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662 > Ischemic Heart Disease > Flashcards

Ischemic Heart Disease Flashcards

1
Q

Ischemic Heart Disease is also know as?

A

Coronary heart disease, or coronary artery disease

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2
Q

Ischemic heart disease is primarily cause by?

A

Artherosclocrosis

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3
Q

Artherosclocrosis results from?

A

From decreases blood flow to the heart and leads to reduced oxygen delivery

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4
Q

When does angina occur?

A

Demand > Supply

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5
Q

How does IHD present itself?

A
  • Chest pain or pressure
  • Discomfort in
    • Neck
    • Jaw
    • Shoulder or arm
  • Pain accumanied with nausea or vomiting
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6
Q

Female patients often describe symptoms as?

A

Indigestion or acid feeling

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7
Q

IHD occurs in women or men more?

A

men

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8
Q

What forms when someone has Artherosclorosis?

A

A plaque forms this is what causes the reduced oxygen

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9
Q

Stable angina is classified as pain lasting?

A

less than 10 minutes

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10
Q

Angina lasting between 10-15 minutes is known as?

A

Variant

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11
Q

Unstable angina is when the pain lasts for?

A

more than 20 minutes

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12
Q

Chest pain is _____ during stable angina

A

predictable

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13
Q

The onset of variant angina is?

A

gradual

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14
Q

In unstable angina the pain is _____ and there is ____ onset

A

severe and the onset is new

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15
Q

Stable angina or occurs upon?

A

Exertion

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16
Q

Variant angina often occurs ____ and at ____

A

in the morning and at rest

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17
Q

Unstable angina occurs ____ or at _____

A

exertion or at rest

18
Q

What are the modifiable risk factors of Ischemic heart disease

The Fat Smoker Checked His Glucose Monitor and his head began to BOIL he then Drank some BEER

A
  • Tobacco smoking
  • Hypercholesterolemia
  • DM
  • HTN
  • Obesity
  • Alcohol
19
Q

What are the non-modifiable risk factors for IHD?

45 + 10 +10

A
  • Men > 45
  • Females >55
  • FH of CVD
    • First degree relative
    • Females < 65
    • Men <55
20
Q

Beta blocker ____ HR

_____ Cardiac contractility

_____ Systolic Pressure

____ Left Ventricle Volume

A

Decrease all

21
Q

What is 1st line therapy for IHD?

A

Beta blockers

22
Q

What are the 3 preferred beta blockers?

A

Carvedilol, metoprolol succinate, bisoprolol

23
Q

Beta Blockers are contra indicated with patients with?

A

Severe bradycardia (<60 bpm)

AV conduction med Digoxin, verapamil, diltiazem

Asthma, COPD, DM, HF

24
Q

CCBs are second line for IHD decrease?

25
Q

Amlodipine is a preferred ____

26
Q

CCBs should not be used when?

A

Digoxin or BB

HF

same as BBs

27
Q

You should not use ____ in patients with variant angina

28
Q

What is the 2nd/3rd line for IHD?

A

Nitrated long acting

29
Q

What do nitrates do?

WHat are they limited by?

A

Decrease wall tension, preload and oxygen demand

Limited in tolerance development thats why you need 8-12 hours of non nitrate therapy

30
Q

Nitrates should not be used with?

Patients wiht _____ hypotension

and cause ____ depletion

A

PDE-5 inhibitors

severe hypotension and can cause volume depletion

31
Q

All patients should use ____ release nitroglycerin

32
Q

How do you educate the patient to use nitroglycerin tablets?

  1. ___ ___ when administering the medication, have phone close by.
  2. Place __ tablet under the tongue and allow it to dissolve.
  3. If pain persists after ___ minutes, administer the 2nd tablet.
  4. Call ____ after administering ___ tablet.
  5. May administer a 3rd tablet if pain continues ____ after the 2nd tablet for a max of ___ tablets in 15 minutes.
A
  1. Sit down
  2. 1 tablet
  3. 5 minutes
  4. Call 911 after admin of 2nd tab
  5. 5 minutes, max of 3 tabs in 15 minutes
33
Q
  1. If a new bottle, prime pump with ____ test sprays
  2. When pain occurs, spray 1-2 sprays into mouth while sitting down and phone close by. Do not ___, ____ or spit out the spray for at least 5- 10 minutes.
  3. Wait 5 minutes, if pain persists may spray a ___ spray and call 911
  4. Replace cap on the bottle
  5. If bottle is not used more than 6 weeks must prime again
A
  1. 5-10
  2. swallow or inhale
  3. 3rd
34
Q

Ranolazine is ____ line for IHD and it has no effect on?

A

2nd 3rd line

no effect on HR or BP

35
Q

Ranolazine contraindications

A
  • Hepatic cirrhosis
  • Use with CYP3A inducers
    • Rifampin, carbamazepine, phenytoin, phenobarbital
36
Q

Revascularization should be used when?

A
  • Max tolerable meds are used and symptoms are still occuring
  • High risk patients multiple comorbidities
37
Q

What is the antiplatelet therapy used after PCI?

A

Aspirin 81 mg forever

Clopidogrel 75 mg daily, ticogrelor 90 BID or Prasugrel 10 mg for 1 year

38
Q

Want to treat Bp if it is >?

39
Q

Consider ____ screening in High risk patients as well as?

A

DM

Depression and Kidney function

40
Q

CCBs like ____, ___ and ____ should be first choice for ____ angina

A

Verapamil, diltiazem and nifedipine

for variant angina

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