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CPR II Week 2 > DSA- Cardiac Clinical Medicine Part 1 > Flashcards

DSA- Cardiac Clinical Medicine Part 1 Flashcards

1
Q

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?

A

Stable angina

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2
Q

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?

A

1) Unstable angina

2) Normal cardiac troponin levels

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3
Q

NSTEMI is defined by ST segment depression and/or T-wave inversions with?

A

Elevated cardiac troponin levels

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4
Q

STEMI is defined by ST segment elevation with?

A

Either abnormal cardiac enzymes, new LBBB or posterior MI

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5
Q

What is the leading cause of death in the U.S?

A

Coronary Artery Disease

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6
Q

What are some modifiable risk factors for CAD?

A

1) HTN
2) Hyperlipidemia
3) DM
4) Smoking
5) Diet

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7
Q

What are some non-modifiable risk factors for CAD?

A

1) Male sex
2) Age
3) Family history of CAD
4) Ethnicity

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8
Q

What makes up the hyperlipidemia seen with CAD?

A

1) Low HDL

2) High LDL

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9
Q

What are some non-traditional risk factors for CAD?

A

1) CKD
2) Proteinuria
3) Inflammatory states such as HIV and RA

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10
Q

Hyperlipidemia, hyperglycemia, and HTN cause dysfunction to what cells?

What does this cause?

A

1) Endothelial cells

2) Platelet adhesion and recruitment of circulating monocytes and T cells

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11
Q

The recruitment of circulating monocytes and T cells, with subsequent cytokine and growth factor release from inflammatory cells leads to?

A

Smooth muscle cell migration and proliferation as well as further macrophage activation

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12
Q

What is the classic presentation for acute coronary syndrome?

A

1) Typical chest pain
2) Dyspnea
3) Nausea and vomiting
4) Diaphoresis
5) Fatigue

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13
Q

AMIs that are painless (silent) and/or have atypical symptoms are more common in what patients?

A

1) Elderly
2) Women
3) Diabetics

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14
Q

Angina pectoris chest pain has what 3 classic components?

What defines typical angina chest pain?

Atypical angina chest pain?

Non-angina chest pain?

A

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

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15
Q

What should be the first test you perform on a patient when diagnosing CAD?

A

Resting ECG

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16
Q

Cardiac stress testing should only be done for patients with?

Patients with positive stress tests should proceed to?

A

1) Intermediate pretest probability of CAD

2) Invasive coronary angiography

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17
Q

If an exercise cardiac stress test can’t be performed what are other options?

A

1) Vasodilators

2) Inotropes and chronotropes

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18
Q

Which pharmacological cardiac stress test dilates the coronary arteries similar to exercise?

Which increases myocardial oxygen demand by increasing heart rate and contractility?

A

1) Vasodilators

2) Inotropes and chronotropes

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19
Q

What is the common inotrope/chronotrope drug used for cardiac stress testing?

A

Dobutamine

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20
Q

A stress ECG test is contraindicated in what patients?

A

Those with baseline ECG abnormalities

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21
Q

What stress test modality is used to look for regional wall motion abnormalities (RWA) or LV dilation?

A

Stress Echocardiography (ECHO)

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22
Q

What stress test modality provides information on perfusion defects between rest and stress, cardiac viability, and LV systolic function?

A

Stress Myocardial Perfusion imaging (MPI)

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23
Q

Regional wall motion abnormalities seen on a stress ECHO can be further broken down into what categories?

A

1) Hypokinesis
2) Akinesis
3) Dyskinesis

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24
Q

When performing a coronary angiography what is deemed significant stenosis?

A

Greater than 70% narrowing

25
Q

What is the STEMI ECG criteria?

A

1) ST segment elevation of ≥ 2 mm in contiguous leads

OR

2) New LBBB

26
Q

When can you diagnose a STEMI in the setting of a previously diagnosed LBBB?

A

Never

27
Q

What is the NSTEMI ECG criteria?

A

ST segment depression and/or T-wave inversions

28
Q

STEMI results typically from?

Non-STEMI results typically from?

A

1) Complete occlusion of blood flow in a coronary vessel

2) Partial occlusion of blood flow in a coronary vessel

29
Q

What is the generalized treatment of stable angina?

A

1) Lifestyle modification
2) Aspirin
3) Statin
4) Anti-Anginal drugs

30
Q

Which Anti-Anginal drug is the 1st line therapy and it decreases angina symptoms by decreasing heart rate and contractility?

A

β-blockers

31
Q

Which Anti-Anginal drug decreases angina symptoms by causing coronary artery vasodilation and reduce cardiac contractility?

A

Calcium channel blockers (CCB)

32
Q

Which Anti-Anginal drug decrease angina symptoms by causing coronary vessel and systemic vasodilation and decreases cardiac preload?

A

Long-acting Nitrates

33
Q

Which Anti-Anginal drug is reserved for more refractory angina and is an inward sodium channel blocker that ultimately decreases myocardial oxygen consumption?

A

Ranolazine

34
Q

What falls under the category of acute coronary syndrome?

A

1) Unstable Angina
2) NSTEMI
3) STEMI

35
Q

What is the initial management of all acute coronary syndrome patients?

A

MONA: Morphine, Oxygen, Nitrates, Aspirin

36
Q

What is the dual antiplatelet therapy used to treat acute coronary syndrome?

A

Aspirin and P2Y12 inhibitor

37
Q

What are the anticoagulation therapies used to treat acute coronary syndrome?

A

Unfractionated heparin or subcutaneous enoxaparin

38
Q

What are the revascularization therapies used to treat acute coronary syndrome?

A

1) Percutaneous coronary intervention (PCI)

2) Coronary artery bypass grafting (CABG)

39
Q

What are the drugs shown to improve mortality in Myocardial Infarction?

A

1) Aspirin
2) β-blockers
3) ACE inhibitors

40
Q

With the treatment of STEMI what is the timeframe to get the patient in the cath lab in a PCI capable hospital?

A

Less than 90 minutes

41
Q

With the treatment of STEMI in a non-PCI capable hospital what should be done?

A

1) Transfer to PCI hospital within < 120 minutes

OR

2) Thrombolytics within ≤ 30 minutes then transfer to PCI capable hospital

42
Q

With the treatment of Unstable angina and NSTEMI what does the TIMI (Thrombolysis in Myocardial Infarction) score predict the risk of?

A

1) 14 day death
2) Recurrent MI
3) Urgent revascularization

43
Q

An inferior MI is seen in what ECG leads?

What coronary artery is affected?

A

1) II, III, aVF

2) RCA

44
Q

A septal MI is seen in what ECG leads?

What coronary artery is affected?

A

1) V1-V2

2) LAD

45
Q

An anterior MI is seen in what ECG leads?

What coronary artery is affected?

A

1) V2-V4

2) LAD

46
Q

A lateral MI is seen in what ECG leads?

What coronary artery is affected?

A

1) V5-V6 or I, AVL

2) Left Circumflex

47
Q

A posterior MI is seen in what ECG leads?

What abnormalities are seen in these leads?

What coronary artery is affected?

A

1) V1-V3
2) Tall R waves and ST depression
3) RCA, Left circumflex, or both

48
Q

What is an immunologically based syndrome typically occurs within weeks to months after an MI?

What does it manifest as?

A

1) Dressler syndrome

2) Pericarditis

49
Q

What are the can’t miss ddx of acute MI?

A

1) Aortic dissection

2) PE

50
Q

Stanford type A dissections involve the?

Stanford type B dissections arise?

Which dissections typically have the most serious complications and the greatest associated mortality?

A

1) Ascending aorta
2) After the great vessels
3) Type A

51
Q

What are common lifestyle risk factors for aortic dissection?

A

1) HTN
2) Smoking
3) Dyslipidemia
3) Cocaine or meth use

52
Q

What connective tissue disorder is a risk factor for aortic dissection?

A

Marfan syndrome

53
Q

What hereditary vascular disease is a risk factor for aortic dissection?

A

Bicuspid aortic valve

54
Q

What autoimmune disorders are risk factors for aortic dissection?

A

Giant-cell arteritis and Takayasu arteritis

55
Q

What infection is a risk factor for aortic dissection?

A

Syphilis

56
Q

What is the classic presentation of aortic dissection?

A

1) Sudden onset chest pain described as “tearing or ripping” which radiates to the back
2) HTN

57
Q

How is aortic dissection diagnosed on CXR?

A

Widened mediastinum

58
Q

What is the most commonly used method to diagnose aortic dissection?

A

CT Angiography

59
Q

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?

A

1) BP ≤ 120 mmHg
2) IV β-blockers
3) Vasodilators

CPR II Week 2 (6 decks)

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