Ischemic HD Flashcards
IHD same as?
coronary HD
coronary artery dx
IHD due to?
Result of?
Imbalance b/w myocardial O2 demands and supply
stenosis (narrowing)
Atherogenesis definition?
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
What properties of HDL make it atheroprotective?
anti-inflamm and anti-oxidant
Natural protective process of endothelial cells to inhibit plaque formation?
release NO
Myocardial Perfusion primarily occurs during which part of cardiac cycle?
diastole
Main coronary arteries located where?
Blood flows from?
epicardium
blood flows from epi to endocardium
Plaques U form at which sites in arteries?
areas of turbulance
e.g. branching points in epicardial aa
Ischemia is
↓ blood flow
IHD presentation?
stable angina
acute coronary syndrome (ACS)
Angina Pectoris presentation?
Location Character Radiation Duration Relief
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
Angina Pectoris U sign of what kind of ischemia?
transient
Atypical Angina presentation?
(More common in elderly and DM) dyspnea (U) women nausea fatigue faintness
Atypical Angina presentation NOT likely from ischemia or true angina?
sharp, fleeting stabs
prolonged, dull ache in L precordial area
IHD physical exam, check for? (8)
BP xanthomas A/V nicking carotid pulses/bruits cardiac enlargement (by palpation) murmurs S3/4 Aorta size/bruits (abdom) extremity pulse/edema
Stable Angina definition?
exertional/stress-related chest or arm discomfort
resolves w/ rest or nitro
<10min
Unstable Angina definition?
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)
Prinzmetal’s Angina definition?
chest pain at rest
a/w transient ST elevation
sxs 2º to vasospasm
U younger w/ low risks
Prinzmetal’s Angina test?
coronary angiography
stress test NOT helpful
Prinzmetal’s Angina tx?
nitrates
Ca2+ channel blocker
Stable Angina tests?
ECG = St-T wave ∆s during chest pain only
Exercise Stress Test = try to reproduce ischemia
Imaging: ECG, Echo, Nuclear
Stress Echo + for ischemia if?
wall mvmt abnorm w/ stress
Coronary Angiography gold standard for?
CAD diagnosis
Doesn’t show vulnerable plaques
Best test for vulnarable plaques?
intracoronary US
IHD tx?
tx sxs, not prevention
Stable Angina tx?
↓risk factors nitrates β blockers Ca2+ channel blockers anti-platelte meds revascularization
Nitrates do what?
↓ O2 demand and ↑ O2 supply
thru preload reduction
β blockers do what?
FIRST LINE for chronic angina
↓ O2 demand
thru ↓ HR, BP, contractility
Ca2+ Channel Blockers do what?
For pt’s who don’t respond to nitrates or β blockers
Vasodilators
↓ O2 demand and ↑ O2 supply
thru ↓ BP, contractility
Anti-platelet med names?
asprin
plavix
2 kinds of revascularization?
PCI
CABG
PCI is?
Do when?
Percutaneous Coronary Intervention:
w/ or w/o stent placement
angina despite tx
evidence of ischemia on stress test
CABG is?
Do when?
Coronary Artery Bypass Grafting
L main coronary stenosis
triple vessel dx
ACS present as?
unstable angina
Non-ST seg elevation MI (NSTEMI)
ST-seg elevation MI (STEMI)
atypical angina sxs
4 UnstbAngina/NSTEMI (P) pathophys processes?
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)
Tests that differentiate UA from NSTEMI?
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
UA/NSTEMI tx? (7)
bedrest w/ monitoring and O2 Nitrates β blockers Morphine (PRN) anti-thrombotic (asprin) anti-coag (heparin) (P) revascularization
STEMI pathophys?
rupture of vulnerable plaque
complete occlusion
1/2 have precipitating event
(4) Emergent DDX for chest pain?
Aortic dissection
PE
Pneumothorax
Perforated viscous (GI organ perf)
ACS tests?
ECG Enzymes Echo Angiogram CXR CBC, lipids
TIMI Risk Score for UA/NSTEMI?
Probability of Thrombolysis (progression from UA/NSTEMI to STEMI)?
pt given a point for each risk factor
TIMI ratings?
0-1 = 4.7% risk 2 = 8.3% 3 = 13.2 % 4 = 19.9% 5 = 26.2% 6-7 = 40.9%
ACS management?
(MONA) Oxygen Nirto Morphine Asprin
STEMI tx?
MONA β blocker (metroprolol) anti-coag (heparin) anti-arrhyth ACE inhib Statin Reperfusion (cath lab)
Goal of reperfusion in STEMI?
limit infarct size
Thrombolytic tx used for?
(fibrinolytic)
for immediate tx of heart attack or stroke
Contraindications for Thrombolytics? (5)
hx of brain hemorr strok w/i yr uncontrolled HTN (>180/110) aortic dissection active internal bleeding
Post MI complications?
recurrent ischemia pump failure (leading cause of death inpt) vent arrhy pericarditis (Dressler's) Mural thrombus (in wall of heart) cardiac rupture depression
