Cardiovascular Disease - Coronary Artery Disease Flashcards
most common underlying cause of myocardial ischemia and injury
obstruction of coronary arteries by artherosclerosis
most common cause of anterior chest musculoskeletal pain
costochondral and chondrosternal syndromes
myocardial perfusion occurs during this time
diastole
remains the major cause of death and premature disability in developed societies
atherosclerosis
site with higher predilection for developing atherosclerotic disease
proximal left anterior descending coronary artery
initial lesion of atherosclerosis
fatty streak
age when lipid screening should start (based on current ATP III guidelines)
20 y/o (fasting lipid profile; total cholesterol; triglycerides; LDL, and HDL), repeated every five years
initial management of dyslipidemia
therapeutic lifestyle changes (TLC)
ultimately causes the gravest complications of atherosclerosis
thrombosis
key feature of metabolic syndrome
central adiposity
most accepted and unifying hypothesis to describe pathophysiology of metabolic syndrome
insulin resistance
driving force behind the metabolic syndrome
obesity
primary approach to metabolic syndrome
weight reduction ( caloric restriction: most important component)
in LDL cholesterol - generally the first choice for medication intervention
HMG-CoA Reductase inhibitors (statins)
drug of choice to lower fasting TG and typically achieve a 35-50% reduction
fibrates
only currently available drug with predictable HDL cholesterol raising properties
nicotinic acid
most common cause of myocardial ischemia
atherosclerotic disease of epicardial coronary artery
major site of atherosclerotic disease
epicardial arteries (most common: left anterior descending artery)
predilection for atherosclerotic plaques to develop at sites of increased turbulence
branch points in the epicardial arteries
reversible damage in myocardium
less then or equal to 20 minutes for total occlusion in the absence of collaterals
typical patient with angina
man >50 years or a woman >60years of age who complains of chest discomfort (heaviness, pressure, squeezing, smothering or choking) and only rarely as frank pain
most commonly used test for both the diagnosis of IHD and estimating the prognosis
electrocardiographic stress testing
route providing most rapid and complete absorption of nitrates
mucous membranes
most common route in administration of nitroglycerin
sublingually
most common pathophysiologic cause of unstable angina
plaque rapture or erosion with superimposed non-occlusive thrombus
clinical hallmark of ACS, typically located in the substernal region or sometimes in the epigastrum, that radiate to the neck, left shoulder, and left arm
chest pain
only absolute contraindications to nitrate use
hypotension
use of sildenafil or similar drugs in previous 24-48 hours
most important adverse effect of all antithrombotic agents
excessive bleeding
most common artery involved in focal spasms of Prinzmetal angina
right coronary artery
main agents for acute episodes of prinzmetal angina and to abolish recurrent episodes
nitrates and calcium channel blockers
type of necrosis seen in M.I.
coagulation necrosis (preserved architecture, faded details)
initial occurrence of gross changes in M.I.
12 hours after onset of symptoms
color changes in M.I.
mottling: 4 hours
bright yellow: 1 week
surrounding red granulation tissue: 2 weeks
gray-white scar: 2 months
full-thickness/transmural; ECG: ST-Elevation, Q waves; associated with increased early mortality rate
Q-wave infarction (clinically equivalent to STEMI)
Partial-thickness/subendocardial; involves inner third of myocardium; ECG: ST depression; increased risk of infarction and sudden cardiac death post-M.I.
Non-Q-wave infarction (Clinically equivalent to NSTEMI)
Fibrous pericarditis (bread & butter pericarditis) associated with M.I.
Dressler’s syndrome (Dressler’s Triad: fever, pleuritic pain, pericardial effusion)
Myocardial rupture post-M.I.
Usually in 1st time M.I. patients (cardiac scar that forms in those with previous M.I. prevents rupture)
most common presenting complaint in STEMI
chest pain
pivotal diagnostic and triage tool because it is at the center of the decision pathway for screening and management in STEMI
12-lead ECG
preferred biochemical markers for MI
cardiac-specific troponin T & cardiac-specific troponin I
most out-of-hospital deaths from STEMI
ventricular fibrillation
primary cause of in-hospital deaths from STEMI
pump failure
greatest delay usually occurs between
onset of pain and the patient’s decision to call for help
principal goal of fibrinolysis
prompt restoration of full coronary arterial patency
door-to-needle time
less than or equal to 30 min
most frequent and potentially the most serious complication of fibrinolysis
hemorrhage (hemorrhagic stroke: most serious complication)
standard antiplatelet agent for STEMI
aspirin
standard anticoagulant agent used in clinical practice (IN STEMI)
unfractionated heparin
most common clinical signs of pump failure
pulmonary rales; s3 and s4 gallop sounds
extent of LV involvement that usually results in cardiogenic shock
infarction >40%
usual duration of hospitalization for an uncomplicated STEMI
5 days
most common complication of angioplasty
restenosis, or re-narrowing of the dilated coronary stenosis
most common thrombi found in NSTEMI
white thrombi (composed mainly of platelets)
most common thrombi found in STEMI
red thrombi (composed of cells and fibrins)
