Heart❤️ Flashcards
The first best appropriate test in investigating the chest pain is …
𝑬𝑪𝑮
What are three main criteria to diagnose ACS (Acute
Coronary Syndrome)?
1）𝑇𝑦𝑝𝑖𝑐𝑎𝑙 𝑐ℎ𝑒𝑠𝑡 𝑝𝑎𝑖𝑛
2）𝑃𝑜𝑠𝑖𝑡𝑖𝑣𝑒 𝐸𝐶𝐺 𝑓𝑖𝑛𝑑Ings
3）𝐸𝑙𝑒𝑣𝑎𝑡𝑒𝑑 𝑙𝑒𝑣𝑒𝑙 𝑜𝑓 𝑐𝑎𝑟𝑑𝑢𝑎𝑐 𝑚𝑎𝑟𝑘𝑒𝑟𝑠
𝑊ℎ𝑎𝑡 𝑎𝑟𝑒 𝑡𝑦𝑝𝑖𝑐𝑎𝑙 𝑠𝑖𝑔𝑛𝑠 & 𝑠𝑦𝑚𝑝𝑡𝑜𝑚𝑠 𝑜𝑓 MI？
．𝑅𝑒𝑡𝑟𝑜𝑠𝑡𝑒𝑟𝑛𝑎𝑙 𝑐ℎ𝑒𝑠𝑡 𝑝𝑎𝑖𝑛 𝑟𝑎𝑑𝑖𝑎𝑡𝑖𝑛𝑔 𝑡𝑜 𝑙𝑒𝑓𝑡 (𝑤𝑖𝑡ℎ 𝑜𝑟 𝑤𝑖𝑡ℎ𝑜𝑢𝑡 𝑟𝑖𝑔ℎ𝑡）， 𝑠ℎ𝑜𝑢𝑙𝑑𝑒𝑟， 𝑎𝑟𝑚， 𝑛𝑒𝑐𝑘， 𝑗𝑎𝑤
． 𝐴𝑠𝑠𝑜𝑐𝑖𝑎𝑡𝑒𝑑 𝑤𝑖𝑡ℎ 𝑑𝑖𝑎𝑝ℎ𝑜𝑟𝑒𝑠𝑖𝑠，𝑛𝑎𝑢𝑠𝑒𝑎， 𝑎𝑛𝑥𝑖𝑒𝑡𝑦
𝑾𝒉𝒂𝒕 𝒂𝒓𝒆 3 𝑬𝒔 𝒕𝒉𝒂𝒕 𝒄𝒂𝒖𝒔𝒆 𝑨𝑪𝑺?
𝑬𝒙𝒆𝒓𝒕𝒊𝒐𝒏
𝑬𝒎𝒐𝒕𝒊𝒐𝒏
𝑬𝒂𝒕𝒊𝒏𝒈
Duration of ACS is …and usually relieves by … and …
< 10-15 min
rest- nitrates
What is Levine’s sign?
Clutchung fist over sternum when describing chest pain
.
What are anginal equivalents?
Dyspenea, acute LV failure, flash pulmonary edema.
Close to … of MIs are
“silent” or unrecognized due to atypical symptoms.
30%
Silent MIs are more common in …
• Females
• Diabetics
• Seniors
• Post-heart transplant
𝑾𝒉𝒂𝒕 𝒂𝒓𝒆 𝒄𝒂𝒓𝒅𝒊𝒂𝒄 𝒎𝒂𝒓𝒌𝒆𝒓𝒔?
CPK / LDH / CK-MB / Troponin I
The physical findings that are most highly associated with cardiac disease include …
hypotension, diaphoresis, and a new S3 gallop
… of patients with cardiac disease will have their pain reproduced by chest wall pressure.
15%
کدام خصوصیات در درد سینه احتمال منشأ قلبی را کم میکند؟
- Sharp quality pain
- Continuous pain for
days or lasting fewer than 2 minutes - If a patient can pinpoint with one finger the localized painful area and is found tender on palpation.
A normal troponin and/or CPK-MB do not rule out cardiac disease; except in cases where the chest pain has been continuous for over…
12 hours
… of all patients with an MI will have a normal ECG in the ED.
9%
Only…% of those with an Ml have a diagnostic ECG in the
ED. Additionally, those with … may have a normal ECG.
50
angina
….is more sensitive in the first … hours than is the troponin (about … versus …).
CK- MB
6
84% 74%
An increased … is associated with increased short term and in-hospital mortality.
troponin
Patients with … disease may have a mildly elevated troponin at baseline due to poor clearance,
renal
… like MI, can elevate the serum troponin.
pulmonary emboli
𝑾𝒉𝒊𝒄𝒉 𝒄𝒐𝒏𝒅𝒊𝒕𝒊𝒐𝒏𝒔 𝒐𝒕𝒉𝒆𝒓 𝒕𝒉𝒂𝒏 𝑴𝑰, 𝒄𝒂𝒏 𝒆𝒍𝒆𝒗𝒂𝒕𝒆 𝒕𝒓𝒐𝒑𝒐𝒏𝒊𝒏?
CHF, PE, burns, sepsis or
other critical illnesses,
stroke.
What is the role of ECG in therapeutic
decisions in MI?
Presence or absence of
elevation in ST segment of
ECG
Aspirin given within half an hour of chest pain is similar to … treatment.
thrombolytic
patient with chest pain that may be cardiac in origin, current use of warfarin or aspirin should not prevent the … in the emergency department.
administration of aspirin
….and … from NSAIDs, are reversible platelet inhibitors that do not give adequate platelet inhibition.
Iboprofen
Maproxen
…. and ….. can block the effect of aspirin by making binding sites
on platelets unavailable.
Ibuprofen
Naproxen
stopping … is considered good practice for any patient who is admitted for possible CAD.
NSAIDs
In ACS percentage of Unstable Angina (UA) is … %
NSTEMI … %
STEMI: plaque rupture and thrombus formation … %
38
25
30
The microemboli breaks away from the ruptured plaque and causes … or …
subendocardial infarction NSTEMI
ischemia UA
The microemboli breaks away from the ruptured plaque and causes … or ….
subendocardial infarction NSTEMI
ischemia UA
𝑰𝒏 𝒄𝒉𝒆𝒔𝒕 𝒑𝒂𝒊𝒏, 𝒏𝒆𝒙𝒕 𝒔𝒕𝒆𝒑 𝒂𝒇𝒕𝒆𝒓 𝑬𝑪𝑮 & 𝒉𝒆𝒂𝒓t 𝒆𝒏𝒛𝒚𝒎𝒆𝒔 𝒘𝒊𝒍𝒍 𝒃𝒆 …
𝒔𝒕𝒓𝒆𝒔𝒔 𝒕𝒆𝒔𝒕
If stress test shows ischemia, the next step will be ..
angiography
… is the most alarming
thing a stress test could show.
Reversible ischemia
… is the most alarming
thing a stress test could show.
Reversible ischemia
… is a defect that remains unchanged between exercise
Fixed defect
The best initial test to evaluate valve function or ventricular wall motion is …
Echocardiography
The most accurate method for evaluating ejection fraction is …
Nuclear ventriculogram
(MUGA scan)
…. is the only one that have resulted in lower mortality in chest pain.
Low molecular weight Heparin (LMWH)
… is the most useful intervention to improve functional capacity and reduce symptomatic claudication in patients with peripheral arterial disease.
A supervised graded exercise program
… reduce overall cardiovascular mortality.
Antiplatelet agents (e.g., aspirin,
clopidogrel)
… should also be given to all patients with clinically significant atherosclerotic cardiovascular
disease.
Lipid-lowering therapy with statins
What is Vincent Angina?
Chest pain because of pharyngitis and tonsillitis, kind of referred pain from the infection location
… is a type of severe cellulitis of the floor of the mouth, in which pus can trickle down to the chest cavity.
Ludwig’s angina
Pain in … is related to activity, occasionally it occurs at rest as well and is linked with rupture of atherosclerotic plaque.
unstable angina
A chest pain that happens after an episode of MI (post MI), after PCI or after CABG is also referred to as …
unstable angina
Based on Canadian Cardiovascular Society (CCS), angina caused with strenuous, rapid, or prolonged activity if indicated as class … angina.
I (one)
According to CCS angina that occur during walking > 2 blocks (same level) or
> 1 flight of stairs with slight imitation of ordinary activity is referred to class …
II (two)
According to CCS, angina that occurs while walking < 2 blocks (same level) or climbing <1 flight of stairs, i.e., limitation of ordinary household activity is referred to class …
III (three)
In class … angina, no physical activity is possible without discomfort
OR
Angina occurs at rest.
IV (four)
چه مقدار LDL در فرد دیابتی پرخطر محسوب میشود؟
بالاتر از mg/dl ۷۰ یا ۱/۸ mEq/L
چه بیمارانی برای آسپرین Eligible هستند؟
1- coronary artery diseases
2- peripheral artery diseases (e.g leg cramp)
(Not just diabetic)
نسبت ankle/brachial در حد …. نشانهی آترواسکلروزِ moderate است و باید … شروع شود.
۱:۵ - ۱:۸
آسپرین
