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CMT > Coronary Artery Disease > Flashcards

Coronary Artery Disease Flashcards

1
Q

Which 3 meds (& their doses) can be used as anti-platelets?

not ASA

A
  1. clopidogrel (75mg PO QD)
  2. Ticagrelor (90mg PO BID)
  3. Prasugrel (10mg PO QD)
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2
Q

when to use clopidogrel & ticagrelor anti-platelets?

A
  1. Clopidogrel: generic, first choice
  2. Ticagrelor: pts w/ DM
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3
Q

contraindication of prasugrel?

A

previous stroke

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4
Q

Coronary Vasospasm

describe

A
  • angina pain usually at rest with no change in exercise function
  • non-exertional chest pain
  • “charlie horse in the heart”
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5
Q

Coronary Vasospasm

risk factors

4

A
  1. women > 50 y/o
  2. exposure to cold
  3. emotional stress
  4. vasoconstricting meds
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6
Q

Coronary Vasospasm

usually involves which artery?

A

right coronary artery

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7
Q

Coronary Vasospasm

what will you see on EKG?

A

ST segment elevation

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8
Q

Coronary Vasospasm

what you use to dx

A

coronary angiography

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9
Q

Coronary Vasospasm

what do you see on coronary angiography?

A

no lesions with poss spasm

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10
Q

Coronary Vasospasm

tx

A
  1. calcium channel blockers and/or nitrates
  2. avoidance of nicotine, caffeiene, cocaine, ergot’s
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11
Q

CAD

modifiable risk factors for CAD

10

A
  1. HTN
  2. DM
  3. Hyperlipidemia
  4. CKD/proteinuria
  5. autoimmune
  6. HIV
  7. Obesity
  8. Smoking
  9. Environmental/Pollution
  10. Elevated CAC, CRP, Lp(a)
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12
Q

CAD

non-modifiable risk factors for CAD

A
  1. family hx
  2. age
  3. sex
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13
Q

CAD

primary vs secondary prevention

general

A

Primary
* does not yet have dx of ASCVD but has risk factors
* wants to prevent the first event

Secondary
* has a dx of ASCVD or equivalent
* wants to prevent a second event

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14
Q

CAD

Primary Prevention- lifestyle interventions

A
  1. no smoking
  2. daily exercise
  3. target BMI
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15
Q

CAD

Primary Prevention- goal for risk reduction

of BP, LDL, A1C

A
  1. BP goal: < 130/80
  2. LDL goal: < 100
  3. A1C goal: < 7.0
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16
Q

CAD

Medications for Secondary Prevention

4

A
  1. Anti-platelet (ASA or other)
  2. Statin (mod to high intensity)
  3. If DM: GLP-1
  4. If CKD: ACE/ARB, SGLT2-Inhibitor
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17
Q

CAD

Secondary Prevention- goal for risk reduction

of BP, LDL, A1C

A
  1. BP goal: < 130/80
  2. LDL goal: < 55
  3. A1C goal: < 7.0
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18
Q

CAD Spectrum

good to bad

A
  1. stable angina
  2. unstable angina
  3. NSTEMI
  4. STEMI
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19
Q

Stable Angina

pathophys

A
  1. occurs when myocardial oxygen demand exceeds oxygen supply
  2. most commonly caused by atherosclerotic obstruction of 1+ coronary arteries
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20
Q

Stable Angina

Sx

3 componeents

A
  • pressure, pain, squeezing, tightness, heaviness
  • exertional or relieved with rest
  • < 20 min in duration
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21
Q

Stable Angina

how may pts with DM present?

general statement, 8 sx

A

with atypical sx
* dyspnea
* indigestion
* arm/jaw pain
* exertional SOB
* nausea
* diaphoresis
* fatigue
* without pain

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22
Q

Stable Angina

Lab findings

A

neg troponin/CK-MB

23
Q

Stable Angina

EKG findings

A
  • resting EKG normal
  • EKG during pain: ST depression, T wave flat or inverted (reverses when pain is gone)
24
Q

Stable Angina

tests to evaluate perfusion

2

A
  • Stress test (w/ or w/out imaging)
  • Cardiac CTA
25
Q

Stable Angina

what to do if stress test is pos?

A

heart cath

26
Q

Stable Angina

First Line Treatments

1

A
  1. beta blocker
  2. ASA (81mg PO QD) or clopidogrel (75mg PO QD)
27
Q

Stable Angina

beta blockers are the only meds which actually do what?

A

prolong life

28
Q

Stable Angina

Which secondary meds can be used?

3

A
  • long acting nitrates
  • ranolazine
  • calcium channel blockers
29
Q

Unstable Angina

sx

A
  • new or worsening sx of myocardial ischemia (pain/squeezing/tightness)
  • unstable angina may come on during rest or with minimal exerction
  • can last > 30 min in duration
30
Q

Unstable Angina

lab findings

A

troponin neg

31
Q

Unstable Angina

EKG findings

A

usually ST depression

32
Q

NSTEMI

sx

A

new or worsening sx of myocardial ischemia

33
Q

NSTEMI

lab findings?

A

troponin pos

34
Q

NSTEMI

EKG findings

A

no ST elevation

35
Q

Unstable Angina/NSTEMI

Treatment in hosp

A
  • MONA-BAS
  • CCB if cocaine induced
  • Fibrinolytics have been found to be harmful
36
Q

Unstable Angina/NSTEMI

what is MONA-BAS?

A
  • M: morphine
  • O: oxygen
  • N: nitroglycerides
  • A: aspirin
  • B: beta blocker
  • A: anti-platelet
  • S: statin
37
Q

Unstable Angina/NSTEMI

meds prescribed upon discharge?

A
  • beta blocker
  • ASA +/- anti-platelet
  • Statin
  • cardiac rehab
38
Q

STEMI

pathophys

A

acute episode of chest discomfort that results from an occlusive coronary thrombus at the site of a pre-existing atherosclerotic plaque

39
Q

STEMI

sx

A
  • depend on severity
  • chest pain
  • can cause sudden death and arrhythmias
40
Q

STEMI

lab findings?

A

pos troponin I/T or CK-MB

41
Q

STEMI

why is it important to trend cardiac enzymes?

A

they elevate at different times. If pt comes in early after pain onset, may not be pos yet. Trending will let you repeat 3/6 hrs later and see changes

42
Q

STEMI

EKG findings

A
  • peaked, hyperacute T waves
  • ST segment elevation
  • Q wave development
  • T wave inverstion
  • new LBBB
  • loss of R wave progression
43
Q

STEMI

what is indicative of STEMI until proven otherwise?

NOT ST ELEVATION BUT YES THAT TOO

A

New LBBB

44
Q

STEMI

which leads will you best see anterior wall MI?

A

V2, V3, V4

45
Q

STEMI

which leads will you best see inferior wall MI?

A

II, III, aVF

46
Q

STEMI

in which leads will you best see lateral wall MI?

A

I, aVL, V5, V6

47
Q

STEMI

tx

A
  • MONA-BAS
  • anti-coag (heparin)
  • fibrinolytic
48
Q

STEMI

within which timeframe must a fibrinolytic ideally be started?

A

first dose 30 min from arrival/ekg
ideally within 3 hrs of sx onset

49
Q

STEMI

when is a fibrinolytic therapy always indicated?

A
  • if > 90 min wait for in house labs
  • > 2 hr wait for transfer
50
Q

STEMI

turn around time goal for reperfusion therapy?

A

90 min or less from first medical contact

51
Q

STEMI

fibrinolytic absolute contraindications

5

A
  1. previous hemorrhagicc stroke or strokes within 1 yr
  2. known intracranial neoplasm
  3. recent head trauma
  4. active internal bleeding
  5. suspected aortic dissection
52
Q

STEMI

what to give after immediate reperfusion therapy?

A
  • ASA
  • Statin
  • BB
  • ACE
  • Aldosterone Antagonists if EF < 45%
53
Q

STEMI

post reperfusion therapy no-no’s

2

A
  • calcium channel blockers
  • non-steroidal anti-inflammatory agents
54
Q

STEMI

post-MI complications

8

A
  1. arrhythmia
  2. CHF
  3. tamponade/thromboembolic
  4. rupture
  5. aneurysm
  6. pericarditis
  7. infection
  8. death/dresslers

CMT (78 decks)

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