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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

A

above 39

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
Q

Wht is typical chest pain

A

central visceral and exertional chest pain

26
Q

what is atypical chest pain criteria

A

have 2 types of chest pain (central, visceral, exertional)

27
Q

What are risk factors for unstable angina

A 
>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
Q

how do you Dx unstable angina

A

new onset chest pain
crescendo pattern
not relieved by NTG

29
Q

what is low risk for unstable angina and NSTEMI

A

0-2 risk factors. medical therapy and stress test to evaluate therapy
if stress test abnomral- angiography

30
Q

what is intermediate risk for unstable angina and NSTEMI, as well as treatment

A

3-4 risk factors, medical therapy and early angiography

31
Q

what is high risk for unstable angina and NSTEMI, as well as treatment

A

5-7 risk factors, medical therapy and early angiography

32
Q

Widened mediastinum on CXR is indicative of what

A

aortic dissection

33
Q

what are signs of pericarditis

A

recent viral illness, pleuritic chest pain, paradoxical pulses

34
Q

what are signs of PE

A

inactivity, new onset A fib

35
Q

what are signs of CHF

A

SOB and orthopnea

36
Q

What is the most significant determining factor for outcome STEMI

A

door to balloon time <90 minutes

37
Q

what are absolute contraindications for thrombolytic therapy

A

intracranial hemorrhage
ischemic CVA in last 3 mo
facial trauma in last 3 mo
bleeding diathesis

38
Q

what are relative contraindications to thrombolytic therapy

A 
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
Q

what other syndromes increase death risk of STEMI in patients

A

new LBBB, anterior wall MI, cardiogenic shock, ventricular arrhythmias, advanced age >75 y/o

40
Q

what are the early complications of MI thrombolytics

A

bleeding

reperfusion arrhythmias

41
Q

What are the early complications with IWMI

A

bradycardia and AV block, AV nodal perfusion by right coronary artery
right ventricular infarction, inferior wall
hypotension for volume depletion

42
Q

what are the early complications with aWMI

A

pump failure and CHF in large area infarcts, cardiogenic shock
intra-aortic balloon pump syncrhonous counterpulsion

43
Q

What are the late complications with MI

A 
cardiogenic shock
VSD
papillary muscle rupture and MR
free wall rupture
L ventricular thrombus
44
Q

What is cardiogenic shock

A

pump faction loss and thought to have inflammatory part

45
Q

how is VSD detected

A

new systolic murmur and thrill on L sternal border

46
Q

what are signs of papillary muscl eruptures and MR

A

new systolic murmur, PE, thrill and cardiogenic shock

47
Q

Where do L vetnricular thrombi occur post MI

A

L ventricular apex

48
Q

What are indications for angiography

A 
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
Q

What is PCI

A

percutaneous intervention

50
Q

when is coronary artery bypass grafting in stable CAD recommended

A

patients with Left main disease, or left main equivalent

51
Q

what are equivalents to left main disease

A

high grade stenosis in proximal LAD and circumflex, three vessel disease, two vessels involving proximal LAD and EF<50%

52
Q

When do you use coronary angiography

A 
positive stress test
resusitated for cardiac arrest
life limiting angina despite medical therapy
unclear Dx evaluation
STEMI
53
Q

how do the elderly present with MIs

A

no chest pain
SOB, exacerbation of existing and new presentation of CHF
confusion/delirium

Year 2 CV (31 decks)

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