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ICM Exam 3 Cardiology > Chronic Ischemic Heart Disease - Yaacoub > Flashcards

Chronic Ischemic Heart Disease - Yaacoub Flashcards

1
Q

Traditional risk factors for atherosclerotic vascular disease (8)

A
  1. Age (45M, 55F)
  2. Fam Hx (M55, F65)
  3. DM or glucose intolerance
  4. HTN
  5. Smoking
  6. Cholesterol
  7. BMI >30
  8. Sedentary
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2
Q

Serum cholesterol risk increase

A

1.92 per 40 mgDL

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3
Q

Age increase in risk

A

1.63 per six years

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4
Q

High cholesterol is more problematic when…

A

there is CHD

greatly increased risk

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5
Q

Metabolic syndrome diagnosis

A

Any three of:

  • HTN (130/85)
  • Abdominal Obesity (waist circum. >40cm)
  • HDL <40
  • Triglycerides >150
  • Fasting plasma glucose >100
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6
Q

Metabolic syndrome associated with

A

inflammation

coagulation abnormalities

progression to T2DM

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7
Q

Manifestations of CAD

A
  • Chronic stable angina
  • Unstable angina
  • Myocardial infarction
  • Ischemic cardiomyopathy
  • Sudden Cardiac death
  • Silent ischemia
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8
Q

IHD often shows ___ during physical exam

A

S4

during periods of ischemia

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9
Q

Evidence of prior infarction on ECG

A

Q waves

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10
Q

Eval for IHD

A

Stress testing + Measurement of LV function

(BP, lipids, BMI, OGTT, Chemistries, CBC)

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11
Q

Angina pectoris sx

A
  • Visceral discomfort
  • Diffuse and substernal
  • Dyspnea, diaphoresis, nausea, lightheadedness
  • Provoked by exertion, stress, meals, cold temperature

Onset = minutes

Relief = rest and NG

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12
Q

Atypical angina =

A

missing one or more of the features of typical angina

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13
Q

Canadian CVS classification

A

1 = no angina

2 = Angina only with more than usual activity

3 = Angina on less activity

4 = Angina at rest or any activity

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14
Q

DDx for chest pain

A
  • CAD/MI
  • Aortic dissection, ulcer, hematoma
  • pericarditis
  • PE, PNA, Pneumothorax
  • Esoph. Spasm, inflamm, or stricture
  • Musculoskeletal
  • Anxiety
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15
Q

Signs of critical disease

A

postprandial symptoms

Nocturnal angina

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16
Q

Atherosclerosis a systemic disease

A

Obstruction

Aneurysm

Embolization

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17
Q

Sx of PE

A

sudden dyspnea and pleuritic pain

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18
Q

Sx of pericarditis

A
  • variable duration
  • sharp
  • positional
  • pleuritic
  • worse with inspiration
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19
Q

Aortic dissection - check for ____

A

unequal pulses

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20
Q

Musculosk. Sx

A

Fleeting, reproduced by palpation

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21
Q

GERD pain

A

substernal, 10-60 min

22
Q

Non-atherosclerotic CAD

A
  • Vasospasm
  • ANomalous Coronary arteries
  • Coronary arteritis (Kawasaki, TGCA)
  • Coronary dissection
  • Myocardial bridge
  • Coronary embolism
23
Q

6 Novel risk factors for atherosclerotic disease

A
  1. Chronic inflammation
  2. Elevated hsCRP
  3. Homocysteine
  4. Chronic kidney disease
  5. Coagulation abnormalities
  6. Chronic infctn
24
Q

6 secondary causes for Myocardial ischemia

A
  1. Severe anemia
  2. Hypoxemia
  3. Uncontrolled HTN
  4. Severe LVH
  5. Uncontrolled Tachycardia
  6. Thyrotoxicosis
25
Coronary dissection is associated with
pregnancy (young females)
26
ECG may be...
normal in 50% of patients
27
Most common finding is \_\_\_\_\_\_\_
non-specific ST-T changes
28
Conduction abnormalities = Associated with...
LBBB LAFB *Associated with LV dysfxn, multivessel disease and poor prognosis*
29
Pretest probability determine
post-test findings
30
Stress tests
Exercise stress ECG (Stress = treadmill, or pharmacologic - dobut or vasodil.)
31
Echo for
Treadmill or dobut
32
Nuclear imaging
Treatmill or vasodilators rarely dobut.
33
Stages of standard bruce protocol
1 = 1.7mph, 5METs, light work 2 = 2.5mph, 7 METs 3 = 3.4mph, 10 METs 4 = 4.2mph, 13 METs
34
About 1/3 of patients with angina also
experience episodes of silent ischemia (asymp)
35
Stress tests function
Confirm grey zone diagnosis (not low-risk) Assess the limitation in functional capacity Assess status of modifiable vascular risk factors Assess the burden of ischemia Assess LV function
36
CONS of Stress ECG
High false positive Unreliable if resting ECG is abnormal False negs
37
Target HR
85% of age-predicted max (220-age)
38
METs =
functional capacity
39
With ST depression in ischemia, _______ is worse
Earlier Longer More leads Higher magnitude
40
ST seg changes in stress ecg
\>1mm horizontal or downsloping ST depression \>1mm ST elevation (in leads w/o Q waves)
41
Sensitivity and specificity of Exercise ECG
68% 77%
42
High risk groups for CAD
1. Left main stenosis \>50% 2. 3 vessel disease especially with LV dysfunction 3. 2 vessel disease involving proximal LAD 4. Multi-vessel disease in diabetics 5. Impaired LV function
43
Stress test findings suggestive of high risk
Inability to complete stage 2 Angina at low workload (\<6MET's) Can't reach 80% HR OR \>120bpm Fall in BP \>10mmHg with progressive exercise ST elevation \>1mm Sustained ventricular tach
44
Oxygen consumption can be...
estimated for various activity levels (METs)
45
\<6 METs =
Low functional capacity
46
\>10 METs =
Good functional capacity
47
Indications for stress imaging
1. **Unable to exercise** 2. **Abnormal baseline ECG** (LBBB, LVH, WPW, digoxin) 3. **Known CAD**
48
Agents for Stress imaging
Regadenoson Adenosine Dipyridamole (coronary vasodil. in normal segments, diseased segments unable to dilate leading to relative hypoperfusion)
49
Stress imaging findings suggestive of high risk
1. Pefusion defects in multiple regions 2. Large reversible defect in single region 3. Transient ischemic LV dilatation 4. Increased lung uptake 5. Abnormal LV (EF below 40%)
50
Stress echo findings suggestive of high risk
Wall motion abnormal in multiple regions Large inducible wall motion abnormalities in one region LV dysfunction (EF \<35%)
51
Indications for coronary angiography in stable CAD
* Persistent Sx * Non-invasive tests suggest high risk CAD, or non-diagnostic * High risk occupation
52
Initial management of IHD
* Aspirin 81mg * Sublingual NG * Lipid lowering therapy Instructions on healthy lifestyle (diet, smoking, wt.) Activity dictated by Sx

ICM Exam 3 Cardiology (8 decks)

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