Gen Med: Lecture 5- Cardiovascular Assessment Flashcards
What are non-modifiable risk factors?
Age
Gender
Family History
What are modifiable risk factors?
Blood lipid abnormalities
Hypertension
Smoking
Physical Inactivity
Hyperglycemia
Obesity
Stress
Diet
What are some new emerging risk factors?
C-Reactive Protein
Homocysteine
Kidney Disease
Environmental Factors
Infection
Sleep
Gender/Race/Ethnic Disparities
What is atherosclerosis?
Progressive inflammatory disease
What is stable angina?
Chest pain related to stress or activity that is predictable
Occurs at set level of oxygen demand
What can stable angina be relieved by?
Rest
Nitroglycerin
What is Prinzmetal Angina?
Variant angina due to coronary vasospasm
Typically occurs at rest
Typically responds to nitrates
What is Unstable angina?
Unpredictable angina
May occur at rest, with exercise, stress
Can be new onset or more severe and prolonged
Medical emergency
How does palpation differ in stable angina compared to nonanginal discomfort?
Stable: Not palpable
Nonanginal: Muscle soreness, joint soreness, pain with deep breaths
How does nitroglycerin affect stable angina compared to nonanginal discomfort?
Stable: Relieves angina
Nonanginal: Generally no effect
How do additional symptoms in stable angina compare to that of nonanginal discomfort?
Stable: Feeling of doom, cold sweats, SOB
Nonanginal: Minimal additional symptoms
How does the ST segment in stable angina compare to nonanginal discomfort?
Stable: ST depression
Nonanginal: No ST depression
What is the single largest killer of men and women?
MI
What directly causes an MI?
Prolonged myocardial ischemia
How important is time with reperfusion following myocardial ischemia?
Early reperfusion can prevent necrosis
Irreversible changes in 20-30 mins
Some recovery possible if reperfusion in 3-6 hours
What are the causes of myocardial ischemia leading to MI?
Thrombus at site of atherosclerotic plaque
Prolonged vasospasm, aortic stenosis, arrhythmia, vasculitis, coronary artery dissection, hypotension
What is the area of myocardial necrosis related to?
Time of ischemia
Myocardial oxygen consumption
Collateral blood flow
How does the coronary artery differ in a STEMI vs Non-STEMI?
STEMI: Complete blockage
Non-STEMI: Partial blockage
How are EKGs different in STEMI vs Non-STEMI?
STEMI: ST elevation, Q wave in 24-48 ours
Non-STEMI: ST depression, T wave changes
What is a transmural infarction and what causes it?
Q wave on EKG in 24 to 48 hours
Caused by STEMI
What does myocardial remodeling depend on?
Size of infarct
Location of infarct
Ventricular load
Blood supply to area
How does scat formation affect the heart?
Restores structural integrity but not function
How is morbidity and mortality affected by an uncomplicated course MI?
Decreased
What is a complicated course MI?
24-48 hours after MI:
V Tach/ V Fib
A flutter/ A Fib
Second or Third degree heart block
Persistent Sinus Tach
Hypotension
PE
Cardiogenic shock
Persistent Angina
Extension of infarction
What is the long term prognosis of an MI related to?
Complications
Presence of disease in other coronary arteries
Left ventricular function
What is the most common cause of death following MI?
Ventricular arrhythmias
What is an average EF?
60%
What is the equation for EF?
SV/EDV
How are MIs identified on EKG?
Abnormal Q waves
ST elevation or depresion
What labs are used to diagnose MI?
LDH
CK-MB
Troponin
Myoglobin
What can be given to patients for treatment of an MI to reduce myocardial demand?
B-blockers
Nitrates
Ca2+ Channel Blockers
What can be given to a patient for treatment of an MI to increase myocardial oxygen supply?
Thrombolytics
Aspirin/Antiplatelets/Anticoagulants
Ca2+ Channel Blockers
Supplemental Oxygen
What can be given to patients for treatment of an MI to prevent arrhythmias?
Anti-arrhythmics
Pacemaker
What can be given to patients for treatment of an MI to relive pain?
Opioids
What surgeries can be done for treatment of MI?
Angioplasty
Stent placement
CABG
IABP
What lab is used to detect for heart failure?
BNP
What labs are used to assess coagulation?
PT
aPTT
INR
What labs are used to assess kidney function?
BUN
Creatinine
What labs are used as general risk factors?
C-reactive protein
Glucose
A1C
When do CK-MB levels begin to rise following an MI?
4-6 hours after
When do CK-MB levels peak following an MI?
12 hours after
When do CK-MB levels return to normal following an MI?
1-2 days
When do Troponin I levels begin to rise following an MI?
2-3 hours after
When do Troponin I levels peak following an MI?
12-24 hours after
When do Troponin I levels return to normal following an MI?
4-7 days
When do Troponin T levels begin to rise following an MI?
2-3 hours
When do Troponin I levels peak following an MI?
10-24 hours after
When do Troponin I levels return to normal following an MI?
10-14 days
What lab value are many facilities moving to to assess for MI?
High Sensitivity Troponin
What should you do if cardiac enzymes are within normal range after the first set of lab?
Wait for all 3 sets
What should you do if cardiac enzyme counts are rising following the 3 sets of labs?
PT contraindicated
What should you do if cardiac enzyme counts are decreasing following the 3 sets of labs?
Initiate PT with close monitoring
