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Internal Med EOR > Coronary Heart Disease > Flashcards

Coronary Heart Disease Flashcards

1
Q

layers of an artery

A

tunica intima, tunica media, tunica adventitia

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2
Q

atherosclerosis

A

pathologic process that causes disease of the coronary, cerebral, and peripheral arteries

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3
Q

what causes focal thickening of the tunica intima?

A

foam cells

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4
Q

foam cells

A

Macrophages that have consumed lipid, seen in atherosclerosis pathogenesis

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5
Q

what type of inflammatory cell is present in a fatty streak?

A

T lymphocytes

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6
Q

what initiates the formation of a fatty streak?

A

vascular injury

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7
Q

what can develop if the plaque remains stable?

A

fibrous cap

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8
Q

fibrous cap

A

dense, collagen-based layer of connective tissue that covers the well defined lipid core of a plaque

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9
Q

function of a fibrous cap

A
  • provides stability to the plaque
  • walls off lesion and prevents blood from coming into contact with the lipid core
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10
Q

what will happen if blood comes in contact with the lipid core?

A

clotting will occur and will eventually lead to occlusion of the vessel and ischemia

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11
Q

function of microvessels

A

originate from the tunica adventitia of large arteries to provide oxygen and nutrients to the outer layers of the arterial wall

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12
Q

as the atherosclerotic plaques expand, ….

A

they acquire their own microvasculature

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13
Q

what can result from plaque rupture?

A

microvascular hemorrhage , leading to progression of atherosclerosis

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14
Q

fibrous plaque develops as ________ accumulates

A

connective tissue

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15
Q

what does the connective tissue of the fibrous plaque consist of?

A

lipid-containing smooth muscle cells and an extracellular lipid pool

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16
Q

coronary arteries remodel in response to _____

A

atheroma formation

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17
Q

positive remodeling

A

increased vessel size occurring early in CHD to compensate for plaque accumulation in an effort to reduce lumen loss

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18
Q

symptoms of positive remodeling

A

unstable angina

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19
Q

negative remodeling

A

results in vessel shrinkage

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20
Q

symptoms of negative remodeling

A

stable angina

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21
Q

intraplaque hemorrhage is a result of …

A

plaque neovascularization

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22
Q

Intraplaque hemorrhage is a critical event that leads to …

A
  • accelerated plaque progression
  • instability
  • ischemic vascular events
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23
Q

what two factors contribute to the pathogenesis of atherosclerosis?

A
  • lipids
  • inflammation
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24
Q

initial step in the development of atherosclerosis

A

endothelial vasodilator dysfunction

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25
Q

why does endothelial vasodilator dysfunction occur?

A

loss of endothelial-derived nitric oxide

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26
Q

the endothelial vasodilator dysfunction process is precipitated by …

A

oxidized LDL

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27
Q

endothelial dysfunction is associated with…

A
  • hyperlipidemia
  • diabetes
  • HTN
  • cigarette smoking
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28
Q

ways to improve endothelial vasodilator dysfunction

A
  • correct HLD
  • Give ACEi for HTN
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29
Q

role of inflammation in atherosclerosis

A
  • macrophages eat oxidized LDL
  • this releases inflammatory substances, cytokines, and growth factors that lead to further plaque proliferation
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30
Q

chronic inflammation leads to …. plaques and acute inflammation leads to …. plaques

A

stable; unstable and ruptured

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31
Q

atherosclerosis is asymptomatic until ……% of the vessel become occluded

A

70-80

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32
Q

2 processes of plaque progress

A
  • chronic: slow luminal narrowing
  • acute: rapid luminal narrowing associated with plaque hemorrhage or luminal thrombosis
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33
Q

plaque erosion

A

occurs in the absence of rupture when endothelium is missing at the plaque site

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34
Q

t/f plaque rupture and erosion may be asymptomatic

A

true

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35
Q

effects of atherosclerosis

A
  • coronaries –> MI and angina
  • CNS —> stroke
  • periphery—> limb ischemia and poor healing
  • renal—> RAS
  • GI—> mesenteric ischemia
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36
Q

1 cause of death in US

A

cardiovascular disease

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37
Q

risk equivalents for CHD

A

a group of diseases that a person could have that allows you to assume that the patient also has CHD so you can treat them as such

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38
Q

examples of risk equivalents for CHD

A
  • symptomatic carotid artery disease
  • PAD
  • AAA
  • DM
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39
Q

modifiable risk factors for CHD

A
  • smoking
  • HLD
  • HTN
  • DM
  • obesity
  • sedentary lifestyle
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40
Q

unmodifiable risk factors for CHD

A
  • premature CHD in a 1st degree relative
  • age
  • male sex
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41
Q

what is considered premature age for CHD?

A

under 55 in men and 65 in women

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42
Q

what age is considered a risk factor for CHD?

A

men: 45
women: 55

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43
Q

1 preventable cause of death and illness in the US

A

smoking

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44
Q

after 1 year of quitting smoking, risk of CHD can decrease by ……%

A

50

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45
Q

smoking promotes atherosclerosis by…

A
  • increasing platelet adhesiveness
  • raises endothelial permeability
  • SNS stimulation by nicotine
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46
Q

risk of atherosclerosis increases as …. increases and ….. decreases

A

LDL;HDL

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47
Q

hypertension causes ….. to the arterial wall

A

mechanical injury

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48
Q

endothelial injury resulting from persistent high BP leads to …

A

plaque formation

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49
Q

at least 65% of people with diabetes die from …

A

some sort of heart or blood vessel disease

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50
Q

atherosclerosis has higher incidence and severity in …..

A

men

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51
Q

why are women at lower risk, but their risk increases after menopause?

A

estrogen has protective qualities, and when you hit menopause, you have a decline in estrogen levels

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52
Q

when do fully developed atheromatous plaques usually appear?

A

40s and beyond

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53
Q

……. predispose individuals to high blood lipid levels

A

hereditary genetic derangements of lipoprotein metabolism

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54
Q

what race is higher risk for atherosclerosis and CHD?

A

african american

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55
Q

how to risk stratify for CHD?

A

ASCVD 10 risk

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56
Q

screening for AAA

A

men aged 65-75 who have ever smoked need screened once

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57
Q

Aspirin use recommendations

A

should not give to CVD patients over 60

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58
Q

BP screening recommendations

A

screen everyone 18 and older at every visit

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59
Q

screening for DM

A

screen in adults 35-70 who are overweight or obese

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60
Q

what are the first things ordered when a patient comes in with chest pain?

A
  • EKG
  • cardiac enzymes
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61
Q

indications for EKGs

A
  • used to assess for heart conditions
  • all adults with chest discomfort without an obvious non-cardiac cause
  • routinely ordered in elderly, DM, and syncopal patients
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62
Q

in patient’s with symptoms, and EKG should be done within ____ minutes if the patient’s arrival to the facility

A

10

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63
Q

if the initial EKG is not diagnostic but the patient remains symptomatic …

A

get serial EKGs every 15-30 minutes for the first 2 hours

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64
Q

earliest present of an acute MI

A

hyperacute T waves

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65
Q

t/f hyper acute t waves in an MI are commonly seen in clinical practice

A

false. they only exist for 20-30 minutes after onset of infarction so they are not often in the facility at that point

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66
Q

ST depression and t wave inversion in 2 continuous leads makes you suspicious of a …

A

NSTEMI

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67
Q

ST elevation makes you suspicious of a …

A

STEMI

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68
Q

cardiac enzymes evaluate for …

A

myocardial damage

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69
Q

troponin

A

contractile protein that normally is not found in the serum and is only released when myocardial necrosis occurs

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70
Q

most sensitive and specific cardiac biomarker

A

troponin

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71
Q

timeline of troponin levels

A
  • increase within 3-6 hours
  • peak at 24-48 hours
  • return to baseline over 5-14 days
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72
Q

when do you measure troponin levels ?

A
  • at presentation
  • at 90 minutes
  • every 6-8 hours after symptom onset x3
  • or until trending down
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73
Q

….have more weight than a single reading for cardiac enzymes

A

trends

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74
Q

normal troponin level

A

0

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75
Q

CK-MB timeline

A
  • increase 4-6 hours after injury
  • peak around 24 hours
  • remain elevated for 36-48 hours
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76
Q

positive CK-MB

A

if CK-MB is >5% of total CK and 2x normal

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77
Q

false positives for CK-MB

A
  • exercise
  • trauma
  • muscle disease
  • DM
  • PE
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78
Q

CK-MD is …. sensitive and specific than troponin

A

less

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79
Q

myoglobin has … sensitivity and …. specificity

A

high; poor

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80
Q

fastest released cardiac enzyme

A

myoglobin

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81
Q

myoglobin can be detected as early as ….. after an MI

A

2 hours

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82
Q

most sensitive early marker for MI

A

myoglobin

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83
Q

LDH for MI detection

A

not specific

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84
Q

possible lab findings of MI

A
  • leukocytosis
  • elevated CRP
  • elevated ESR
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85
Q

why is there leukocytosis in an MI?

A

under stress so white count will elevate

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86
Q

patients without biochemical evidence of myocardial necrosis but with …… are at risk of a subsequent ischemic event

A

elevated CRP

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87
Q

most commonly used and recommended initial noninvasive procedure for evaluating ischemia

A

stress test

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88
Q

2 methods of a stress test

A
  • exercise
  • pharmacologic
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89
Q

exercise stress tests are the preferred form of stress for what type of patients?

A

patients who can attain an adequate level of exercise

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90
Q

how do you determine if a patient can attain an adequate level of exercise?

A

if a person can walk for 5 minutes on flat ground or up 1-2 flights of stairs without needing to stop

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91
Q

indications for exercise stress test

A
  • confirm diagnosis of angina
  • determine severity of angina
  • assess prognosis
  • evaluate response to therapy
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92
Q

limitations of exercise stress test

A

-more false positives

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93
Q

exercise stress tests are most useful in…

A

patients with low pretest likelihood and a normal EKG

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94
Q

goal HR of exercise stress test

A

85% max

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95
Q

max HR

A

220-age

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96
Q

the intensity of exercise is periodically increased, continuing until…

A
  • patient reaches max HR
  • changes in heart function are detected on the EKG
  • patient is symptomatic
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97
Q

positive exercise stress test

A

ST depression of 1 box

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98
Q

indications for terminating exercise stress test

A
  • sustained ventricular tachycardia
  • ST elevation in leads without diagnostic Q waves
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99
Q

CI to exercise stress test

A
  • MI within 2 days
  • high risk unstable angina
  • uncontrolled arrythmias
  • severe symptoms
  • PE
  • pericarditis
  • aortic dissection
  • HF
  • baseline abnormalities on the EKG
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100
Q

indications for stress test with imaging component

A
  • when the resting EKG makes an exercise EKG difficult to interpret
  • localize a region of ischemia
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101
Q

exercise stress test with nuclear imagine

A

provides relative perfusion data following injection of a radioactive material before a stress test and then after a stress test

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102
Q

SPECT

A
  • provides slices of the heart for imaging
  • enable imaging of wall motion and estimation of EF
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103
Q

stress echo

A

Utilizes a echocardiogram along with an exercise stress test to increase the sensitivity and specificity of the stress test

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104
Q

what are you looking for in a stress echo?

A
  • regional wall motion abnormalities
  • LV dilation
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105
Q

pharmacologic stress test

A

used when a patient is unable to exercise to a sufficient cardiac workload or has a CI

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106
Q

pharmacologic stress tests are always combined with….

A

an imaging modality

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107
Q

preferred pharmacologic stress test agent

A

vasodilators (adenosine, dipyridamole, regadenoson)

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108
Q

CI of using vasodilators for pharm stress test

A

bronchospasm

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109
Q

2nd line for pharm stress test

A

adrenergic stimulating agents

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110
Q

coronary angiogram/cardiac catheterization uses

A
  • evaluate or confirm the presence of coronary artery disease, valvular disease, or aortic disease
  • evaluate heart muscle function
  • determine the need for further treatment
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111
Q

right heart Cath is useful in…

A

pulm HTN

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112
Q

left heart Cath is used to assess…

A

cardiac valves and LV function

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113
Q

prep for coronary angiogram

A
  • NPO 4-6 hours
  • IV NS for 24 hours to flush out contrast
  • hold metformin for 48 hours
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114
Q

ventriculogram

A

x-ray image of the ventricles

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115
Q

indications for coronary angiogram

A
  • life limiting stable angina
  • high pretest likelihood
  • emergent for STEMI
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116
Q

relative CI to coronary angiogram

A
  • renal disease
  • allergy to contrast
117
Q

risks of coronary angiogram

A
  • stroke
  • coronary artery dissection
  • hemorrhage
  • AKI
  • femoral pneudoaneurysm
118
Q

CXR for IHD

A
  • useful to identify pulm causes of chest pain
  • see mediastinal widening with aortic dissection
119
Q

chest CT with IV contrast can help exclude …

A

PE and aortic dissection

120
Q

Transthoracic echo can be helpful in detecting…

A
  • effusions
  • wall motion abnormalities
  • aortic dissections
121
Q

HR for CT of coronary arteries

A

below 50

122
Q

if the CT of coronary arteries is positive, what should follow up?

A

cardiac cath

123
Q

first line therapy in patients with acute coronary syndrome

A

nitrates

124
Q

MOA of nitrates

A

nitrate enters vascular smooth muscle and is converted to nitric oxide, leading to activation of cGMP and vasodilation

125
Q

SE of nitrates

A

reflex tachycardia

126
Q

long acting nitrites

A

isosorbide

127
Q

purpose of long acting nitrites

A

used for long term prophylaxis of angina

128
Q

method of nitrate administration

A

non-parenteral
* SL
* topical
* IV (if pain persists or recurs)

129
Q

AE of nitrates

A

HA

130
Q

tolerance of nitrates

A

prolonged treatment of nitrates may induce a loss of response and decrease angina threshold

131
Q

CI of nitrates

A

combination of nitrates and PDE5 inhibitors due to cGMP accumulation and dramatic reductions in blood pressure

132
Q

action of morphine for MI

A
  • decreases sympathetic tone
  • decreases vascular resistance
  • decrease O2 demand
133
Q

use morphine with caution in …

A

hypotension, hypovolemia, and respiratory depression

134
Q

aspirin therapy for MI

A

give high dose aspirin (chewed) to all MI patients to reduce mortality

135
Q

use aspirin with caution in …

A
  • active PUD
  • hypersensitivity
  • bleeding disorders
136
Q

after you treat the acute MI with high dose aspirin…

A

go back to 81mg for long term management

137
Q

….. is used in support of Cath/stent or if unable to take ASA

A

p2y12 inhibitors

138
Q

how long toes p2y12 therapy need to last?

A
  • 3-12 months
  • mostly 12
  • 3 is it is an isolated event that we can determine the cause
139
Q

elective CABG and p2y12 dose

A
  • plavix and brilinta: postpone for 5 days after last dose
  • efficient: postpone for 7 days after the last dose
140
Q

Glycoprotein IIb/IIIa inhibitors inhibits platelet aggregation at ……

A

final common pathway

141
Q

…..is used in combo with ASA

A

heparin

142
Q

….. is more effective than unfractionated heparin in preventing recurrent ischemic events

A

LMWH

143
Q

…..should be started 24-48 hours after an MI once a patient is stable

A

beta blockers

144
Q

BB reduce …

A
  • infarct size and complications
  • rate of re-infarction
  • rate of life threatening tachyarrythmias and thus reduce mortality
  • cardiac remodeling
145
Q

MOA of ranexa

A

late Na channel blocker, decreases intracellular calcium overload

146
Q

indication of ranexa

A

stable angina

147
Q

advantages of ranexa

A
  • no effect on HR or BP
  • safe to use with ED drugs
148
Q

SE of ranexa

A

prolonged QT interval

149
Q

you see an increase in ….. post MI

A

ACE

150
Q

use of ACE/ARBs …. at the scar site and remote to the infarct

A

reduce fibrosis and remodeling

151
Q

t/f ACE/ARBs can help preserve myocardium in the setting of an MI

A

true

152
Q

other pharm that can help in IHD

A
  • Statins start immediately following diagnosis of acute coronary syndrome
  • warfarin: thrombus history
  • aldosterone antagonists: for selected patients with LV dysfunction
153
Q

t/f CCB are first line vasodilators for IHD

A

false. not shows to favorable affect outcome

154
Q

fibrinolytic therapy is used for ….. only

A

STEMI

155
Q

SE of fibrinolytic

A

bleeding

156
Q

anticoagulation post fibrolytic infusion

A

aspirin and anticoagulation (LMWH) should be continues until revascularization or for the duration of the hospital stay

157
Q

when should you use fibrolytic therapy?

A

If and only if, cardiac Cath can’t be done within a few hours of the ischemic event

158
Q

goal is to initiate fibrinolytic therapy within ……

A

30 minutes of arrival in ED

159
Q

the greatest benefit occurs if fibrinolytic treatment is initiated within the ….

A

first 3 hours after onset of presentation

160
Q

all patients with STEMI treated with fibrinolytic should be started on prophylactic …..

A

PPIs

161
Q

CI of thrombolytic therapy

A
  • any prior intracranial hemorrhage
  • any trauma within the last 3 months
162
Q

benefit of PCI (stents) are seen in…

A

unstable disease

163
Q

stents are more effective than ….. for opening occluded arteries

A

thrombolysis

164
Q

following PCI, patients should receive…

A

DAPT (ASA + P2y12) for 3-12 months

165
Q

balloon angioplasty

A

inflation of a balloon within the coronary artery to compress plaque against the walls of the artery and open the lumen

166
Q

stent angioplasty

A

similar to balloon angioplasty but involves the use of a small expandable mesh-like tube of thin wire along with the balloon

167
Q

bare metal stents

A

vascular stent without a coating

168
Q

drug-eluting stents

A

stent that slowly releases a drug to block cell proliferation

169
Q

preferred stent used in PCI

A

drug-eluting stent

170
Q

DAPT with drug eluting stents

A

requires a longer period of DAPT to prevent stent thrombosis so they aren’t appropriate for all patients

171
Q

atherectomy

A

specialized catheter for mechanical removal of plaque from the arterial walls

172
Q

CABG

A

procedure in which arteries or veins harvested from elsewhere in the body and are grafted to the coronary arteries to bypass atherosclerotic narrowing and improve blood supply to the myocardium

173
Q

CABG is preferred method for revascularation in patients with …

A
  • left main trunk artery stenosis
  • poor LV function
174
Q

On pump vs off pump CABG

A

on pump: connected to machine that stops the heart and perfuses the body
off pump: heart is still beating

175
Q

Enhanced External Counterpulsation

A

noninvasive procedure performed on individuals with angina or HF or cardiomyopathy inn order to diminish symptoms of ischemia, improve functional capacity, and quality of life

176
Q

goal of Enhanced External Counterpulsation

A

reduce cardiac workload and improve blood flow to the heart

177
Q

results of Enhanced External Counterpulsation

A

relieve angina and decrease the degree of ischemia in a cardiac stress test

178
Q

workup of stable angina

A
  • cardiac enzymes
  • EKG
  • CBC to rule out anemia
  • screen for risk factors
  • determine pretest liklihood
179
Q

resting EKG in stable angina

A

typically normal

180
Q

low to intermediate pretest probability of stable angina

A

noninvasive stress testing

181
Q

if the stress test in normal…

A

treat symptoms

182
Q

if the stress test is abnormal …

A

refer to cardio and for possible cardiac cath

183
Q

high pretest probability of stable angina

A

refer for cardiac cath

184
Q

management of stable angina

A
  • manage sx (NTG, BB, CCB, ranexa, revascularization)
  • prevent CV events (modify risk factors and anti platelet therapy)
185
Q

prinzmetal angina involves spasm of the coronary arteries, which leads to …

A

decreased coronary blood flow

186
Q

what may cause onset of prinzmetal angina ?

A
  • spontaneous
  • cold exposure
  • emotional stress
  • vasoconstriction medications
187
Q

…._ can occur as a result of spasm in the absence of visible instructive CHD

A

MI

188
Q

……may induce myocardial ischemia and infarction by causing coronary artery vasoconstriction or by increasing myocardial energy requirements

A

cocaine

189
Q

presentation of prinzmetal angina

A
  • chest pain w/o usual precipitating factors
  • ST elevation
  • early morning
  • no CAD on cardiac cath
190
Q

management of prinzmetal angina

A
  • emergent coronary arteriography (cath)
  • nitrates
  • CCB
191
Q

order of management of acute coronary syndrome

A
  • ASA
  • NTG
  • O2 (if needed)
  • morphine
192
Q

management of unstable angina and NSTEMI

A
  • admit to hospital
  • cardiac monitoring
  • O2 if needed
  • NTG
193
Q

Primary PCI should be performed w/in …. mins of MI presentation?

A

90

194
Q

thrombolysis should be administered within ….. of hospital presentation and ….. after onset of symptoms

A

30 minutes; 6-12 hours

195
Q

all patients with a suspected STEMI should recieve…

A
  • high dose ASA regardless of whether fibrinolytics are being considered or if low dose ASA has already been given
  • reperfusion therapy (PCI or fibrinolytic)
196
Q

manifestations of ischemic complications

A
  • angina
  • reinfarction
197
Q

manifestations of mechanical complications

A
  • HF
  • MV dysfunction
  • cardiac rupture
198
Q

manifestations of arrhythmic complications

A

atrial or ventricular arrhythmias

199
Q

manifestations of arrhythmic complications

A

atrial or ventricular arrhythmias

200
Q

manifestations of embolic complications

A

stroke
PE

201
Q

manifestations of inflammatory complications

A

pericarditis

202
Q

Dressler’s syndrome

A

pericarditis post MI or CABG

203
Q

etiology of Dressler’s syndrome

A

caused by an immune system mediated inflammatory response following damage to heart tissue or the pericardium

204
Q

how long does dressers syndrome occur post MI?

A

1-12 weeks

205
Q

symptoms of Dressler’s syndrome

A

CP and fever

206
Q

presentation of RV infarct

A
  • hypotension
  • preserved LV function
207
Q

RV infarctions present in 1/3 of patients with …

A

inferior wall infarction

208
Q

treatment of RV infarction

A

treat hypotension with IV NS and inotropic agents (Epi)

209
Q

MC location for ventricular free wall rupture

A

anterior or lateral wall of LV

210
Q

ventricular free wall rupture is associated with …

A
  • elderly
  • poor collateral circulation
  • first MI
211
Q

ventricular free wall rupture occurs commonly within …. post MI

A

24 hours

212
Q

mortality rate is …. for free wall ruptures

A

extremely high

213
Q

how may ventricular free wall rupture present?

A
  • pericardial effusion
  • pulseless electrical activity
214
Q

post MI ventricular septal defect is associated with … MIs involving the …

A

transmural; septum

215
Q

MV regurg is a rare complication of MI due to…

A

ruptured papillary muscle

216
Q

presentation of MV regurg due to ruptured papillary muscle

A

sudden onset decompensation HF

217
Q

LV aneurysm puts patient at a high risk for ….

A

rupture

218
Q

changes involved in cardiac event recovery

A
  • diet
  • exercise
  • addition of appropriate meds
  • increased frq of follow up care visits
219
Q

discharge instructions for cardiac event

A
  • education on meds, diet, exercise, and smoking
  • referral to cardiac rehab
220
Q

follow up for cardiac event

A
  • follow up with cardio and PCP
  • low risk: 4-6 weeks
  • high risk: 1-2 weeks
221
Q

dietary changes post-MI

A
  • limit the intake of saturated and trans fatty acids, free sugars, and salt
  • increase intake of fruits, veggies, legumes, nuts, and whole grains
222
Q

exercise post MI

A
  • work up to 150 minutes of moderate intensity exercise per week or 75 minutes of high intensity exercise per week
  • aerobic exercise
223
Q

psych issues following an MI

A
  • debility
  • activity/recreation
  • depression
  • sexual activity
  • work/driving
224
Q

cardiac blues

A

strong emotional reaction at the time of or soon after an acute cardiac event

225
Q

consequences of depression post-MI

A
  • emotional distress
  • increased risk of another MI
  • poorer prognosis
226
Q

sexual activity post-MI

A
  • uncomplicated: wait 1 week
  • complicated: 2-3 weeks
  • must be asymptomatic
227
Q

cardiac rehab

A

improves cardiac function and reduces mortality / development of complications

228
Q

3 aspects of cardiac rehab

A
  • exercise
  • education to help reduce risk factors
  • counseling to help patients deal with stress, anxiety, and depression
229
Q

Most common, serious, chronic, life-threatening illness in the US

A

IHD

230
Q

….% of the population has sustained an MI

A

3-4

231
Q

MC risk factors for IHD

A
  • genetics
  • smoking
  • sedentary lifestyle
  • poor diet
232
Q

pathogenesis of IHD

A

demand for blood by the coronary arteries is greater than the supply

233
Q

oxygen supply is determined by the….

A

blood flow

234
Q

blood flow is regulated by …

A

pressure vs resistance ratio

235
Q

most critical factor in oxygen supply

A

the radius of the blood vessel

236
Q

what can influence the radius of the blood vessel?

A
  • atherosclerosis
  • vascular tone
  • endothelial cell dysfunction
237
Q

4 different types of IHD

A
  • prinzmetal angina
  • stable angina
  • unstable angina
  • MI (STEMI or NSTEMI)
238
Q

Prinzmetal angina

A

drop in blood flow through the coronary arteries caused by a vasospasm in the artery, not by atherosclerosis

239
Q

stable angina

A

chest pain that occurs when a person is active or under severe stress

240
Q

unstable angina

A

chest pain that occurs while a person is at rest and not exerting himself

241
Q

what does unstable angina result from?

A

results from plaque rupture and thrombus formation, but is not occluding blood flow

242
Q

NSTEMI vs STEMI

A

STEMI: ST elevation and q waves
NSTEMI: ST depression and inverted t waves

243
Q

what does NSTEMI result from?

A

plaque rupture and thrombus formation that partially impedes blood flow through the coronary vessels

244
Q

what does a STEMI result from?

A

plaque rupture and thrombus formation that completely impedes blood flow through the coronary vessels

245
Q

characteristics of stable angina

A

-predictable
-lasts 1-15 minutes
-goes away with rest or NTG

246
Q

characteristics of stable angina

A
  • predictable
  • lasts 1-15 minutes
  • goes away with rest or NTG
247
Q

characteristics of unstable angina

A
  • unexpected
  • goes not go away with rest for NTG
  • warning sign of an MI and is an emergency
248
Q

ischemia presents as soon as there is a…

A

decrease in blood supply to the myocardial tissue

249
Q

cardiac cells can tolerate …. for a short time

A

mild-moderate anoxia

250
Q

prognosis of ischemia, injury, and infarct on the myocardial cells

A
  • ischemia: cells usually return to normal after blood supply is returned
  • injury: damage is reversible and may return back to normal but it also may not
  • infarct: cells sustain irreversible injury and die
251
Q

MI

A

irreversible myocardial injury resulting in necrosis of a portion of the myocardium

252
Q

Acute MI suggests the infarct is …. days old

A

3-5

253
Q

most severe and complicated type of infarct

A

transmural: goes through the entire wall of the myocardium

254
Q

area of involvement of a NSTEMI

A

small area in the subendocardial wall of the LV, ventricular septum, or papillary muscle

255
Q

what part of the myocardium is typically damaged first?

A

subendocardial area

256
Q

area of injury for a STEMI

A

extends through the whole thickness of the heart muscle

257
Q

a STEMI is associated with with atherosclerotic plaques in a coronary artery that causes ……

A

complete occlusion

258
Q

nickname for ST elevation

A

tombstoning

259
Q

type 1 MI

A

Spontaneous MI related to ischemia due to a primary coronary event such as plaque erosion and/or rupture, fissuring, or dissection

260
Q

Type 2 MI

A

MI secondary to ischemia due to either increased oxygen demand or decreased supply

261
Q

examples of type 2 MI

A
  • coronary artery spasm (primzmetal)
  • coronary embolism
  • anemia
  • HTN
262
Q

type 3 MI

A

sudden cardiac death

263
Q

type 4 MI

A

Mi associated with coronary angioplasty or stents

264
Q

type 5 MI

A

Associated with CABG

265
Q

silent ischemia is MC in ..

A

elderly, women, diabetics

266
Q

myocardial stunning

A

reversible myocardial dysfunction following re-perfusion of an ischemic insult

267
Q

hibernating myocardium

A

result in prolonged reduction in blood flow from coronary artery disease and causes ventricular contractile dysfunction that will improve after blood flow improves

268
Q

artery associated with inferior wall MI

A

right coronary artery

269
Q

artery associated with anterior wall MI

A

LAD

270
Q

artery associated with lateral wall MI

A

Left circumflex artery

271
Q

artery associated with posterior wall MI

A

posterior descending branch of the right coronary

272
Q

artery associated with septal wall MI

A

LAD

273
Q

inferior wall MI is often accompanied by a ____ due to involvement of the sinus node

A

decreased HR

274
Q

effects of an anterior wall MI

A

affects the main pump so it can lead to decreased HR and BP and eventually HR

275
Q

typical presentation of an MI

A
  • episodic chest discomfort
  • heaviness
  • pressure
276
Q

location of pain for an MI

A
  • substernal
  • can radiate to the left arm/shoulder, neck, jaw, back/scapula
277
Q

duration of MI chest pain

A

2-5 min

278
Q

setting of MI chest pain

A

typically with exertion

279
Q

aggravating factors for MI chest pain

A
  • exercise
  • meals
  • stress
  • cold exposure
  • sex
  • morning
280
Q

alleviating factors for MI chest pain

A

NTG
Rest

281
Q

….test may be less accurate in women

A

stress test

282
Q

how is prinzmetal angina treated?

A

CCB and nitrates to vasodilate

283
Q

MC population to get prinzmetal angina

A

middle aged women

284
Q

important PE assessments for IHD

A
  • vitals
  • heart and lung sounds
  • neuro
  • psych
  • abdominal
285
Q

everyone with chest pain CC gets a ….. and …..

A

EKG
cardiac biomarkers

286
Q

TMI risk score

A

used to risk stratify patients to help determine who should undergo aggressive evaluation/treatment

287
Q

risk on TMI scale

A

low risk: 0-2
intermediate risk: 3-4
high risk: 5 or more

288
Q

risk on HEART scale

A

low: 0-3
intermediate: 4-6
high: 7 or more

Internal Med EOR (18 decks)

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