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D118 > Coronary Disease > Flashcards

Coronary Disease Flashcards

1
Q

Angina Pectoris

A

ew-onset angina (angina occurring within 1 month), angina occurring at rest and with minimum exertion, or crescendo angina

-Admit to hospital!

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2
Q

Causes of CV Disease

A

Genetics
Lifestyle
CAD Risk factors

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3
Q

CAD Risk Factors

A

obesity
diet
hypertension
high cholesterol
smoking
stress
diabetes

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4
Q

Diabetes and heart disease

A

death risk is 2 -4 times higher

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5
Q

Women with higher CAD risk

A

pregnancy-related disorders (gestational HTN or Diabetes, ecclampsia)
Polycystic ovarian disease
hyptohalamic anemia
breast cancer

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6
Q

Hypertension goals

A

<140/90
<130/80 if renal disease as well

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7
Q

Lipid Goals

A

Trig <200
TC<130

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8
Q

ASA in CAD

A

75-162 mg PO daily
plavix or warfarin if ASA is contraindicated

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9
Q

Beta Blockers in CAD

A

All patients who had a MI, ACS, or LV dysfunction should be on beta blocker unless contraindicated

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10
Q

ACE Inhibitors in CAD

A

All patients with left ventricular ejection fraction ≤ 40% and those with hypertension, diabetes, or chronic kidney disease, unless contraindicated

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11
Q

Chronic Stable Angina

A

chest pain precipitated by exertion and relieved by rest. A reduction in myocardial oxygen supply or increases in myocardial oxygen demand are the determinants of coronary ischemia. Predictable presenting or causative factors.

Pain may be variable and may radiate.

Rest or NTG reduces pain within minutes

Symptoms longer than 20 mins = ED refer

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12
Q

Asymptomatic CAD

A

Asymptomatic occurrences of ischemia can be more common than symptomatic episodes in patients with exertional angina symptoms.7 Silent myocardial ischemia occurs when there is objective evidence of ischemia in the absence of symptoms.

Higher risk of this in diabetics

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13
Q

Asymptomatic CAD

A

Asymptomatic occurrences of ischemia can be more common than symptomatic episodes in patients with exertional angina symptoms.7 Silent myocardial ischemia occurs when there is objective evidence of ischemia in the absence of symptoms.

Higher risk of this in diabetics

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14
Q

Microvascular Angina

A

Affects women more than men
Chest discomfort with exercise and positive stress test, but no coronary artery obstruction

Chest pain that is unpredictable, does not go away with rest and doesn’t respond to NTG

Usual treatment is beta blockers to reduce oxygen demand

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15
Q

Vasospastic Angina (Variant or Prinzmetal)

A

coronary artery spasm can cause chest discomfort at rest evidenced by ST elevation or depression on electrocardiogram (ECG).17 Spasm can occur in any coronary artery and the exact cause is not

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16
Q

Unstable Angina

A

Plaque rupture causes occlusive thrombus that may be transient and can resolve spontaneously but usually recur, if it becomes fixed then MI occurs

17
Q

STEMI

A

MI occurs when an atherosclerotic plaque ruptures and then serves as a nidus for thrombus formation with resultant coronary artery occlusion, ischemia, myocyte necrosis, infarction, and death

18
Q

Suspected Myocardial Infarction With Nonobstructed Coronary Arteries

A

Myocardial infarction with nonobstructed coronary arteries (MINOCA) is described as the occurrence of an acute MI, but without an obvious cause (i.e., no obstruction)

19
Q

Stress Testing

A

Stress testing, which may be pharmacologic or exercise based, is performed for diagnostic, prognostic, and management purposes. With an overall sensitivity of 50% and specificity of 90%, exercise stress testing can be a cost-effective strategy for evaluation of CAD. ST segment changes consistent with MI changes are positive.

20
Q

CT Angiography

A

coronary computed tomography angiography (CTA) is highly sensitive, with a detection rate over 90%, but is not very specific. This means that a negative result will essentially rule out CAD with 90% accuracy, but if the test result is positive, this result is less conclusive

21
Q

MI Labs

A

Serial cardiac troponin I or T levels (when a contemporary assay is used) should be obtained at presentation and 3 to 6 hours after symptom onset. Samples for C-reactive protein analysis may also be drawn to determine the presence of an inflammatory response. Measurement of B-type natriuretic peptide or N-terminal pro-B type natriuretic peptide may be considered to assess risk for heart failure.

22
Q

EKG in MI / CAD

A

ST segment elevation at the j point of two contiguous leads of >1mm or more indicates MI
ST segment depression plus T-wave inversion indicates ischemia early
New left bundle branch block is also suggestive of M
Hyperacute T-Wave changes (inversion) may be seen before ST changes
ST segment depression may also indicate injury in the opposite area of the heart

23
Q

Leads and Heart locations

A

2, 3, aVF - Inferior
V1-V2 - Anterior
V3-V4 - Septal
1, aVL, V5, V6 - Lateral

24
Q

Troponin and CK-MB Levels

A

Troponin elevates within 3-12 hours, peaks in 4 hours, normalizes in 14 days
CK-MB rises in 3-12 hours, peaks at 24 hours, normalizes in 48-72 hours

25
Q

Chest Pain Differentials

A

Aortic dissection
PE
Spotaneous Pnuemothorax
Takotsubo cardiomyopathy
GI
Psych (panic attack)
Respiratory

26
Q

Chronic Stable Angina Treatment

A

Aspirin
Beta Blockers
Lipid control
NTG as needed

27
Q

Microvascular Angina Treatment

A

Beta Blockers - first treatment
Calcium channel blockers
ACE Inhibitors
Ranolazine

28
Q

Vasospastic Angina treatment

A

NTG

29
Q

Unstable Angina Treatment

A

Consider NSTEMI and Refer
Aspirin immediately
Beta blockers as needed
NTG as needed

30
Q

Refer Criteria

A

Unstable Angina
Suspected MI
Co-morbid conditions
Chronic stable angina that has a change in the angina pattern
Signs of ischemia

31
Q

Angina Classifications (Numeric Class)

A

1 - Onset is prolonged exertion, no effect on normal activity
2 - Onset occurs with walking 2 blocks, slight effect on normal activity
3 - Onset occurs walking less than 2 blocks, marked effect on normal activity
4 - Occurs at rest or with minimal activity, severe effect of normal activities

D118 (67 decks)

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