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Internal Medicine > Coronary Artery Disease > Flashcards

Coronary Artery Disease Flashcards

1
Q

What is the etiology of CAD?

A

HTN (most significant)
Hyperlipidemia
Cigarette smoking
Diabetes

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2
Q

Predictably reproducible, unchanging, consistent over time
precipitated by physical effort
relived by cessation of activity, rest, nitroglycerin
good prognosis

A

Stable angina

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3
Q

changing character, increase in intensity or frequency, precipitated by less effort, can occur at rest
resolution of symptoms not predictable with methods that previously worked (nitro, rest)
character of blocked arteries is evolving
poor prognosis …impending MI

A

Unstable angina

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4
Q

How is CAD diagnosed?

A
  1. electrocardiogram (ECG)
  2. exercise stress test
  3. cardiac catheterization with angiography
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5
Q

Cardiac catheterization with angiography is ___ and ___.

A

diagnostic and therapeutic

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6
Q

How is CAD treated?

A
  1. ID and treat associated diseases that worsen/precipitate angina
  2. reduction in risk factors for CV disease
  3. stress management, weight loss, exercise
  4. pharmacologic management
  5. revascularization
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7
Q

How can you pharmacolgically manage CAD?

A
  1. nitroglycerin
  2. beta blockers
  3. anti-platelet therapy
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8
Q

Nitroglycerin is a ___ that decreases cardiac load and oxygen demand. It can be used acutely and ____. What are the 4 different ways it can be administered?

A

venodilator; prophylactically

  1. tablet
  2. spray
  3. ointment
  4. transdermal patch
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9
Q

This medication decreases the HR and contractility to reduce the myocardial oxygen demand.

A

beta blockers

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10
Q

Aspirin (75-325 mg) is an example of this drug that is proven to have a reduction in fatal events and is for all patients.

A

anti-platelet

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11
Q

What are two examples of surgical revascularization of coronary arteries?

A
  1. angioplasty +/- stent

2. coronary artery bypass grafting (CABG)

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12
Q

What are the two types of stents?

A
  1. bare metal

2. drug eluting

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13
Q

10 - 50% of ___ ___ stents re-stenos within ___ months

A

bare metal; 6

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14
Q

These stents release anti-proliferative agents to inhibit re-stenosis.

A

drug-eluting

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15
Q

Drug eluting stents are at increased risk of ___ for ___ year so patients are placed on ___-____ therapy (aspirin and/or clopidogrel).

A

thrombosis; 1; anti-platelet

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16
Q

The ___ ___ ___ ___ sutures the donors vein or artery in place and reroutes blood around the occluded vessels.

A

coronary artery bypass graft (CABG)

17
Q

T/F. Patients with stent should stop taking their anti-platelet medications prior to having an extraction.

A

False

18
Q

What is an intermediate risk factor for increased perioperative CV events?

A

stable angina - elective care with modifications

past MI (>1mo) - elective care with modifications, recommend consultation with treating cardiologist

19
Q

What is a major risk factor for increased perioperative CV events?

A

unstable angina or recent MI (less than 1 month): emergency care only

20
Q

What type of angina or MI should you avoid electrosurgery adn ultrasonic scalers if there is an implanted defibrillator or pacer?

A

stable angina or past MI

21
Q

What are the emergency steps to treating a patient experiencing angina in the office?

A
  1. stop procedure
  2. nitro (1tab/spray Q5 mins up to 3 doses, relief w/in 1-2 mins)
  3. oxygen via nasal cannula (4L)
22
Q

What drugs and equipment should one consider for a patient with unstable angina or recent MI?

A

prophylactic nitro
supplemental O2
modest epi

periodic vitals

23
Q

If a patient with angina is not responding and you anticipate an possible MI, what should be done?

A
  1. activate EMS
  2. Have patient chew aspirin
  3. continue BLS
24
Q

What is the goal of medical management of acute MI?

A

minimize infarct size and prevent death from lethal arrythmias

25
Q

What is done in the ED for patients experiencing an acute MI?

A

determine extent of ischemia and type of MI with ECG
early fibrinolytics and catheterization improve outcome in MI
pacemaker or defibrillator is used

Internal Medicine (21 decks)

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