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Year 2 CV > Exam 3, intro IHD, MI, angina > Flashcards

Exam 3, intro IHD, MI, angina Flashcards

1
Q

what are the risk factors for heart disease

A

increasing age, male, smokine, HTN, DM, high cholesterol, FMH, cocaine use, meth use, physical inactvity

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2
Q

what is considered a low risk for heart attacks

A

<10% 10 year risk off framingham scale

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3
Q

what is a high risk for mI

A

> 20% 10 yr risk on framingham scale

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4
Q

What scale should you use for sex specificity in risk for MI

A

reynolds risk score

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5
Q

What is metabolic syndrome

A 
insulin R
hyperglycemia
HTN
inc TGs
low HDL cholesterol
obesity
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6
Q

metabolic syndrome increases risk of CAD by how much

A

2 fold

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7
Q

what are the conditional risk factors for CAD

A 
homocysteine
lipoprotein(a)
hsCRP
LDL particle size
antioxidants
omega 3 fatty acids intake
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8
Q

what conditional risk factors have been shown to dec risk CAD

A

antioxidants and omega 3 fatty acids

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9
Q

what helps reduce risk factors for MI

A

aspirin, reduction BP, reduction HLD, smoking cessation, regular exercise
weight reduction and reduction of BMI <25

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10
Q

What are the Dx testing for MI

A

serum bio-markers: CK MB, troponin, LDH (1-5)
exercise stress test
pharmacological stress test
imaging augmentation
angiography
CT determined coronary artery calcium score

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11
Q

what is a stress test

A

every 3 min, grade and speed of treadmill goes up so myocardial O2 demand increases

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12
Q

what is HR maximum

A

220-age

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13
Q

what are the pharmacological ways for stress test

A

dobutamine ( inc cardiac O2 demand)

adenosine/dipyridamole (vasodilation)

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14
Q

What imaging do you order for suspected MI

A

nuclear and echo
angiography - golden standard for coronary occlusion
CT/MRI

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15
Q

what imaging is most useful for estimating coronary artery calcium scoring

A

CT/MRI

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16
Q

What is central chest pain

A

substernal discomfort
usually retro sternal
may radiat to shoulder, arms, jaw or back

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17
Q

what is visceral chest pain

A

poorly located, associated with nausea, vomiting, diaphoresis and SOB

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18
Q

what is exertional chest pain

A

brought on increased with activity or emotional stress
25% may be silent ischemia
25% atypical: women, DM, elderly

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19
Q

typical chest pain is usually alleviated by what

A

nitrates or rest

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20
Q

at what age are Men with typical chest pain at high risk for CAD

A

above 39 years old

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21
Q

at what age are Females with typical chest pain at high risk for CAD

A

above 59 yeras old

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22
Q

at what age are Men with nonanginal chest pain at intermediate risk for CAD

23
Q

If patient has intermediate risk for CAD what testing should be done

A

EKG norma- stress test

EKG abnormal- stress test with possible imagin augmentation, treatment based on findings

24
Q

If patient is at high risk for CAD what testing is done

A

medical therapy followed by stress test and or coronary angiography

25
Wht is typical chest pain
central visceral and exertional chest pain
26
what is atypical chest pain criteria
have 2 types of chest pain (central, visceral, exertional)
27
What are risk factors for unstable angina
``` >65 y/o >3 traditional cardiac risk factors documented CAD with >50% stenosis ST segment abnormalities >2 anginal episodes in last 24 hours used aspirin in last week elevated cardiac enzymes ```
28
how do you Dx unstable angina
new onset chest pain crescendo pattern not relieved by NTG
29
what is low risk for unstable angina and NSTEMI
0-2 risk factors. medical therapy and stress test to evaluate therapy if stress test abnomral- angiography
30
what is intermediate risk for unstable angina and NSTEMI, as well as treatment
3-4 risk factors, medical therapy and early angiography
31
what is high risk for unstable angina and NSTEMI, as well as treatment
5-7 risk factors, medical therapy and early angiography
32
Widened mediastinum on CXR is indicative of what
aortic dissection
33
what are signs of pericarditis
recent viral illness, pleuritic chest pain, paradoxical pulses
34
what are signs of PE
inactivity, new onset A fib
35
what are signs of CHF
SOB and orthopnea
36
What is the most significant determining factor for outcome STEMI
door to balloon time <90 minutes
37
what are absolute contraindications for thrombolytic therapy
intracranial hemorrhage ischemic CVA in last 3 mo facial trauma in last 3 mo bleeding diathesis
38
what are relative contraindications to thrombolytic therapy
``` chronic, severe HTN severe uncontrolled HTN ischemic CVA >3 mo known intracranial path dementia internal bleeding within last 4 wks pregnancy peptic ulcer disease anticoagulant use ```
39
what other syndromes increase death risk of STEMI in patients
new LBBB, anterior wall MI, cardiogenic shock, ventricular arrhythmias, advanced age >75 y/o
40
what are the early complications of MI thrombolytics
bleeding | reperfusion arrhythmias
41
What are the early complications with IWMI
bradycardia and AV block, AV nodal perfusion by right coronary artery right ventricular infarction, inferior wall hypotension for volume depletion
42
what are the early complications with aWMI
pump failure and CHF in large area infarcts, cardiogenic shock intra-aortic balloon pump syncrhonous counterpulsion
43
What are the late complications with MI
``` cardiogenic shock VSD papillary muscle rupture and MR free wall rupture L ventricular thrombus ```
44
What is cardiogenic shock
pump faction loss and thought to have inflammatory part
45
how is VSD detected
new systolic murmur and thrill on L sternal border
46
what are signs of papillary muscl eruptures and MR
new systolic murmur, PE, thrill and cardiogenic shock
47
Where do L vetnricular thrombi occur post MI
L ventricular apex
48
What are indications for angiography
``` EF <40% clinically significant ischemia on non-invasive testin arrhythmias during acute hospital stay recurrent chest painduring hospital stay significant heart failure during stay ```
49
What is PCI
percutaneous intervention
50
when is coronary artery bypass grafting in stable CAD recommended
patients with Left main disease, or left main equivalent
51
what are equivalents to left main disease
high grade stenosis in proximal LAD and circumflex, three vessel disease, two vessels involving proximal LAD and EF<50%
52
When do you use coronary angiography
``` positive stress test resusitated for cardiac arrest life limiting angina despite medical therapy unclear Dx evaluation STEMI ```
53
how do the elderly present with MIs
no chest pain SOB, exacerbation of existing and new presentation of CHF confusion/delirium

Year 2 CV (31 decks)

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