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ICM -- Cardiology > Chronic Ischemic Heart Disease > Flashcards

Chronic Ischemic Heart Disease Flashcards

1
Q

Risk factors for atherosclerotic vascular diseasE?

A

Age, Family History, Diabetes, HTN, Smoking, Cholesterol (biggest increase in risk), Obesity, Sedentary Lifestyle

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2
Q

What is Metabolic Syndrome?

A 
Any three out of...
HTN
Abdominal obesity 
Low HDL
High Triglycerides
High Blood Sugar
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3
Q

Metabolic Syndrome is associated with…

A

Inflammation, Coagulation Abnormalities, Progression to DM type II

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4
Q

Manifestations of Choronary Artery Disease?

A 
Chronic Stable Angina
Unstable Angina
Myocardial Infarction
Ischemic Cardiomyopathy
Sudden Cardiac Death
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5
Q

Ischemic Heart Disease Physical Exam findings

A

Check pulses for evidence of atherosclerosis
Often an S4 in periods of ischemia
Possibly totally normal

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6
Q

Ischemic Heart Disease EKG findings

A

Evidence of prior infarction (Q Waves)
Evidence of LVH
ST and T wave changes

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7
Q

Two important components of ischemic heart disease evaluation (the stuff he made red)

A

Stress testing

Measure LV function

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8
Q

Angina pectoris – what is it, what symptoms present with it

A

visceral discomfort that s diffuse and substernal that turns on over the course of several minutes

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9
Q

Angina pectoris is also usually accompanied with what symptoms?

A

Dyspnea, Diaphoresis, Nausea, Light-headedness

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10
Q

Difference between typical angina and atypical angina?

A

Typical – Substernal, brought on by exertion, relieved by rest
Atypical – Missing one or more of above features

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11
Q

Four classifications of Angina in the Canadian CV Society Classification

A

I - No Angina
II – ON more than usual activity
III - On less than usual activity
VI - At rest or with any activity

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12
Q

Three ways that atherosclerosis makes problems…

A

Obstruction, Aneyursms, Embolism

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13
Q

Describe the sensation of aortic dissection

A

Excruciating, ripping, sudden anterior radiating to the back

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14
Q

Symptoms of Pulmonary embolism

A

Sudden onset of dyspnea and pleuritic pain

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15
Q

Symptoms of GERD

A

Substernal burning. Lasts 10-60 minutes. Related to meals

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16
Q

Secondary causes of Myocardial Ischemia

A

Severe anemia, hypoxemia, uncontroled HTN, severe LVH, Uncontrolled Tachy, Thyrotoxicosis

17
Q

Most common EKG change in ischemic heart?

What else tends to be around?

A

Non-specific ST-T changes (ex. T wave inversion)

Abnormal Qs from previous infarcts, conduction abnormalities (LBB, LAFB)

18
Q

Stress Test Modalities

A

Exercise ECG

Stress imaging modalities

19
Q

What drugs can be used in a stress test of someone who cannot exercise?

A

Dobutamine (Echo), Vasodilators (Nuclear imaging)

20
Q

Describe the Ischemic Cascade

A

Decreased Relaxation –> Systolic Dysfxn –> Decreased Filling –> decreased ST –> Angina

21
Q

Pros of an Exercise stress ECG

A

Low Cost, Versatile, Validated, No IV

22
Q

Cons of an exercise stress ECG

A 
High false positive, Unreliable with abnormal resting ECG findings
False negative (failure to achieve HR)
23
Q

Target HR in an exercise stress test

A

85% of age predicted maximal HR

24
Q

What ST changes are associated with Chronic Ischemia?

A

Horizontal ST depression

Downsloping ST depression

25
Q

Coronary Artery Disease High Risk Groups (kinda specific)

A 
Left Main Stenosis
3 vessel stenosis (esp. with LV dysfunction)
2 vessel disease (w/LAD)
Multi vessel in diabetics
Impaired LV function
26
Q

What tends to happen on a stress test of a high risk patient?

A

Can’t get through stage II of bruce protocol
Angina at low workload
Ischemic ST depression

27
Q

Oxygen consumption can be estimated by….

A

METs

under 6 is poor. Over 10 is good

28
Q

Indications for Stress imaging?

A

Unable to exercise
Abnormal baseline EKG
Known CAD

29
Q

LV dysfunction indicated high risk if the Ejection fraction is below…

A

35%

30
Q

Revascularization is only wise in patients with ischemia above….

A

10%

31
Q

Indications for Coronary angiography in Stable CAD

A

Persistent Symptoms, despite therapy
Non-invasive test results look like CAD
Non-diagnostic test results
High risk Occupation

32
Q

EKG leads for Inferior heart (Right Coronary)

A

II, III, F

33
Q

EKG leads for Anteroseptal (LAD)

A

V1-V4

34
Q

EKG leads for Lateral (Circumflex)

A

I, L, V4-V6

35
Q

Initial Management for Ischemic Heart Disease

A

Aspirin, NTG as needed
Lipid Lowering therapy
Lifestyle/Activity Changes
Report symptom changes immediately

ICM -- Cardiology (9 decks)

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