Exam 2: Cardiac Flashcards
What is required for the diagnosis of myocardial infarction (MI)?
Rise and/or fall of cardiac biomarkers with at least one value > 99th percent of upper limit reference range AND >1 of the following:
* Ischemic symptoms
* New ischemic ECG changes
* Image evidence of nonviable myocardium
* Imaging showing new regional wall motion abnormalities
These criteria help in confirming MI in patients presenting with chest pain or other ischemic symptoms.
What are the two main types of myocardial infarction?
Type 1 and Type 2 MI
Type 1 MI is spontaneous and related to a primary event, while Type 2 MI is related to an imbalance between myocardial oxygen supply and demand.
What is a key characteristic of Type 1 myocardial infarction?
Related to a primary event such as plaque erosion, rupture, fissuring, or dissection
Type 1 MI can lead to ST-elevation MI (STEMI) or Non-ST-elevation MI (NSTEMI).
What does Type 2 myocardial infarction result from?
Imbalance between myocardial oxygen supply and demand resulting from prolonged tachycardia, coronary spasm, anemia, hypertension
Type 2 MI typically leads to NSTEMI only.
NSTEMI more common postop
What is the recommended time frame for coronary angiography in patients with Non-ST-elevation MI?
Within days of symptoms after initiation of medical treatment in risk stratification
This approach helps in evaluating the severity and management of coronary lesions.
What is the difference between systolic heart failure and diastolic heart failure?
Systolic HF has reduced EF
Diastolic HF has preserved EF
Both types can be chronic or acute.
What is the significance of troponin elevation in chronic heart failure?
Chronic HF = sustained troponin elevation
Acute HF = acute troponin release
What is the recommended duration of dual antiplatelet therapy (DAPT) for angioplasty with drug-eluting stents?
6 months DAPT
This is crucial to prevent thrombotic events after stent placement.
What functional capacity assessment question can be asked to evaluate cardiac risk preoperatively?
Can you climb two flights of stairs without stopping and without chest pain or shortness of breath?
Can you walk two to four blocks on level surface without having chest pain or shortness of breath?
This helps to gauge the patient’s exercise tolerance and risk for major adverse cardiac events (MACE).
What does a PRE-OP ECG assess for?
Suspected valvular disease, left or right ventricular function, pulmonary hypertension, cardiomyopathies
It is indicated to address specific clinical questions arising from patient history or examination.
What is the role of echocardiography in heart failure?
Detects myocardial ischemia and provides information on cardiac function
It is not recommended for routine preoperative assessment but can be useful in specific cases.
What is the definition of heart failure?
Impaired ventricular filling or limited ventricular ejection where cardiac output declines below the minimum needed to meet metabolic demands
This condition can lead to symptoms such as fatigue, dyspnea, and edema.
What are the common laboratory tests for heart failure optimization?
CBC = Anemia results in twofold increase in mortality post
Chemistries = Electrolyte abnormalities & Renal function
PT = Prolonged if liver congestion present
BNP
Addressing these factors can significantly improve patient outcomes.
When should HF medications be continued or resumed in relation to surgery?
ARB, ACEI, Angiotensin II Inhibitors =
Continue until 1 day before surgery
Resume within 48 hours
Beta Blockers = Continue day of surgery
Do not initiate just prior to surgery
This is important to manage blood pressure effectively around the time of surgical intervention.
What is the most common type of stenotic valvular disease?
Aortic stenosis
Mitral stenosis is also prevalent but less common than aortic stenosis.
What type of murmur is associated with mitral regurgitation?
High pitched holosystolic murmur
This can indicate significant valvular dysfunction and may require intervention.
What are the symptoms that may indicate a new diagnosis of heart failure?
Fatigue, dyspnea, edema, congestion
These symptoms warrant further evaluation to confirm or rule out heart failure.
What are ABP and VPB?
Atrial premature beats and ventricular premature beats
Depolarizations initiated by ectopic foci outside the SA node, very common, can be with or without cardiac disease.
What is Supra Ventricular Tachycardia?
A rapid heart rate originating above the ventricles, can involve focal or reentrant mechanisms
Includes atrial tachycardia, AV reentry tachycardia, and bypass mediated tachycardia (e.g., WPW).
What characterizes Wolf-Parkinson White syndrome?
Symptomatic arrhythmia in the presence of an accessory pathway
Features short P-R interval, delta wave, and wide QRS; ablation is the treatment of choice.
Define Ventricular Tachycardia.
3 or more VPBs at a rate of 100 or greater
Requires cardioversion and is associated with CAD.
What is Long QT Syndrome?
A disorder arising from mutations in cardiac ion channels resulting in prolonged QT
Can be inherited or acquired, often treated with beta blockers and ICD.
What are the characteristics of Atrial Fibrillation?
Most common arrhythmia preoperatively, irregular R-R intervals, no distinctive P waves
Associated with CAD, hypertension, and increased risk of thromboembolism.
