- symptoms of MI
- ST elevation >0.1mV on 2 leads
- onset of symptoms within 12 hrs
- can’t have PCI within 90 minutes or prolonged transport (>1 hr to facility)
pleuritic chest pain (with inspiration - sharp/stabbing), relieved by sitting upright and forward, friction rub, diffuse ST elevation
Pericarditis
What is #1 cause of pericarditis?
Viral infection
What is Dressler’s Syndrome?
Pericarditis after an acute MI
Pericarditis Treatment?
if hemodynamic compromise = pericardiocentesis
-NSAID or Steroid
if bacterial (usually viral) - may require ABX
What chest pain usually lasts <3 minutes, exacerbated by physical activity, relieved by rest?
Angina Pectoris - stable
Severe tearing sensation, radiates to back, most severe pain is at onset, male
involves only intima layer
Aortic dissection
- Type A = ascending (65%)
- Type B = descending (35%)
Risk Factors for Aortic Dissection?
pregnancy, cocaine, chronic HTN, bicuspid aortic valve, aortic coarctation, giant cell arteritis, CT disease, marina’s syndrome, ehler’s-danlos syndrome
Gold Standard for Aortic Dissection?
Aortic Angiography
-CT is generally first choice
Treatment for Aortic Dissection?
- lower BP (nicardipine, esmolol, labetalol, nitroprusside)
- Type A = surgical management
- Type B = medically first, maybe surgery
ADR of nitroprusside?
may cause cyanide toxicity, leading to AMS and high anion gap acidosis
abrupt onset of severe pain unrelieved by position change, back pain/pulsatile mass/hypotenstion
> 60
involves 3 layers
Aortic Aneurysm
