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Q2 Clin Med Final (Cardiology, Hyperlip) > Ischemic HD > Flashcards

Ischemic HD Flashcards

1
Q

IHD same as?

A

coronary HD

coronary artery dx

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2
Q

IHD due to?

Result of?

A

Imbalance b/w myocardial O2 demands and supply

stenosis (narrowing)

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3
Q

Atherogenesis definition?

A

Development of plaques due to:
oxidation of lipids ->
deposited in intima
(innermost layer of artery, made of endothelial cells)
->
inflammatory process that produces foam cells

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4
Q

What properties of HDL make it atheroprotective?

A

anti-inflamm and anti-oxidant

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5
Q

Natural protective process of endothelial cells to inhibit plaque formation?

A

release NO

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6
Q

Myocardial Perfusion primarily occurs during which part of cardiac cycle?

A

diastole

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7
Q

Main coronary arteries located where?

Blood flows from?

A

epicardium

blood flows from epi to endocardium

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8
Q

Plaques U form at which sites in arteries?

A

areas of turbulance

e.g. branching points in epicardial aa

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9
Q

Ischemia is

A

↓ blood flow

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10
Q

IHD presentation?

A

stable angina

acute coronary syndrome (ACS)

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11
Q

Angina Pectoris presentation?

Location
Character
Radiation
Duration
Relief
A

Loc = Substernal (Levine’s Sign: fist over sternum)

Char = (U) not “pain”
heaviness, pressure
squeeze/tight, smothering/choking

Rad = shoulder, arms
neck, jaw, teeth
epigastric, mid-back

Dur = 2-5 min
(U) cresceno-decresc

Rel = <5 min w/ rest or nitro

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12
Q

Angina Pectoris U sign of what kind of ischemia?

A

transient

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13
Q

Atypical Angina presentation?

A 
(More common in elderly and DM)
dyspnea (U) women
nausea
fatigue
faintness
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14
Q

Atypical Angina presentation NOT likely from ischemia or true angina?

A

sharp, fleeting stabs

prolonged, dull ache in L precordial area

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15
Q

IHD physical exam, check for? (8)

A 
BP
xanthomas
A/V nicking
carotid pulses/bruits
cardiac enlargement (by palpation)
murmurs S3/4
Aorta size/bruits (abdom)
extremity pulse/edema
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16
Q

Stable Angina definition?

A

exertional/stress-related chest or arm discomfort
resolves w/ rest or nitro
<10min

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17
Q

Unstable Angina definition?

A

discomfort w/ at least one of the following:

1) at rest, >10min
2) severe and new (w/i last 6wks)
3) crescendo (more severe, longer or frequent than previous)

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18
Q

Prinzmetal’s Angina definition?

A

chest pain at rest
a/w transient ST elevation
sxs 2º to vasospasm
U younger w/ low risks

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19
Q

Prinzmetal’s Angina test?

A

coronary angiography

stress test NOT helpful

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20
Q

Prinzmetal’s Angina tx?

A

nitrates

Ca2+ channel blocker

21
Q

Stable Angina tests?

A

ECG = St-T wave ∆s during chest pain only
Exercise Stress Test = try to reproduce ischemia
Imaging: ECG, Echo, Nuclear

22
Q

Stress Echo + for ischemia if?

A

wall mvmt abnorm w/ stress

23
Q

Coronary Angiography gold standard for?

A

CAD diagnosis

Doesn’t show vulnerable plaques

24
Q

Best test for vulnarable plaques?

A

intracoronary US

25
Q

IHD tx?

A

tx sxs, not prevention

26
Q

Stable Angina tx?

A 
↓risk factors
nitrates
β blockers
Ca2+ channel blockers
anti-platelte meds
revascularization
27
Q

Nitrates do what?

A

↓ O2 demand and ↑ O2 supply

thru preload reduction

28
Q

β blockers do what?

A

FIRST LINE for chronic angina
↓ O2 demand
thru ↓ HR, BP, contractility

29
Q

Ca2+ Channel Blockers do what?

A

For pt’s who don’t respond to nitrates or β blockers

Vasodilators
↓ O2 demand and ↑ O2 supply
thru ↓ BP, contractility

30
Q

Anti-platelet med names?

A

asprin

plavix

31
Q

2 kinds of revascularization?

A

PCI

CABG

32
Q

PCI is?

Do when?

A

Percutaneous Coronary Intervention:
w/ or w/o stent placement

angina despite tx
evidence of ischemia on stress test

33
Q

CABG is?

Do when?

A

Coronary Artery Bypass Grafting

L main coronary stenosis
triple vessel dx

34
Q

ACS present as?

A

unstable angina
Non-ST seg elevation MI (NSTEMI)
ST-seg elevation MI (STEMI)
atypical angina sxs

35
Q

4 UnstbAngina/NSTEMI (P) pathophys processes?

A

1) plaque erupt w/ nonocclusive thrombus (C)
2) dynamic obstruction (e.g. spasm)
3) progressive mechanical obstruction (athsclero post PCI)
4) UA 2º to ↑ O2 demand or ↓ supply (e.g anemia or tachycard)

36
Q

Tests that differentiate UA from NSTEMI?

A

UA:
no ↑ of CK-MB or Troponin
(P) ST depress or T wave invert

NSTEMI:
↑ of CK-MB or Troponin
(U) no ST elev
(P) ST deprss or T wave invet

37
Q

UA/NSTEMI tx? (7)

A 
bedrest w/ monitoring and O2
Nitrates
β blockers
Morphine (PRN)
anti-thrombotic (asprin)
anti-coag (heparin)
(P) revascularization
38
Q

STEMI pathophys?

A

rupture of vulnerable plaque
complete occlusion
1/2 have precipitating event

39
Q

(4) Emergent DDX for chest pain?

A

Aortic dissection
PE
Pneumothorax
Perforated viscous (GI organ perf)

40
Q

ACS tests?

A 
ECG
Enzymes
Echo
Angiogram
CXR
CBC, lipids
41
Q

TIMI Risk Score for UA/NSTEMI?

A

Probability of Thrombolysis (progression from UA/NSTEMI to STEMI)?
pt given a point for each risk factor

42
Q

TIMI ratings?

A 
0-1 = 4.7% risk
2 = 8.3%
3 = 13.2 %
4 = 19.9%
5 = 26.2%
6-7 = 40.9%
43
Q

ACS management?

A 
(MONA)
Oxygen
Nirto
Morphine
Asprin
44
Q

STEMI tx?

A 
MONA
β blocker (metroprolol)
anti-coag (heparin)
anti-arrhyth
ACE inhib
Statin
Reperfusion (cath lab)
45
Q

Goal of reperfusion in STEMI?

A

limit infarct size

46
Q

Thrombolytic tx used for?

A

(fibrinolytic)

for immediate tx of heart attack or stroke

47
Q

Contraindications for Thrombolytics? (5)

A 
hx of brain hemorr
strok w/i yr
uncontrolled HTN (>180/110)
aortic dissection
active internal bleeding
48
Q

Post MI complications?

A 
recurrent ischemia
pump failure (leading cause of death inpt)
vent arrhy
pericarditis (Dressler's)
Mural thrombus (in wall of heart)
cardiac rupture
depression

Q2 Clin Med Final (Cardiology, Hyperlip) (8 decks)

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