Complex Cardiac Disorders

Question 1

What causes Coronary Artery Disease?

Answer 1

Atherosclerosis

Question 2

What is Angina?

Answer 2

Chest discomfort associated with ischemia caused by an
imbalance of supply and demand within the coronary
arteries which supply the myocardium.

Question 3

What causes Angina?

Answer 3

• Ischemia (decreased blood supply to myocardial tissues)

Question 4

What are some atypical signs of Angina

Answer 4

Women and diabetic patients may present with no pain but other symptoms
such as shortness of breath, light-headedness and nausea, fatigue.

Question 5

Coronary Artery Disease Risk Factors

Answer 5

Hypertension
Sedentary lifestyle
Hyperlipidemia
Diabetes

Contributing factors
• High fasting glucose
• Elevated homocysteine levels

Question 6

Stable Angina environmental causes

Answer 6

Occurs with exertion, cold weather, emotional distress or exposure to heavy meals. These increase the workload of the heart leading to decreased blood flow.

The pain can be in the chest, described as squeezing,
heaviness, or a pressure, which can radiate to the jaw, neck,
back, and/or arms.

Question 7

what symptoms do patients with stable angina have

Answer 7

The pain can be in the chest, described as squeezing,
heaviness, or a pressure, which can radiate to the jaw, neck,
back, and/or arms.

Question 8

Treatment for stable angina?

Answer 8

Stable angina is relieved with rest or nitroglycerin.

Question 9

Characteristics of unstable angina

Answer 9

Usually lasts more than 5 minutes.
History of stable angina that is not relieved by rest or
nitroglycerin.
Myocardial damage without elevated serum cardiac
markers.

Question 10

unstable angina symptoms

Answer 10

Pain in a crescendo pattern: severe, prolonged, and

more frequent than pre-existing angina pattern.

Question 11

Pathophysiology of STEMI

Answer 11

Atherosclerosis

Partial occlusion
NSTEMI

Excessive build
up of plaque -
Rupture

Platelet
aggregation

Thrombus
formation

(Complete occlusion of
coronary flow)
STEMI

Question 12

STEMI patho

Answer 12

full thickness damage
Higher cardiac marker elevation
irreversible

Question 13

NSTEMI patho

Answer 13

partial thickness damage
milder cardiac marker elevation
reversible

Question 14

Prodromal symptoms (MI)

Answer 14

• Fatigue, chest discomfort,

malaise

Question 15

Pain (MI)

Answer 15

• Severe chest pain not relieved
by rest, position change or
nitrates

Question 16

Cardiovascular manifestations of MI

Answer 16

►Cardiovascular
• Initially: ↑ HR and BP
• Later: ↓ BP 2o
to ↓ CO
• Crackles, JVD, (S3 or S4, or a
new murmur)

Question 17

Body symptoms of MI

Answer 17

Shortness of breath
• Diaphoresis
• Skin ashen, cool & clammy
• Anxiety
• Lightheadedness
• Nausea, vomiting
• Fullness
• Indigestion
• Choking feeling

Question 18

ECG studies

Answer 18

ECG
• T-wave changes
• ST depression: ischemia 
• ST elevation: injury
• Q wave: infarct

Question 19

Laboratory MI results

Answer 19

High troponin

High CK-MB

Question 20

Echocardiogram MI results

Answer 20

• ↓ Ejection fraction

* Wall motion abnormalities

Question 21

Coronary angiography if the patient has a

Answer 21

STEMI

Question 22

Pharmacologic stress testing

Answer 22

EKG Changes

Negative biomarkers

Question 23

Medical management of MI

Answer 23

Oxygen 
Aspirin 
Nitroglycerine tabs
Morphine sulfate 
B-adrenergic blockers 
Heparin
Nitroglycerine IV
angiotensin converting enzyme inhibitors 
Antiarrythmic if needed

Question 24

Medical managment of STEMI

Answer 24

Reperfusion therapy
• Percutaneous Coronary
Intervention (PCI) – first line
treatment for patients with
confirmed STEMI – door to
balloon – 90 minutes
• Fibrinolytics - 30 minutes after
arrival
• Coronary Artery Bypass Graft
Surgery - Unsuccessful PCI

Question 25

NSTEMI medical management

Answer 25

►Medications
• Antiplatelets,
anticoagulants, nitrates -
Statins, ACE inhibitors or
ARBs

• Angiography and
PCI/CABG - if medications
do not relieve symptoms

Question 26

Complications after AMI (2-3 days)

Answer 26

Dysrhythmias
Heart failure
Pericarditis

Question 27

Complications after AMI (3-5 days)

Answer 27

Recurrent Infarction
Angina
Thromboembolism
Mitral valve regurgitation
Cardiac rupture

Question 28

Complications after AMI Late (> 5 days)

Answer 28

Post-MI syndrome
Shoulder-hand syndrome
Ventricular aneurysm
Recurrent dysrhythmias