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Clinical Medicine II > Ischemic Heart Disease > Flashcards

Ischemic Heart Disease Flashcards

1
Q

Where do atheroslcerotic plaques tend to form?

A

sites of increased turbulence

branching points

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2
Q

LDL, when oxidized leads to what three processes that eventually result in non-calcified plaque formation?

A
  1. endothelial dysfunction
  2. fatty streak
  3. inflammation
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3
Q

Plaque rupture leads to what two severe conditions?

A

thrombosis and ACS

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4
Q

Presence of three or more of the following results in what condition?

abdominal obesity

HDL < 40 (M) or < 50 (F)

TGs 150 or higher

FBG 110 or higher

HTN

A

metabolic syndrome

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5
Q

What contributes to the increased mortality of women with IHD?

A

delayed dx and delayed tx due to atypical sxs

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6
Q

Sxs of IHD in women are induced during what activities?

A

rest, sleep, mental stress

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7
Q

A patient presents with the following signs/sxs and hx:

Hx of substernal chest pressure for 5-10 minutes

pain began when walking up stairs at office

radiation to jaw

Pain lessened with time

What is your presumptive Dx?

A

stable angina

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8
Q

What would you expect to find on PE of a patient with stable angina?

A

tachycardia

HTN

abnormal heart sounds

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9
Q

A clenched fist or hand over the chest is known as…

A

Levine’s sign

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10
Q

A female patient presents with the following sxs… what should you immediately consider?

dyspnea

nausea

fatigue

faintness

A

Stable angina

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11
Q

A patient presents to the clinic with the following:

  • Sharp chest pain localized with one finger
  • pain lasted for seconds and resolved

Do you suspect angina/ischemia?

A

no

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12
Q

What sxs are not likely to be ischemia or angina related?

A

sharp, fleeting CP

prolonged ache in left precordial

localization

short lasting or constant pain

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13
Q

A patient presented to the ED with crescendo/decrescendo CP lasting 7 minutes. What tests do you want to order?

A

EKG

CXR

Cardiac enzymes

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14
Q

Why do we order a CXR for patients with angina?

A

to rule out other causes of CP like fx or masses

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15
Q

What are you looking for during an exercise stress test on a patient with angina?

A

EKG changes

decreased perfusion on imaging

SBP drop 10mmHg

sx development

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16
Q

The Bruce Protocol for an exercise stress test states that speed and incline are increased every ______ minutes until HR is at _____% of maximum

A

3 minutes

85% of max HR

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17
Q

what are the indications for a stress echo?

A

prior MI

Sxs of heart failure

undiagnosed murmur

complex ventricular arrhythmia

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18
Q

Which medications decrease oxygen demand?

A

Nitrates

Beta blockers

CCBs

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19
Q

1st line tx for acute angina…

A

short acting nitrates

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20
Q

Which medications reduce preload?

A

nitrates

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21
Q

When are long acting nitrates indicated?

A

chronic angina

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22
Q

1st line tx for chronic angina?

A

beta blockers

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23
Q

this medication decreases HR, BP, contractility and afterload…

A

beta blockers

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24
Q

The only antianginal medication proven to prevent re-infarct and improve survival post-MI…

A

beta blockers

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25
Q

This medication decreases BP, contractility and afterload, but doesn’t lower HR…

A

CCBs

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26
Q

who is indicated for CCBs with respect to IHD?

A

non-response to nitrates and beta blockers

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27
Q

Which medications increase oxygen supply via coronary vasodilation?

A

nitrates

CCBs

28
Q

what antiplatelet medications can be considered for stable angina?

A

aspirin

clopidogrel

combo of the two

29
Q

Why are statins useful in treating stable angina?

A

reduce clinical events

slow and regress coronary atherosclerosis

30
Q

What statin dosage should you consider regardless of baseline LDL-C for stable angina?

A

high intensity

31
Q

What are the two forms of revascularization?

A

percutaneous coronary intervention (PCI, angiography)

Coronary artery bypass grafting

32
Q

What is the most common physiologic process by which ACS/acute MI begins?

A

plaque rupture with occlusive thrombus

33
Q

Acute Coronary Syndrome (ACS) is composed of what three conditions?

A

unstable angina

non-ST Elevation MI

ST Elevation MI

34
Q

Sxs of Prinzmetal’s angina are secondary to what?

A

vasospasm

35
Q

When does CP occur in Prinzmetal’s angina?

A

at rest

36
Q

What can be seen on EKG during Prinzmetals angina?

A

transient ST elevation

37
Q

young patients with few risk factors and CP should be considered for what condition?

A

Prinzmetal’s angina

38
Q

Is stress testing helpful in dx of Prinzmetal’s angina?

A

no

39
Q

What can help dx Prinzmetal’s?

A

coronary angiography

40
Q

how do you treat Prinzmetal’s Angina?

A

nitrates and CCBs

41
Q

A patient presents with the following sxs… what should immediately be considered?

CP

SOB

Weakness

Nausea

Anxiety/Sense of impending doom

A

ACS

42
Q

What atypical sxs present in women, DM, and elderly patients?

A

sudden breathlessness, dyspnea

43
Q

Dx of unstable angina requires ischemic discomfort and one of which 3 sxs?

A

occurrence at rest

severe and new onset

crescendo pattern

44
Q

The diagnostic approach to UA/NSTEMI should include what 5 things?

A
  1. clinical Hx
  2. EKG
  3. cardiac enzymes/biomarkers
  4. stress testing if safe
45
Q

When should you consider stress testing for a patient with potential NSTEMI/UA?

A

no evidence of infarction/normal cardiac enzymes

unclear diagnosis

46
Q

What differentiates NSTEMI from UA?

A

NSTEMI: elevated cardiac enzymes

UA: normal cardiac enzymes

47
Q

What may be present on EKG of NSTEMI?

A

ST Depression, T wave inversion

ST elevation typically not present

48
Q

What can be seen on EKG in UA?

A

usually normal

may have ST elevation, T wave inversion

49
Q

How should UA/NSTEMI be managed?

A

Oxygen

Nitro

antiplatelet therapy

beta blockers

50
Q

The following criteria make up what test for progression of UA/NSTEMI to STEMI?

Age 65+

3+ CHD risk factors

prior coronary stenosis of 50+%

ST deviation on admission

2+ anginal episodes in previous 24 hours

elevated cardiac enzymes

aspirin use in last 7 days

A

TIMI variables

51
Q

What factors precipitate STEMI in 50% of cases?

A

vigorous exercise

extreme emotional stress

medical/surgical illness

52
Q

What is the cause of STEMI?

A

rupture of vulnerable plaque leading to complete occlusion of coronary artery

53
Q

What diagnostics should you order on a pt. you suspect of STEMI?

A

EKG

CXR

Cardiac Enzymes

CBC

Coags

electrolytes

Lipid panel

2D echo

54
Q

ST Elevation and + cardiac enzymes should make you think of…

A

STEMI

55
Q

ST depression with (-) cardiac enzymes should make you think of…

A

UA

56
Q

no ST elevation with (+) cardiac enzymes should make you think of…

A

NSTEMI

57
Q

A patient presents with STEMI. How do you immediately manage the patient?

A

ASA 325 mg

sublingual nitro

beta blockers

high intensity statin

identify reperfusion strategy

58
Q

What is the preferred method of reperfusion in STEMI?

A

PCI

59
Q

When should you consider fibrinolytic therapy in STEMI?

A

PCI not available within 120 minutes of first medical contact

sxs < 12 hrs

absence of contraindications

60
Q

the following are what contraindications to fibrinolysis?

hx of intracranial hemorrhage

hx of stroke in past year

poorly controlled HTN

suspected aortic dissection

internal bleeding

A

absolute contraindications

61
Q

the following are what contraindications to fibrinolysis?

current anticoagulation

recent invasive procedure

prolonged CPR

known bleeding

pregnancy

active peptic ulcer

hemorrhagic ophthalmic condition

hx of severe HTN

streptokinase use

allergic rxn

A

relative contraindications

62
Q

Can thrombolytics be used in NSTEMI/UA?

A

no

63
Q

CP due to pericardial inflammation following MI, CABG, or traumatic injury is known as?

A

Dressler’s syndrome, pericarditis

64
Q

What medications should be used after MI tx?

A

beta blockers

aspirin

65
Q

A patient is seeing you on f/u after MI. Pt. has LV dysfunction. What can be given?

A

ACE, ARB

Clinical Medicine II (31 decks)

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