DSA- Cardiac Clinical Medicine Part 1 Flashcards
What term is described as chest pain or pressure for at least 2 months’ duration that is precipitated by exertion or emotional stress and has not appreciably worsened?
Stable angina
What term is described as new onset angina, angina with minimal exertion, angina at rest, or angina accelerating in frequency or severity?
How are the cardiac enzymes with this condition?
1) Unstable angina
2) Normal cardiac troponin levels
NSTEMI is defined by ST segment depression and/or T-wave inversions with?
Elevated cardiac troponin levels
STEMI is defined by ST segment elevation with?
Either abnormal cardiac enzymes, new LBBB or posterior MI
What is the leading cause of death in the U.S?
Coronary Artery Disease
What are some modifiable risk factors for CAD?
1) HTN
2) Hyperlipidemia
3) DM
4) Smoking
5) Diet
What are some non-modifiable risk factors for CAD?
1) Male sex
2) Age
3) Family history of CAD
4) Ethnicity
What makes up the hyperlipidemia seen with CAD?
1) Low HDL
2) High LDL
What are some non-traditional risk factors for CAD?
1) CKD
2) Proteinuria
3) Inflammatory states such as HIV and RA
Hyperlipidemia, hyperglycemia, and HTN cause dysfunction to what cells?
What does this cause?
1) Endothelial cells
2) Platelet adhesion and recruitment of circulating monocytes and T cells
The recruitment of circulating monocytes and T cells, with subsequent cytokine and growth factor release from inflammatory cells leads to?
Smooth muscle cell migration and proliferation as well as further macrophage activation
What is the classic presentation for acute coronary syndrome?
1) Typical chest pain
2) Dyspnea
3) Nausea and vomiting
4) Diaphoresis
5) Fatigue
AMIs that are painless (silent) and/or have atypical symptoms are more common in what patients?
1) Elderly
2) Women
3) Diabetics
Angina pectoris chest pain has what 3 classic components?
What defines typical angina chest pain?
Atypical angina chest pain?
Non-angina chest pain?
1) Substernal chest pain or discomfort
2) Provoked by exertion or emotional stress
3) Relieved by rest and/or Nitroglycerin
1) Has all 3 components
2) Has 2 of the 3 components
3) Has ≤ 1 of the components
What should be the first test you perform on a patient when diagnosing CAD?
Resting ECG
Cardiac stress testing should only be done for patients with?
Patients with positive stress tests should proceed to?
1) Intermediate pretest probability of CAD
2) Invasive coronary angiography
If an exercise cardiac stress test can’t be performed what are other options?
1) Vasodilators
2) Inotropes and chronotropes
Which pharmacological cardiac stress test dilates the coronary arteries similar to exercise?
Which increases myocardial oxygen demand by increasing heart rate and contractility?
1) Vasodilators
2) Inotropes and chronotropes
What is the common inotrope/chronotrope drug used for cardiac stress testing?
Dobutamine
A stress ECG test is contraindicated in what patients?
Those with baseline ECG abnormalities
What stress test modality is used to look for regional wall motion abnormalities (RWA) or LV dilation?
Stress Echocardiography (ECHO)
What stress test modality provides information on perfusion defects between rest and stress, cardiac viability, and LV systolic function?
Stress Myocardial Perfusion imaging (MPI)
Regional wall motion abnormalities seen on a stress ECHO can be further broken down into what categories?
1) Hypokinesis
2) Akinesis
3) Dyskinesis
When performing a coronary angiography what is deemed significant stenosis?
Greater than 70% narrowing
What is the STEMI ECG criteria?
1) ST segment elevation of ≥ 2 mm in contiguous leads
OR
2) New LBBB
When can you diagnose a STEMI in the setting of a previously diagnosed LBBB?
Never
What is the NSTEMI ECG criteria?
ST segment depression and/or T-wave inversions
STEMI results typically from?
Non-STEMI results typically from?
1) Complete occlusion of blood flow in a coronary vessel
2) Partial occlusion of blood flow in a coronary vessel
What is the generalized treatment of stable angina?
1) Lifestyle modification
2) Aspirin
3) Statin
4) Anti-Anginal drugs
Which Anti-Anginal drug is the 1st line therapy and it decreases angina symptoms by decreasing heart rate and contractility?
β-blockers
Which Anti-Anginal drug decreases angina symptoms by causing coronary artery vasodilation and reduce cardiac contractility?
Calcium channel blockers (CCB)
Which Anti-Anginal drug decrease angina symptoms by causing coronary vessel and systemic vasodilation and decreases cardiac preload?
Long-acting Nitrates
Which Anti-Anginal drug is reserved for more refractory angina and is an inward sodium channel blocker that ultimately decreases myocardial oxygen consumption?
Ranolazine
What falls under the category of acute coronary syndrome?
1) Unstable Angina
2) NSTEMI
3) STEMI
What is the initial management of all acute coronary syndrome patients?
MONA: Morphine, Oxygen, Nitrates, Aspirin
What is the dual antiplatelet therapy used to treat acute coronary syndrome?
Aspirin and P2Y12 inhibitor
What are the anticoagulation therapies used to treat acute coronary syndrome?
Unfractionated heparin or subcutaneous enoxaparin
What are the revascularization therapies used to treat acute coronary syndrome?
1) Percutaneous coronary intervention (PCI)
2) Coronary artery bypass grafting (CABG)
What are the drugs shown to improve mortality in Myocardial Infarction?
1) Aspirin
2) β-blockers
3) ACE inhibitors
With the treatment of STEMI what is the timeframe to get the patient in the cath lab in a PCI capable hospital?
Less than 90 minutes
With the treatment of STEMI in a non-PCI capable hospital what should be done?
1) Transfer to PCI hospital within < 120 minutes
OR
2) Thrombolytics within ≤ 30 minutes then transfer to PCI capable hospital
With the treatment of Unstable angina and NSTEMI what does the TIMI (Thrombolysis in Myocardial Infarction) score predict the risk of?
1) 14 day death
2) Recurrent MI
3) Urgent revascularization
An inferior MI is seen in what ECG leads?
What coronary artery is affected?
1) II, III, aVF
2) RCA
A septal MI is seen in what ECG leads?
What coronary artery is affected?
1) V1-V2
2) LAD
An anterior MI is seen in what ECG leads?
What coronary artery is affected?
1) V2-V4
2) LAD
A lateral MI is seen in what ECG leads?
What coronary artery is affected?
1) V5-V6 or I, AVL
2) Left Circumflex
A posterior MI is seen in what ECG leads?
What abnormalities are seen in these leads?
What coronary artery is affected?
1) V1-V3
2) Tall R waves and ST depression
3) RCA, Left circumflex, or both
What is an immunologically based syndrome typically occurs within weeks to months after an MI?
What does it manifest as?
1) Dressler syndrome
2) Pericarditis
What are the can’t miss ddx of acute MI?
1) Aortic dissection
2) PE
Stanford type A dissections involve the?
Stanford type B dissections arise?
Which dissections typically have the most serious complications and the greatest associated mortality?
1) Ascending aorta
2) After the great vessels
3) Type A
What are common lifestyle risk factors for aortic dissection?
1) HTN
2) Smoking
3) Dyslipidemia
3) Cocaine or meth use
What connective tissue disorder is a risk factor for aortic dissection?
Marfan syndrome
What hereditary vascular disease is a risk factor for aortic dissection?
Bicuspid aortic valve
What autoimmune disorders are risk factors for aortic dissection?
Giant-cell arteritis and Takayasu arteritis
What infection is a risk factor for aortic dissection?
Syphilis
What is the classic presentation of aortic dissection?
1) Sudden onset chest pain described as “tearing or ripping” which radiates to the back
2) HTN
How is aortic dissection diagnosed on CXR?
Widened mediastinum
What is the most commonly used method to diagnose aortic dissection?
CT Angiography
What is the goal of anti-impulse therapy in the treatment/management of aortic dissection?
What is the first line therapy?
What can you add to this therapy?
1) BP ≤ 120 mmHg
2) IV β-blockers
3) Vasodilators
