Coronary artery Disease - Johnston Flashcards
Main risk factors for atherosclerosis
- Hyperlipidemia
- smoking
- DM
- HTN
Chronic stable angina is a consequence of imbalance between _
- lack of Oxygen supply ( coronary vasoconstriction, stenosis, platelets release serotonin and thromboxane A2)
- Increased O2 requirements (exercise, stress, emotion, fever, thyrotoxicosis, LVH due to AS, anemia.
What are the three main disturbances due to ischemia? give examples of each.
- Mechanical consequence: HF, angina, MI, segmental akinesis/dyskinesis
- Biochemical consequnces (FA’s cant be oxidized, lactate production, decreased pH w/ metabolic acidosis
- Electrical consequences: inversion of T wave, transient displacement of ST segment, ST depression, /elevaation; electrical instability; VT, VF
In what leads are you likely to see ischemia/MI due to: A. LAD B. RCA C. Circumflex D. Posterior descending
A. V1-V5
B. II, III, AVF, V3R-V6R
C. I, aVL; V5-6
D. V1-V3 (reciprocal ST depression)
How is Non-STEMI recognized on EKG?
inverted T waves WITHOUT ST elevation
New onset of S3 heard during angina or MI indicates _
impending LV dysfunction leading to heart failure
58 yr old caucasian man presents with hx of chest pain described as heaviness and pressure in the retrosternal region. Pain radiates into the base of then eck and into jaw with some discomfort in the L arm. Pain started about 20 minutes. ON PE a systolic murmur was heard over apex with radiation into the left axilla. What is the significance of the murmur in this scenario? What artery is likely involved in the patient’s chest discomfort?
Murmur = mitral regurg due to dysfunction of papillary muscle during the chest pain.
RCA
What are some cardiac causes of chest pain?
- angina
- MI
- pericarditis
- aortic dissection
- associated with lung: pneumonia, pneumothorax, pleurisy
What are some non chest pain symptoms of chronic ischemic heart disease?
- Dyspnea
- Mild epigastric or abd
- diaphoresis
- excessive fatigue and weakness
- dizziness and syncope
What do pts with any of skin abnormalities have in common: Xanthelasma,xanthomas, diabetic skin lesions, nicotine stains, pale appearing skin
Angina/ischemic heart disease.
Xanthelasma (soft yellow spots on eyelids associated with lipid depsoits)
Xanthomas - lipid deposits
What four medical CV conditions that can mimic angina w/o CAD?
- AS
- AI
- Pul HTN
- Hypertrophic cardiomyopathy
New or worsening chest pain more severe, prolonged, frequent, lasts longer than 20 mins each time with no myocyte necrosis or cardiac enzyme elevation indicates _
Unstable angina
Chest pain, with elevated cardiac enzymes but no ST elevation indicates _
NSTEMI
inverted T waves with severe chest pain indicates _
MI
In unstable angina, he deep of ST segment depression indicates _
mortality rate.
1mm or greater in 2 or more leads = 4x likely to die within 1yr
2mm or greater= 6x likely to die within 1 yr
2mm or greater in more than one region of ECG = 10x likely to die within 1 yr
