Cardiovascular from PANCE Pearls Flashcards
What is Angina
Substernal chest pain often brough on by exertion
What causes Angina
CAD
Coronary Artery Spasms
Pulmonary HTN
Hypertrophic Cardiomyopathy
What are risk factors for Angina
DM
Hyperlipidemia
HTN
Smoking
Sx of Angina
Substernal chest pain
May radiate to arm, lower jaw, back, shoulder
Short duration
Dx of Angina
Best non-invasive
Gold Standard
EKG: ST Depression with exertion, T wave inversion
Stress is best non-invasive screening
Coronary Angiograph is Gold Standard and Definitive dx
What is a Cath
Coronary Angiography
Outlines coronary artery anatomy, determines location and extent of CAD
What are indictions for PTCA (Percutaneous Transluminal Coronary Angioplasty) or PCI (Percutaneous Coronary Intervention
Used for 1 or 2 vessel disease not involving main left coronary artery + Normal or near normal left ventricular function
What are indications for CABG (Coronary Artery Bypass Graft)
Left main coronary artery disease
Sx 3 vessel disease
Left Ventricular EF
How does Nitroglycerin work
Increased myocardial blood supply, so increases oxygen and collateral blood flow
Decreases Demand which will reduce cardiac work and decrease preload
How do beta-blockers work
Increases myocardial blood supply
Decreases Demand
1st line drug for chronic management
How do Calcium Channel Blockers work
Increased myocardial blood supply
Decreases Demand
Used in patients not able to use beta-blockers
How does Aspirin work
Prevents platelet activation/aggregation
What is Acute Coronary Syndrome
Symptoms of acute MI due to acute plaque rupture and coronary artery thrombosis
Includes unstable angina, NSTEMI, and STEMI
What causes Acute Coronary Syndrome
Atherosclerosis caused by plaque rupture
Coronary artery vasospasms, usually due to cocaine, Prinzmetal’s variant angina
Sx of Acute Coronary Syndrome
Anginal Pain
Sympathetic stimulation: Anxiety, Diaphoresis, Tachycardia, N/V, Palpitations, Dizziness
Silent MI: atypical sx such a abdominal pain, dyspnea without chest pain
Dx of Acute Coronary Syndrome
EKG
Unstable Angina and NSTEMI: T wave inversion/ST Depression
STEMI: ST elevations
What does the location of Q waves or ST elevation tell you about where the MI occured
V1-V4: Anterior. Involves Left Anterior Descending
I, aVL, V5, V6: Lateral. Involves Cirucumfelx
I, aVL, V4, V5, V6: Anterolateral. Involves LAD or CFX
II, III, aVF: Inferior. Involves Right Coronary Artery
ST DEPRESSION in V1-V2: Posterior. Involves RCA, CFX
What are 2 main cardiac markers and what does the timing of their apperace mean
CK/CK-B: Peaks 12-24 hours, Baseline at 3-4 days
Troponin: Peaks 12-24 hours, Baseline 7-10 days
What is Prinzmetal’s Angina
Coronary Spasm that leads to transient ST elevations
Sx of Prinzmetal’s Angina
Ches pain at rest, usually in the mornings with hyperventilation, emotional stress or cold exposure. Not usually due to exertion
Dx of Prinzmetal’s Angina
EKG: Transient ST elevations (usually resolve wth CCB and NTG)
Angiography: No fixed stenosis seen
Tx of Prinzemtal’s Angina
CCB, NTG as needed
What is Heart Failure
Inability of the heart to pump sufficient blood to meet the metabolic deamns of the body at normal filling pressures
What causes Heart Failure
CAD
What causes Left sided HF
CAD and HTN
What causes Right sided HF
Left sided HF
Pulmonary disease
What is the pathophysiology behind CHF
An insult leads to increased afterload, increased preload, decreased contractility
Injured heart tries to make short term compensation tha promotes cardiovascular deterioration
Sympathetic nervous system is activated, myocyte hypertrophy/remodeling, RAAS activation, fluid overload, ventricular remodeling
Sx of Left Sided HF
Increased venous pressure from fluid backing up into lungs
Dyspnea, Orthopnea, Paroxysmal Nocturnal Dyspnea
Pulmonary Cognestion: Rales, Rhonchi, pink frothy sputum
HTN, Cheyne Stoke’s
Dusky pale skin, Diaphoresis
Sx of Right sided HF
Increased systemic venous pressure, see signs of systemic fluid retention
Peripheral Edema
Jugular Venous Distention
Anorexia, N/V, Hepatosplenomegaly, RUQ tenderness, Hepatojugular Reflex
Dx of CHF
Echo: Can test Ejection Fraction
CXR: Cephalization of flow, Kerley B lines, butterfly pattern, Cardiomegaly, Pleural Effusions
Increased BNP (Ventricles release BNP during volume overload)