IHD Flashcards
Definition of Ischemic Heart Disease
narrowing of one or more coronary arteries due to atherosclerosis
Main Types of Cardiovascular disease
IHD
cerebrovascular disease (CVD)
peripheral arterial disease (PAD)
venous thromboembolic disease (VTE)
Heart failure
arrhythmia
Types of Acute Coronary Syndrome
unstable angina
NSTEMI
STEMI
What is unstable angina
inadequate “supply regardless of demand”
blockage without cardiac cell death
What is stable angina
dull ache in the chest
problem of “demand exceeding supply”
What is fixed obstruction angina
increase demand that cannot be accommodated with increase supply
What is affected of coronary atherosclerosis?
increase of demand
increase HR, BP, contractility, venous return
What are some triggers for stable angina
SNS activity
exertion after a heavy meal
metabolic demands
anemia
What is the definition of fixed obstructions in the heart?
if epicardial vessels obstructed
it will cause the heart muscle to not get enough blood
What is it if the chest pain is relieved by rest
it is stable angina
you will see ST segment depression
What are the different ECG to look for?
ST segment depression (ischemia)
ST segment elevation (infarction)
QT interval
T or F a normal QT is normal in a healthy patient
no it is not normally seen
if you can see it ventricular de/repolarization is off
(evidence of the past heart attack)
T or F Stable angina is not an emergency
True
What are the core meds after a ACS?
Antiplatelet
Blood pressure
Cholesterol lowering
K-CKD
Diabetes
Exercise (lifestyle)
What is primary prevention?
before a cardiac event
What is secondary prevention?
stopping the next cardiac event
What is first line for prevention of angina?
metoprolol (BB)
nitro to treat pain PRN
What is the second line for prevention of angina?
Metoprolol + NTG patch
Metoprolol + amlodipine (if BP increased)
increase metoprolol
switch to add on ranolazine
When is ACE used with stable?
helps with pt. who have low EF, HTN, CKD
List what drugs are part of antianginal therapy
BB
DHP-CCB
Non-CCB
nitrates
ranolazine
When is BB and DHP CCB CI?
heart block (AV block) can be a consequence and CI
Ways to treat coronary atherosclerosis
CABG
PCI
fibrinolytic medications
Explain CABG
coronary artery bypass
- bypass graft to create a new path
-requires open heart surgery
Explain PCI
percutaneous coronary intervention
-mesh tube to open the artery
When is fibrinolytic medications used for CA?
for acute emergencies
-myocardial infarction
After PCI he needs DAPT
dual antiplatelet therapy
ASA +ADPi
List the ADP inhibitors
ticagrelor
clopidogrel
prasugrel
What are the two types of stents?
bare metal stents
drug eluting stents
Why are drug eluting stents used?
usually immunosuppressants to decrease inflammatory cytokines and cell proliferation following stent implantation
Role of DAPT is a key question in ACVP
long DAPT = increase risk of bleeding
short DAPT = increase risk of events
What should be Monitored with DAPT
clinical signs of bleeding (hematemesis, blood stool, bruising)
generally tolerability (GI upset)
Lab test (RBC, platelet count)
