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Cardiology > Ischemic Heart Disease > Flashcards

Ischemic Heart Disease Flashcards

1
Q

What is the typical in a patient history for stable angina?

A

Symptoms precipitated by stress or exertion. Relieved by rest or nitrates. Long standing >1-2 months

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2
Q

What is the typical in a patient history for unstable angina?

A

Chest pain at rest or with minimal exertion. New onset angina. Worsening angina (crescendo)

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3
Q

How is ischemic heart disease classified?

A

class I: asymptomatic. class II: mild limitation of excercise tolerance and sx w/ordinary exertion. class III: moderate limitation of excercise tolerance and sx w/minimal exertion. class IV: severe limitation of activities and sx at rest

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4
Q

What labs should be done for unstable angina?

A

troponin I, CK-MB, CBC, TSH, update lipids, CMP, DM

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5
Q

What EKG changes are suggestive of ischemia?

A

New bundle branch block, T wave inversion, depression or flattening, ST depression or elevation, Q waves

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6
Q

When is cardiac catheterization/coronary angiography indicated for chronic stable angina?

A

Persistent limiting angina despite maximal medical therapy. Stress test suggestive of high risk disease.
History of aortic valve disease. Worsening symptoms

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7
Q

How are short acting nitrates used for immediate relief of anginal sx?

A

0.4mg sublingual nitroglycerin tablets or spray. Repeat in 3-5 min if needed until pain is gone. Pain lasting > 20 min call EMS

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8
Q

How do nitrates decrease the O2 demand on the heart?

A

causes vasodilation that decreases arteriolar and venous tone, preload, afterload, and BP.

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9
Q

What are most common side effects of nitroglycerin?

A

HA, dizziness, hypotension, flushing

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10
Q

What are contraindications to nitrates?

A

hypotension, aortic stenosis, volume depletion, acute RV infarction, hypertrophic cardiomyopathy, ED meds

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11
Q

Describe the use of long acting nitrates for ischemic heart disease

A

Used to prevent sx. added to beta blockers or calcium channel blockers. Need a nitrate free interval of 8-10 hours a day to help prevent development of tolerance

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12
Q

What are the three long acting nitrates?

A

Isosorbide dinitrate (Isordil), Isosorbide mononitrate (Imdur), Transdermal patch (NitroDur)

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13
Q

What is the first line therapy for treatment of angina?

A

beta blockers: decrease HR, contractility, rate of AV conduction therefore decreasing myocardial O2 consumption

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14
Q

What are contraindications to beta blockers?

A

Severe bronchospasm, Bradyarrhythmias, Decompensated heart failure, May worsen Prinzmetal’s angina

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15
Q

What is the only approved calcium channel blocker for use with CHF?

A

Amlodipine (Norvasc). Belongs to class of dihyropyridines which don’t decrease HR or contractility

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16
Q

Name the calcium channel blockers

A

Dihydropyridines: Amlodipine (Norvasc) and Nifedipine (Adalat, Procardia). Nondihydropyridines: Diltiazem (Cardizem) and Verapamil (decrease HR and contractility)

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17
Q

What are the common side effects of calcium channel blockers?

A

edema*, HA, constipation, hypotension, dizziness, bradycardia (nondihyropyridines-Cardizem/Verapamil)

18
Q

What are contraindications to nondihyropyridines (Diltiazem/Verapamil)?

A

Systolic CHF, AV block or bradycardia

19
Q

What are the common antiplatelet agents used for ischemic heart disease?

A

Aspirin 81-325 mg daily or Clopidogrel (Plavix) 75 mg

20
Q

What diagnostic results characterize vasospastic/Prinzmetal’s/Variant angina?

A

EKG evidence of ischemia during pain (ST elevation), Normal exercise tolerance, Normal coronary angiogram

21
Q

What is vasospastic/Prinzmetal’s/variant angina?

A

chest pain w/o usual precipitating factors that may awaken pt from sleep, be associated with arrhythmias or conduction defects, and presents in a cyclical pattern over months

22
Q

What are vasospasm triggers?

A

Exposure to cold, Emotional stress, Vasoconstricting meds, Cocaine, Tobacco, Beta blockers

23
Q

What disorders are associated with coronary vasospasm?

A

concomitant coronary artery disease, Migraine headaches, or Raynaud’s phenomenon

24
Q

How is a coronary vasospasm treated?

A

Rule out obstructive disease with cardiac catheterization. SL nitro for acute relief. Calcium channel blockers and long acting nitrates for prevention. NO beta blockers

25
Q

What three medical conditions are classifed as acute coronary syndromes?

A

NSTEMI, unstable angina, STEMI

26
Q

What is the EKG criteria for diagnosis of NSTEMI?

A

New horizontal or down sloping ST depression > .05 mV in 2 contiguous leads and/or T wave inversions

27
Q

What is the EKG criteria for diagnosis of STEMI?

A

ST elevation at the J point in 2 contiguous leads of ≥ .1mV. ST elevation ≥ .2mV in men or ≥ .15mV in women in leads V2, V3

28
Q

What is the medical therapy for unstable angina and NSTEMI?

A

Oxygen, Nitroglycerin, Morphine, Beta blockers, Antiplatelet therapy, Anticoagulation

29
Q

What should be added to the antiplatelet therapy for NSTEMI after checking with a cardiologist?

A

a P2Y12 receptor blocker (platelet inhibitor): Clopidogrel (Plavix), Prasugrel (Effient), Ticagrelor (Brilinta). Often wait until after angiogram because they irreversible inhibit platelets

30
Q

What is recommended for anticoagulation in unstable angina instead of heparin?

A

Enoxaparin (Lovenox): 1mg/kg subcutaneous Q 12 h

31
Q

What should be added to anticoagulation therapy for patient’s with NSTEMI who are high risk and have early invasive surgery in addition to heparin?

A

GP IIb/IIIa inhibitor: Abciximab (Reo Pro), Eptifibatide (Integrilin), Tirofiban (Aggrastat)

32
Q

What should be provided to all ischemic heart disease before discharge?

A

Statins: Atorvastatin (Lipitor) 80 mg daily

33
Q

What % of risk of all cause mortality for MI are associated with each TIMI score?

A 
0-1: 4.7%. 
2: 8.3%. 
3: 13.2%
4: 19.9%
5: 26.2%
6-7: at least 40.9%
34
Q

How is a cocaine associated MI treated?

A

similar to other ACS patients except give benzodiazepines early and do not use beta blockers

35
Q

What is a STEMI?

A

MI due to complete obstruction of the coronary artery

36
Q

What is medical therapy for STEMI?

A

same as for NSTEMI plus fibrinolytic therapy or PCI

37
Q

What is the first line therapy for STEMI?

A

primary percutaneous coronary intervention (PCI) unless not available within 90-120 minutes otherwise administration of fibrinolytics

38
Q

What is the mechanism of action of fibrinolytics?

A

Initiation of local fibrinolysis by binding to fibrin in the thrombus and converts entrapped plasminogen to plasmin

39
Q

What are contraindications to fibrinolytics?

A

intracranial hemorrhage, ischemic stroke, cerebral vascular malformation, metastatic intracranial malignancy, aortic dissection, bleeding disorder, closed head injury

40
Q

Why is there a greater mortality in NSTEMI vs STEMI?

A

may be related to the fact that over half of patients with NSTEMI have multivessel disease and a greater likelihood of residual ischemia

Cardiology (19 decks)

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