Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Gen Med Unit 7: Cardio > Ischemic Heart Disease 1 > Flashcards

Ischemic Heart Disease 1 Flashcards

1
Q

What is the leading cause of death in both men and women?

A

Ischemic Heart Disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the strongest risk factor for CAD?

A

age

CAD may become clinically apparent by age 40, but people ≥ 65 yr account for approx. 85% of deaths from CAD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is the Leading cause of death for people of most racial and ethnic groups in US?

A

Ischemic heart disease
Most common in Hispanic Americans and least common in Asian Americans, Pacific Islanders, American Indians, and Alaska Natives

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are CAD risk factors?

A 
(+) FH
-Younger the onset in a first degree relative, the greater the risk (< 55 yr)
Male gender
Dyslipidemia
DM
HTN
Physical inactivity
Truncal obesity
Cigarette smoking
Psychosocial factors
Excess ETOH consumption
Poor diet
Low estrogen state
Cocaine use
High sensitive CRP
-Inflammatory marker
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the modifiable risk factors for CAD?

A 
1. Tobacco use
A. Number 1 modifiable cause of CAD
2. Dyslipidemia
A. ↑ Risk with high levels LDL
B. ↓ Risk with high levels HDL
3. Metabolic syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Define metabolic syndrome

A

Constellation of 3 or more of the following

  1. Truncal obesity
  2. Triglycerides > 150 mg/dl
  3. HDL cholesterol < 40 mg/dl in men and < 50 mg/dl in women
  4. Fasting glucose > 110 mg/dl
  5. HTN
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is included in ischemic heart disease?

A
  1. Chronic Stable Angina Pectoris
  2. Coronary Vasospasm & Angina
  3. Unstable Angina
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

define ischemic heart disease

A

Characterized by insufficient oxygen supply to cardiac muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the causes of IHD?

A
  1. Most often caused by atherosclerotic narrowing
  2. Can be caused by coronary artery vasospasm
  3. Rare causes
    A. Congenital anomalies
    B. Emboli
    C. Arteritis
    D. Dissection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Define stable angina

A

Exacerbated by physical activity and relieved by rest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Define Prinzmetal’s angina

A
  1. Also called variant angina

2. Caused by vasospasm at rest with preservation of exercise tolerance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Define unstable angina

A
  1. Increasing pattern of pain in a previously stable patient

2. Less responsive to meds, lasts longer and occurs at rest or with minimal exertion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what are Circumstances that may precipitate & relieve angina?

A
  1. Occurs most commonly during activity & relieved by rest

2. Can be precipitated by excitement and exposure to cold

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what are Characteristics of discomfort in CAD?

A

Sensation of tightness, squeezing, burning, aching, indigestion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what are Characteristics of location and radiation in CAD?

A

Substernal discomfort w/ radiation to left shoulder & upper arm and down medial aspect arm, neck, jaw, mid upper back

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what are Characteristics of duration of attack in CAD?

A
  1. Short duration, usually < 3 mins if asst w/ exertion
  2. Attacks brought on by heavy meal last ≈ 15-20 min
  3. Attacks > 20-30 min suggest unstable angina or MI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the effects of NTG in CAD?

A

If SL NTG promptly relieves discomfort, suspect angina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is levine’s sign?

A
  1. Clenched fist over sternum and clenched teeth when describing chest discomfort
  2. Classic sign of ischemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the sxs of CAD?

A
  1. Elevated SBP & DBP common during episode of chest discomfort
  2. Levine’s sign
  3. +/- S3 gallop
    A. If pt in heart failure
  4. +/- arrhythmia
    A. Can be cause or result of ischemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What diagnostic studies are indicated for CAD?

A
  1. Cardiac enzymes
    Serial Troponins, CK-MB
  2. Serial EKGs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How often are cardiac enzymes monitored?

A

Evaluated q 6-8 hrs x 3

22
Q

How often are EKGs monitored?

A

Evaluated q 6-8 hrs x 3

23
Q

What may be seen in EKG in CAD pts?

A

Horizontal or downsloping ST segment depression that reverses after sxs disappear is strong evidence for ischemia
Flattened or inverted T waves may also be seen

24
Q

What is pts risk of CAD based on?

A

H&P
EKG
Labs (Lipids, Glucose, normal Troponin/CK-MB)

25
Q

What is indicated for low risk CAD pts?

A

Patients with low to intermediate pretest probability undergo non-invasive stress testing

26
Q

What is indicated for high risk CAD pts?

A

Patients with high pretest probability are generally referred for cardiac catheterization

27
Q

When is an exercise stress test indicated?

A
  1. Most commonly used noninvasive procedure for evaluating inducible ischemia
  2. Used in low risk patient without baseline ST segment abnormalities
  3. Pt’s with sx’s or signs suggestive of CAD
  4. Pt’s with significant risk factors for CAD
  5. To evaluate exercise tolerance when pt’s have unexplained fatigue and SOB
  6. To evaluate BP response to exercise in pt’s with borderline HTN
  7. To look for exercise-induced serious irregular heart beats
  8. Evaluate response to Tx
28
Q

What is the protocol for exercise stress testing?

A
  1. Treadmill speed & elevation ↑ q 3 min up to 9 min (3 stages) until symptomatic / EKG ∆’s, or achieves target heart rate
    A. 85% of the maximal heart rate predicted for the patient’s age
  2. 3 EKG leads are continually monitored
29
Q

What needs to be done to beta blocker meds before an exercise stress test?

A

Beta blockers must be tapered off before test and then restarted

30
Q

when is an exercise stress test unreliable? What tests are then preferred?

A
  1. Reliability drops drastically if there are significant EKG changes at rest*
    A. Long standing HTN
    B. Permanent pacemaker
    C. LBBB
    D. WPW syndrome
  2. Echo Stress Test or Nuclear Stress Test preferred
31
Q

What are the precautions and risks for exercise stress tests?

A
  1. Risk of 1 MI or 2 deaths per 2500 tests

2. Risk determination important in selecting pt’s for EST

32
Q

What are the contraindications for exercise stress tests?

A 
Uncontrolled HTN (>200/110 mmHg)
Severe or symptomatic aortic stenosis 
Unstable angina within 48 hrs
Unstable cardiac rhythm
Acute myocarditis or pericarditis
Inadequately controlled CHF 
Severe pulmonary HTN
Acute illness
33
Q

What is a positive EKG interpretation during an exercise stress test?

A
  1. 1 mm (0.1 mV) horizontal or downsloping ST depression
  2. 1 mm (0.1 mV) ST elevation
  3. Upsloping ST depression ≥ 2 mm (0.2 mV) 0.08 sec from J point
  4. U wave inversion
  5. Occurrence of frequent PVCs, multifocal PVCs or VT at mild exercise (< 70% of maximal heart rate)
34
Q

What are the positive clinical findings in an exercise stress test?

A
  1. Exercise-induced hypotension (>10 mmHg drop of SBP)
  2. Exercise-induced angina
  3. Appearance of an S3, S4 gallop or heart murmur during exercise
    A. Cardiac muscle dysfunction
35
Q

What is the max SBP for an exercise stress test?

A

Max allowed SBP of 230 mm Hg

If >, Tx for HTN

36
Q

What percentage of pts w/ CAD will have a positive exercise stress test?

A

60-80%

37
Q

What percentage of pts w/o CAD will have a false positive exercise stress test?

A

10-30%

38
Q

When is a pt referred for cardiac catheterization?

A

If EST is (+) and pt has risk factors, signs & sx’s consistent with ischemia

39
Q

What meds are used to induce stress?

A
  1. Adenosine
  2. Dobutamine
  3. Lexiscan
40
Q

What are pharmacologic stress agents used with?

A

Used along with echo or nuclear imaging

41
Q

Why is adenosine used for CAD stess testing?

A

Adenosine - Dilates coronary arteries
Causes ↑ blood flow in normal vessels and less of a response in stenotic vessels
Perfusion defects appear in cardiac nuclear scans or as ST-segment changes
S/E - flushing, chest pressure or pain, SOB, &/or headache

42
Q

Why is dobutamine used for CAD stess testing?

A

Dobutamine - Increases heart rate
Cardiac inotrope and chronotrope (affects rate and pumping action)
S/E - Chest pain, ↑ BP, arrhythmias, dizziness, nausea and extreme fatigue, MI (rare)
Avoid using with WPW syndrome, LBBB, permanent pacemaker (Adenosine preferred)

43
Q

Why is lexiscan used for CAD stess testing?

A

Lexiscan (regadenoson)-Dilates coronary arteries

Approved by the FDA in 2008

44
Q

What are the indications for myocardial perfusion scintigraphy?

A

When resting EKG makes an EST difficult to interpret
(LBBB, WPW, pacemaker, baseline ST-T wave changes)
Confirms EST when pt asymptomatic
Localizes region of ischemia
Distinguish ischemia from infarction
Assess revascularization post-op after CABG or angioplasty

45
Q

What is the procedure for myocardial perfusion scintigraphy?

A

Radioactive material injected IV
Thallium 201
Technetium 99m sestamibi
Radioactive material attaches to the heart muscle
Pictures of the heart taken at rest
Exercise or chemical stress test performed
During the stress portion of the test, 2nd injection given
Repeat pictures
Pre and post stress pictures are compared to look for evidence of blockage

46
Q

What is the interpretation for myocardial perfusion scintigraphy?

A

Defect in zone of hypoperfusion is evident during stress phase
Indicative of ischemia or scar
Defects observed when radiotracer is injected at rest or still present 3-4 hours after injection
Indicative of myocardial infarction (old or recent)

47
Q

What is the interpretation accuracy for myocardial perfusion scintigraphy?

A

(+) in ≈ 75-90% of pts with anatomically significant CAD

(+) in 20-30% of pts without significant CAD

48
Q

What is a stress echo used for?

A

Used as initial screen in pt’s with EKG that shows Nonspecific ST-T wave changes

49
Q

What is the protocol for stress echo?

A
  1. Resting echocardiogram is performed
  2. Pt then exercises on treadmill or chemical injected IV
  3. Exercise ECHO is then done
  4. Looking for exercise induced wall motion abnormalities (hypokinesis, akinesis)
  5. Requires considerable expertise for interpretation
50
Q

What is the interpretation for stress echo?

A
  1. (+) test will demonstrate wall motion abnormalities

A. Hypokinesis inferior wall, lateral wall, septum, anterior wall

Gen Med Unit 7: Cardio (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions