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ICM-Cardio > ischemic heart disease > Flashcards

ischemic heart disease Flashcards

1
Q

DDx of chest pain: MI

A 
atherosclerotic disease
anomalous coronary arteries
HTN urgency
pulmonary HTN
aortic valve disease
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2
Q

DDx of chest pain

A 
acute aortic syndrome (dissection, intramural hematoma)
pericarditis
PE
GERD, spasms, achalasia
pulmonary (pneuothorax, pneumonia_
chest wall
anxiety
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3
Q

cardiac markers good, ECG normal but patient still has chest pain

A

aortic dissection
PE
-want to rule those out

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4
Q

chest pain history

A 
location
character
radiation
intensity
duration
frequency 
associated symptoms
exacerbating/relieving factors
pattern over time
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5
Q

where is it bad for pain to radiate to?

A

neck or arms

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6
Q

branches off left anterior descending

A

called diagnol

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7
Q

branches off the left circumflex

A

called marginal

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8
Q

non-atherosclerotic coronary artery disease

A

coronary vasospasm
anomalous coronary arteries
coronary arteritis (Kawasaki’s, giant cells)
myocardial bridge
coronary dissection: young (30’s), female
coronary embolization

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9
Q

metabolic syndrome

A 
HTN
abdominal obesity
HLD 150
fasting plasma glucose >100
associated with inflammation, coagulation abnormalities, progression to type 2 DM
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10
Q

risk factors for atherosclerotic heart disease

A

smoking
HTN
diabetes

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11
Q

why is it difficult to get BP in optimal range in elderly?

A

stiffer blood vessels

-may get light headed when stand up

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12
Q

novel risk factors for atherosclerotic disease

A
  • chronic inflammation
  • elevated hsCRP
  • homocytsteine
  • chronic kidney disease
  • coagulation abnormalities
  • chronic infection
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13
Q

MI: secondary causes

A
  • severe anemic
  • hypoxemia
  • uncontrolled HTN
  • severe LVH
  • uncontrolled tachycardia
  • thyrotoxicosis
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14
Q

manifestation of coronary artery disease

A
  • chronic stable angina
  • unstable angina: new or changing chest pain
  • MI
  • ischemic cardiomyopathy (CHF)
  • sudden cardiac death
  • silent ischemia
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15
Q

which angina needs to be treated?

A

unstable angina

-dynamic process

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16
Q

angina

A

visceral discomfort

  • feels like pressure
  • diffuse and sub-sternal
  • dyspnea, sweating, nausea, light headness
  • provoked by physical exertion, emotional upset, heavy meal, working in cold temperature
  • rest makes better
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17
Q

where does pain radiate to for aortic dissection?

A

to back

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18
Q

typical angina

A

sub sternal

brought by exertion

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19
Q

angina equivalents

A
  • dyspnea
  • arm, jaw, or back pain
  • nausea
  • sweating
  • fatigue
  • silent ischemia
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20
Q

atypical signs in

A

women, diabetics, eldery

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21
Q

ischemic heart disease evaluation

A

history
physical
ECG

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22
Q

ST elevation means

A

means infarction

-ischemia, cells are dying

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23
Q

coronary insufficiency will give

A

ST depression

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24
Q

upward ST depression

A

benign

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25
Q

flat ST depression

A

pathological

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26
Q

dynamic ECH changes with chest pain at rest

A

send to heart catheter lab

-DON’T do stress test

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27
Q

can see inverted T waves with

A

long standing HTN
LVH
previous MI

28
Q

alternatives for ST elevation: non chest pain, stable, in previous heart attack

A

-aneurysm

29
Q

Q waves instead of R waves

A

loss of myocardium

30
Q

large p waves means

A

right atrial enlargement

  • caused by pulmonary HTN
  • rotates heart, makes R wave progression diminish
31
Q

who can have large P waves

A

in COPD

32
Q

UAP versus NSTEMI

A

UAP-> new, rest or worse pain
physical exam often normal
ST changes-> 50% have non

33
Q

high risk chest pain

A 
recurrent pain
positive markers
persistant ECH changes
unstable hemodynamics
arrhythmia (VT)
Low EF
previous CABG
diabetes
renal insufficiency
34
Q

Q wave and T wave inversion, pattern of

A

inferior MI

-from an occluded RCA

35
Q

treatment for high risk chest pain

A
  • ASA, heparin, beta blockers, morphine, O2, nitrates
  • clopidogrel, antithrombin therapy-heparin/Lovenox
  • glycoprotein IIb, IIIa receptor target-tirofiban, abciximab, eptifibatide
36
Q

when is reperfusion therapy needed?

A

only in STEMI with <12 hours pain duration

37
Q

management for STEMI

A
  • ST elevation >1 mm in 2 or more leads
  • monitor, O2, ASA, heparin, beta blockers, nitrates, morphine
  • pain less than 12 hours-> attempt reperfusion
38
Q

who is at highest risk and needs surgery?

A

left mains stenosis
3 vessels (reduced LV function)
2 vessel disease (prox LAD)
multi-vessel diabetics

39
Q

diagnostic tests are only as accurate (stress test)

A

the group you apply it to

40
Q

treatment for STEMI in acute coronary syndrome is

A

take them to the cath lab

41
Q

NSTEMI acute coronary syndrome

A

inadequate blood flow to a segment of the myocardium caused by transient or high grade occlusion or epicardial coronary artery
ECG could be normal
elevated cardiac enzyme (troponin)

42
Q

STEMI acute coronary syndrome

A

complete occlusion
ST elevation in 2 or more ECG or new LBBBB
cardiac enzymes elevation

43
Q

presenting symptoms of acute coronary syndromes

A

rapidly accelerating exertional angina

unprovoked angina

44
Q

atypical presentation of acute coronary syndromes

A 
women
elderly
diabetics
CHF
-dyspnea
45
Q

diagnosis of ACS

A 
target history, physical exam
ECH within 10 min of arrival
CXR
cardiac markers
echo
46
Q

initial management of ACS

A 
aspirin
morphine
nitrates 
blood chemistries, CBC, cardiac markers
ECG
47
Q

ST elevation

A

injury

48
Q

ST depression

A

ischemia

49
Q

inferior leads

A

RCA

50
Q

septal leads

A

LAD

51
Q

antieror leads

A

LAD

52
Q

high lateral leads

A

diagonal or LCX

53
Q

PCI

A

best treatment if given in a timely manner

54
Q

adjunctive therapies for ACS

A 
aspirin
clopidogrel
anticoagulants
beta bockers
nitrates
morphine
ACE-I or ARB
55
Q

NSTEMI ACS initial management

A 
anti-platelet (aspirin, clopidogrel, IIB/IIIA inhibitors)
anticoagulants (heparin, LMWH)
beta blockers
nitrates
morphine
ACE-I
lipid lowering therapy
56
Q

long term ACS

A 
aspirin for life
clopidogrel for at least 1 year
ACE-I
beta-blockers
S-L nitro
lipid lowering therapy (high dose)
smoking cessation
tight control diabetics
tight control blood pressure
57
Q

complications

A 
recurrent ischemia or infarction
ventricular arrhythmias 
conduction disturbances
pericarditis
cardiogenic shock
58
Q

right ventricular infarction

A 
occluded right marginal from RCA-> damage RV
-occurs in inferior STEMI
hypotension
elevated JVP (kussmaul sign)
clear lungs

give fluids

59
Q

an inferior infarction can often develop?

A

heart block

-give atropine

60
Q

right ventricular infarction management

A

give fluids

61
Q

papillary muscle rupture

A

usually inferior MI
sudden hypotension and pulmonary edema
MR

62
Q

S4 sound could mean

A

LVH

-HTN heart disease

63
Q

drug coated stents

A

less ingrowth

longer blood thinner

64
Q

non drug coated stents

A

more ingrowth

less duration of taking blood thinner

65
Q

CABG

A

left internal mammary artery

-LIMA into LAD

66
Q

what vein will never have a balloon?

A

Left main stenosis

-they go to surgery

67
Q

slight depression of the PR segment

A

acute pericarditis

ICM-Cardio (21 decks)

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