Cardiology (Step up son) Flashcards
What is the most common site of coronary occlusion?
Left Anterior Descending artery
What does the Posterior Descending artery branch off of?
Right coronary artery (70%)
Left Circumflex artery (10%)
An anastomosis of the RCA and Circumflex (20%)
What increases stroke volume? (6 things)
Catecholamine release Increase intracellular Calcium Decrease in extracellular Sodium Digoxin use Anxiety Exercise
By remembering how digoxin works, two of the other causes of increased stroke volume can be remembered. How does digoxin work?
Digoxin inhibits Na/K-pump. Leading to increased intracellular sodium (thus decreased extracellular sodium) which causes increased intracellular calcium
What decreases stroke volume?
Beta-blockers
Heart failure (chicken vs. egg)
Acidosis
Hypoxia
What is the Fick Principle? What does it determine
(Rate of O2 use) / ([O2]a – [O2]v)
Cardiac Output…just follow the units
Which increases first to increase CO during exercise, SV or HR?
SV increases first, then HR
What equations can be used to determine Mean Arterial Pressure?
CO x TPR
Diastolic pressure + 1/3 pulse pressure
When is an exercise stress test complete?
85% expected max HR (220-age)
Angina like symptoms
Signs of ischemia on ECG
What can be done if an exercise stress test results are ambiguous?
Nuclear exercise test (inject thallium-201 or tech-99)
Exercise stress test with echo
What is used in pharm stress testing? When is this done?
Dobutamine
Comorbidities
PET myocardial imaging can be done…
…gives 3D images
What is the gold standard in identifying CAD?
Coronary angiography
What is the most common cause of hypercholesterolemia?
Most cases are acquired
When they say/show high levels of serum homocysteine, what should you think about?
Atherosclerosis (3x risk of significant amount)
For the bulk of the cholesterol meds, what are the common side effects?
Muscle damage/pain
Increased LFTs
Person has substernal chest pain with activity that is relieved with rest. What do they have? How should they be treated? How should they be diagnosed?
Angina pectoris (Prinzmetal if d/t vasospasm) [until proven otherwise] GERD, esophageal spasm, etc.
Nitroglycerin and rest
Stress test (exercise vs pharm) or nuclear
Patient previously diagnosed with CAD presents with worsening symptoms–now having symptoms at rest–and decreased response to treatment. What are the likely causes?
Plaque rupture*
Hemorrhage
Thrombosis
Patient previously diagnosed with CAD presents with worsening symptoms–now having symptoms at rest–and decreased response to treatment. What should be done in-patient? What is seen on ECG?
ECG and serial cardiac enzymes
ST depression*
T-wave flattening/inversion
Patient previously diagnosed with CAD presents with worsening symptoms–now having symptoms at rest–and decreased response to treatment. What treatment should be done regardless of whether PCI is planned?
MONA BS
M-Morphine
O-Oxygen
N-Nitroglycerin
A-Aspirin
B-Beta blocker
S-Statin (preferably before PCI)
Patient previously diagnosed with CAD presents with worsening symptoms–now having symptoms at rest–and decreased response to treatment. What should be added to MONA BS if PCI is planned?
GPIIb/IIIa inhibitor
Unfractioned heparin
What are the GPIIb/IIIa inhibitors?
Abciximab
Tirofiban
Eptifibatide
Patient previously diagnosed with CAD presents with worsening symptoms–now having symptoms at rest–and decreased response to treatment. What should be added to MONA BS if PCI is NOT planned?
Clopidogrel or ticagrelor
LMWH
Patient previously diagnosed with CAD presents with worsening symptoms–now having symptoms at rest–and decreased response to treatment. What electrolytes should be monitored?
Potassium > 4mEq/L
Magnesium > 2mEq/L
