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Block 3 FCM > Coronary heart disease > Flashcards

Coronary heart disease Flashcards

1
Q

RISK FACTORS FOR CAD

A 
¥	Male gender
¥	Diabetes mellitus (DM)
¥	Smoking history
¥	Hypertension
¥	Age 
¥	Hyperlipidemia
¥	Prior Stroke and Peripheral Vascular Disease
¥	Inherited metabolic disorders
¥	Methamphetamine and Cocaine use
¥	Occupational stress
¥	Connective tissue disease (Lupus/RA/etc)
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2
Q

_______ includes the diagnoses of angina pectoris, myocardial infarction, silent myocardial ischemia, and CHD mortality that result from coronary artery disease.

A

Coronary heart disease (CHD)

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3
Q

Non-Modifiable Risk Factors for Ischemic heart disease / CAD

A

o Age, Sex, family history, rheum dz

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4
Q

Modifiable Risk Factors for Ischemic heart disease / CAD

A

o Dyslipidaemia, smoking, diabetes mellitus, obesity, hypertension
o Lack of exercise, high alcohol consumption, type A personality, CRP

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5
Q

Clinical Manifestations of CAD

A
  1. CHEST PAIN
  2. Myocardial Infarction
    -Have an infarction and effect ejection factor and have arrhythmias
  3. Acute Coronary syndromes leads to (downstream)
    -Heart Failure: 4.8 million Americans
    -Arrhythmias
    -Sudden death: SCD accounts for approximately 325,000 deaths per year in the United States; more than to lung cancer, breast cancer, or AIDS.
    ▪ Even if you survive a heart attack your risk for sudden death is increased
  4. Asymptomatic
    -A lot of CAD can be asymptomatic; sometimes they think its reflux or something else and it ends up being reflux
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6
Q

what is stable angina?

A

involves episodic pain lasting 5-15 minutes, Provoked by exertion and Relieved by rest or nitroglycerin.

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7
Q

what is unstable angina?

A

▪ new-onset exertional angina
▪ Angina of increasing frequency or duration or refractory to nitroglycerin
▪ Angina at rest

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8
Q

what is Variant angina (Prinzmetal angina)?

A

occurs primarily at rest, is triggered by smoking, and thought to be due to coronary vasospasm.
▪ In younger patients, may not have CAD

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9
Q

character of Chronic Stable Angina

A

More often described as a discomfort, pressure, (not Pain) or squeezing sensation. Less commonly as burning, sticking, or sharp.

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10
Q

location of Chronic Stable Angina

A

Most often in the substernal area, precardium, or epigastrium with radiation to the left arm, jaw, or neck. Less commonly felt only in radiation areas and not in the chest.

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11
Q

Precipitation of Chronic Stable Angina

A

Often provoked by exertion, emotion, exposure to cold, eating (4 “E”s), or smoking, and relieved by rest, removal of provoking factors, or sublingual nitrates.

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12
Q

duration of Chronic Stable Angina

A

Usually lasts a few minutes, rarely over 20-30 minutes.

o Rarely over 30 minutes, should come and go

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13
Q

What unstable angina could be? (4)

A

o Preinfarction angina
o Impending myocardial infarction
o Progressive or crescendo angina (gets worse overtime or accelerated angina)
o New onset angina

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14
Q

Angina of recent onset (less than 1 month) that is provoked by minimal exertion is referred to as _____

A

unstable angina

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15
Q

Chronic stable angina showing a crescendo pattern, with chest pain occurring more frequently, with greater severity and duration, with less provocation, and requiring larger doses of nitroglycerine to abort attacks is referred to as ______.

A

unstable angina

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16
Q

______ angina has Prolonged chest pain at rest, clinically indistinguishable from acute MI at the time of presentation.

A

unstable

17
Q

pathologies of atypical angina

A 
¥	Cardiac pathology
	Pericarditis, aortic dissection
¥	Pulmonary pathology
	Pulmonary embolus, pneumothorax, pneumonia
¥	Gastrointestinal pathology
	Peptic ulcer disease, reflux, pancreatitis
¥	Musculoskeletal pathology
	Trauma, costo chondtritis
18
Q

______ is caused by coronary artery disease and heart attacks. Lack of blood damages the heart muscle, causes damage to it, resulting in cardiomyopathy

A

Ischemic Cardiomyopathy

19
Q

These forms of cardiomyopathy are not related to coronary artery disease (poor coronary artery blood supply).

A

Nonischemic cardiomyopathy

20
Q

There are four types of nonischemic cardiomyopathy, what are they?

A

o Dilated Cardiomyopathy
o Hypertrophic Cardiomyopathy
o Restrictive Cardiomyopathy
o Arrhythmogenic Right Ventricular Dysplasia (ARVD)

21
Q

4 causes of Acute Coronary Syndrome (ACS)

A

o unstable angina,
o non–ST-elevation myocardial infarction (NSTEMI) (labs! NO ST elevation),
o ST-elevation myocardial infarction (STEMI),
o dynamic obstruction

22
Q

Myocardial ischemia is most often due to atherosclerotic plaques, which reduce the blood supply to a portion of myocardium. Initially, the plaques allow sufficient blood flow to match myocardial demand. When myocardial demand increases, the areas of narrowing may become clinically significant and precipitate _____.

A

angina

23
Q

_____ is Irreversible tissue necrosis caused by an occlusive thrombus

A

MI (Myocardial Infarction)

24
Q

RISK FACTORS FOR ACS

A 
¥	Male gender
¥	Diabetes mellitus (DM)
¥	Smoking history
¥	Hypertension
¥	Age 
¥	Hyperlipidemia
¥	Prior Stroke and Peripheral Vascular Disease
¥	Inherited metabolic disorders
¥	Methamphetamine and Cocaine use
¥	Occupational stress
¥	Connective tissue disease (Lupus/RA/etc)
¥	FH
25
Q

Workup for ACS – 3 Things

A

1: EKG!!, #2: labs, #3: Imaging

26
Q

Common EKG findings in acs

A

▪ Transient or fixed ST-segment elevations
▪ Dynamic T-wave changes (inversions, normalizations, or hyperacute changes)
▪ ST depressions (may be junctional, downsloping, or horizontal)
▪ New BBB, arrhythmia (v-tach, Blocks, etc)

27
Q

______ is considered the preferred biomarker for diagnosing myocardial necrosis

A

Troponin I

28
Q

______ may demonstrate complications of ischemia, such as pulmonary edema, or it may provide clues to alternative causes of symptoms, such as thoracic aneurysm or pneumonia.

A

Chest radiograph

29
Q

____shows valvular defects and wall motion abnormalities

A

ECHO

30
Q

Rationale For Attempts At Early Reperfusion For Acute MI

A

¥ MI is due to abrupt coronary occlusion due to either thrombosis or (spasm)
¥ Myocardial cell death following coronary occlusion is rapid but slow enough to allow for attempts at myocardial salvage
¥ Myocardial salvage should result in better LV function and thus, improved survival

31
Q

STEMI TREATMENT

A

o EKG!
o 02 and IV access
o ASA (325mg chewable); or Plavix loading dose (unless already on plavix)
o Anticoagulation → give heparin, LMWH
o Beta blocker → decrease myocardial oxygen demand and maybe afterload demand
o Nitroglycerin → decreases symptoms and sympathetic tone, and decrease preload (which decreases stress on the heart); nitro drip
o Put them on oxygen

then cath lab

32
Q

should you give morphine in a STEMI?

A

NO

33
Q

if pt is Non STEMI, you should still treat as STEMI if they have?

A

o ongoing symptoms highly suggestive of acute coronary ischemia and nondiagnostic ECG (eg, left bundle-branch block [LBBB])
o Ongoing symptoms refractory to aggressive medical therapy (above medical therapy)
o Hemodynamic instability or shock
o Evidence of acute valvular dysfunction
o Known severe aortic stenosis and ongoing symptoms

34
Q

Antiplatelet agents used in ACS

A

Aspirin and Plavix.

35
Q

Anticoagulants used in ACS

A

o Heparin – Antithrombin III. Does not actively lyse but inhibits further thrombogenesis
o Low Molecular Weight Heparin (Lovenox) – just as effective as heparin
o Direct Thrombin Inhibitors (Bivalirudin/Lepirudin) – future drugs of choice
o Glycoprotein IIB/IIA inhibitors (ReoPro/Integrelin) - prevent the binding of fibrinogen and improve unstable outcomes

36
Q

These agents oppose coronary artery spasm and reduce myocardial oxygen demand by reducing both preload and afterload

A

¥ Nitrates (Nitroglycerin SL/IV/ER)

37
Q

these agents reduce afterload and wall stress while decreasing infarct size as well as short- and long-term mortality, which is a function of their anti-ischemic and antiarrhythmic properties.

A

¥ Beta Blockers (Esmolol/Metoprolol)

38
Q

These agents reduce pain, which decreases sympathetic stress, in addition to providing some preload reduction. these are always the LAST RESORT

A

¥ Analgesics (Morphine)

39
Q

when should a CABG be performed

A

o Left main stenosis
o Severe symptomatic 3 vessel CAD with reduced LVEF
o Symptomatic 2 Vessel with proximal LAD and demonstrable ischemia

Block 3 FCM (7 decks)

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