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2020 CPR II Cardio Exam 1 > Clinical Medicine 1 : Chest Pain, SOB, Palpitations, Syncope, Edema (Selby GOAT) > Flashcards

Clinical Medicine 1 : Chest Pain, SOB, Palpitations, Syncope, Edema (Selby GOAT) Flashcards

1
Q

What is stable angina?

A

chest pain or pressure for at least 2 months precipitated by exertion or emotional stress and not worsening

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2
Q

What is unstable angina?

A

new onset angina with minimal exertion, angina at rest or angina that is worsening

may/may not have ST depression or T wave inversions with NORMAL cardiac enzymes

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3
Q

What is an NSTEMI?

A

ST segment depression and/or T wave inversions with

ABNORMAL cardiac enzymes

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4
Q

What is a STEMI?

A

ST segment elevation and ABNORMAL cardiac enzymes

(or a new LBBB or a posterior MI)

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5
Q

What features make up acute coronary syndrome?

A

Unstable angina

or NSTEMI

or STEMI

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6
Q

What are the modifiable risk factors for CAD?

A

HTN

HLD (Atherogenic: low HDL <40 mg/dL, high LDL, and high non-HDL)

DM

Overweight/Obese

Smoking

Inactivity

Unhealthy diet

Stress

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7
Q

What are non-modifiable risk factors for CAD?

A

Male sex

Age (M>45, F>55)

FMhx of premature CAD (F<65 M<55)

Ethnicity (AA, Hisp, SE Asian)

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8
Q

What are some non-traditional risk factors for CAD?

A

CKD

Proteinuria

Inflammatory States (HIV, RA, Psoriasis, etc)

metabolic syndrome

Elevated coronary calcium scores (CAC)

High sensitvity CRP (>2)

High apolipoportein B levels (>130)

High lipoprotein A (>50)

Elevated homocysteine

Premature menopause

A-fib

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9
Q

What is the classic presentation for ACS?

A

Chest pain radiating to jaw, neck, abd.

Dyspnea

N/V

Diaphoresis

Fatigue

***20% of AMI are painless (silent) and/or atypical symtoms, which is more common in women, the elderly, and diabetics.

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10
Q

20% of AMI are silent/atypical and commonly in which populations?

A

Elderly

Women

Diabetics

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11
Q

What are the three classic components of Angina Pectoris

(Diamond-Forrester Criteria of Chest Pain)

**MEMORIZE**

A
  1. Substernal chest pain
  2. Provoked by exertion/stress
  3. Relieved by rest and or NTG

Typical Angina has all three

Atypical has 2/3

Non-angina has 1/3

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12
Q

What does a resting ECG look for?

A

ST elevation/depression

T wave inversions

new LBBB

posterior MI

Q waves

etc.

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13
Q

What is a cardiac stress test used for?

What if it’s positive?

A

For patients with intermediate pretest probablilty of CAD

If it is a positive, pt’s should proceed with invasive coronary angiography

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14
Q

How is an exercise stress test done?

What drugs are used for a pharm stress test?

A

typically done with a treadmill or stationary bike

vasodilators (adenosine) to dilate coronary artery

Inotropes/Chronotropes (Dobutamine) to increase myocardial oxygen demand, HR, and contractilty

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15
Q

who cannot have a stress test?

A

Those with baseline ECG abnormalities

(pre-existing BBB, paced rhythm, WPW, etc)

or >1mm of ST depression

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16
Q

What is a stress echo used for?

A

looks for regional wall motion abnormalities or LV dilation

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17
Q

What is a stress myocardial perfusion imaging test used for?

A

AKA nuclear stress test

provides info on perfusion defects between rest and stress, cardiac viability, and LV systolic function

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18
Q

A Dobutamine stress echo can evaluate contractility of the heart to determine what features?

A

Normal contractility

Regional wall abnormalities such as hypokinesis, akinesis, or dyskinesis

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19
Q

What are cardiac biomarkers (labs) ?

A

Myoglobin (and CK isoforms)

rise first, gone by 24hrs

CK, CK-MB

detectable after 3hrs, peak 24hrs, dissapear in 3-4 days

Troponin I or T

detectable after 3hrs, last 5-10 or 5-14 days

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20
Q

What is the diagnostic criteria for a STEMI?

A

ST-elevation of greater than or equal to 2mm in continuous leads or a new LBBB

You cannot diagnose a STEMI in the setting of a known/old LBBB

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21
Q

Diagnosis of STEMI in Pts with chest pain

A

ST-segment elevation > 2mm (2 small boxes) in 2 continguous leads and positive biomarkers!

ST-elevation equivalents include

  • new LBBB,
  • posteroir MI (tall R waves and ST depressions in V1-V3)

*cannot dx STEMI in the setting of old LBBB

22
Q

What are the criteria for an NSTEMI?

A

Positive biomarkers w/o ST elevation

New ST depression of greater than or equal to 0.5mm in two contiguous leads

AND / OR

T wave inversions greater than 1 in two contiguous leads

with prominent R waves or R/S ratio >1

23
Q

What is a type I AMI due to?

What is a type II AMI due to?

A

Tyep 1: Infarction due to coronary atherothrombosis

Type 2: Infarction due to a supply-demand mismatch not the result of acute atherothrombosis

24
Q

STEMI results typically from a complete occlusion of blood flow where?

NSTEMI results typically from what?

A

STEMI: Complete occlusion in a coronary vessel

NSTEMI: P_artial occlusion_ in a coronary vessel

OR

in the presence of complete occlusion of blood flow but in the presence of collateral circulation

25
Q

What are the treatments for stable angina?

A

1) lifestyle modifications

2) ASA

3) Statin

4) Anti-anginal drugs

  1. a) Chronic, BB, CCB, LA Nitrates, Ranolazine
  2. b) Acute: SA Nitrates
26
Q

What drugs are used for chronic angina prevention?

A

B-blockers

Ca channel blockers

long-acting Nitrates

Ranolazine

27
Q

What drugs are used for acute angina relief?

A

short-acting NTG (SL NTG)

28
Q

How is EECP therapy used?

(external enhanced counterpulsation therapy)

A

35 daily outpatient treatments

compression devices put on LE and inflate during diastole

29
Q

What are the three indications for CABG?

A

3 vessel diseases >70% stenosis

Left main diseases

LV dysfunction

30
Q

What is the initial management for all ACS patients (unstable angina)

Mnemonic

A

MONA

Morphine

O2

Nitrates

ASA

31
Q

What antiplatelet therapy is given to patients with ACS (unstable angina)

A

Dual Antiplatelet Therapy;

1) ASA*
2) P2Y12 inhibitors*

PLUS

Glycoprotein IIb/IIIa inhibitors

32
Q

Which drugs have been shown to improve mortality in myocardial infarction?

A

ASA

B-blockers

ACEi

33
Q

Which drug is a COX1/2 inhibitor?

Which drug is a ADP inhibitor?

Which drug inhibits GPIIb/IIIa?

A

ASA (irreversible!)

P2Y12 inhibitors (ticlopidine)

GPIIb/IIIa inhibitors (abciximab)

34
Q

What is the PCI mangement timeline in a STEMI?

(Percutaneous coronary intervention)

A

PCI capable hospital: <90min

non-PCI capable hospital: transfer within <120min

thrombolytics within <30min then transfer

35
Q

What does the TIMI score predict?

A

14 day risk of death

recurrent MI

or urgent revascularization

36
Q

What are the TIMI criteria?

A

age >65

>3 CAD risk factors

documented CAD with >50% stenosis

ST segm deviation

>2 aginal episodes in past 24hrs

ASA use in past week

Elevated cardiac biomarkers (CK, MB, or troponin)

0-2: low risk

3-4: intermediate risk

5-7: high risk

37
Q

What is Dressler Syndrome?

(Postmyocardial infarction syndrome)

A

immunologically based syndrome typically occurs wihtin weeks to months after an MI

manifests as pericarditis

38
Q

What are some of the DDx of acute MI?

(aka other causes with similar presentation)

A

Aortic Dissection

Pulmonary Embolism

39
Q

What are the two classification systems for thoracic aortic dissection?

A
  1. Debakey
  2. Stanford* (Selby and Taylor want this)
40
Q

What is the epidemiology of aortic dissection?

A

uncommon, catastrophic (1-2% mortality rate per hour after sx onset)

3-5 cases per 100000, typically men and elderly

acquired and genetic conditions can predispose

ascending aortic dissection is more common then descending

41
Q

What are risk factors in younger patients for aortic dissection?

A

LIFESTYLE: HTN, smoking, dysplipidemia, and cocaine or meth use

CONNECTVIE TISSUE: Marfans, ED, etc

HEREDITARY: Bicuspid aortic valve

INFECTIOUS: Syphilis

TRAUMA: car crash, falls

42
Q

What is the classic presentation for Aortic Dissection?

A

Sudden onset of tearing/ripping chest pain radiating to back

HTN (but hypotension can be seen as well)

43
Q

What are some other cardiac features of aortic dissection?

A

MI

aortic regurgitation

BP asymmetry in UE

tamponade

syncope

44
Q

What are some GI/Pulm/Renal sx of aortic dissection?

A

mesenteric ischemia, GI bleeding

hemothorax

ARF

45
Q

How to diagnose aortic dissection?

A

ECG and cardiac biomarkers to rule out MI

CXR (widen mediastinum)

CTA (most common way to diagnose)

TEE

46
Q

What is the acute medical management for Aortic dissection?

A

Anti-impulse therapy to lower HR

Get BP to less than 120

First line: IV b-blockers and can add vasodilators

Opiates for pain control

47
Q

What are the surgical options for aortic dissection?

A

open surgery

endovascular stenting

48
Q

Which type of aortic dissection has a better survival rate?

A

Type B (descending aorta, past isthmus)

49
Q

Management of Type A Aortic Dissection

A

Mortality rate is significantly reduced in Type A with surgical management

50
Q

Management in Type B Aortic Dissection

A

Medical and endovascular management have better outcomes for survival in Type B aortic dissection.

2020 CPR II Cardio Exam 1 (31 decks)

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