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Cardio 2 > ischemic heart disease, angina, MI > Flashcards

ischemic heart disease, angina, MI Flashcards

1
Q

ischemic heart disease

A

coronary blood demand exceeds coronary blood flow

myocardial metabolism is aerobic

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2
Q

etiologies of IHD

A 
atherosclerosis
hyperthyroidism
anemia
emotional stress
variant angina
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3
Q

ischemic equivalents/associated symptoms

A 
SOB
diaphoresis
nausea/vomiting
dizziness
weakness
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4
Q

framingham

A 
1948
5000+ M and F, 30-62
return every 2 years
second generation in 1971
third gneration in 2002
omni chohorts in 1994
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5
Q

low risk

A

<10% 10-year framingham risk

monitor

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6
Q

intermediate risk

A

10-20% 10 yr framingham risk

further evaluation- EKG, stress test

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7
Q

high risk

A

> 20% 10 yr framingham risk

aggressive risk modification

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8
Q

metabolic syndrome

A 
insulin resistance
hyperglycemia
HTN
elevated triglycerides
low HDL
obesity
doubles risk for CV disease
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9
Q

conditional risk factors

A

homocystein
Lp(a)
hsCRP
LDL particle size

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10
Q

conditional preventions

A

antioxidant therapies

omege-3-FAs

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11
Q

Lp(a)

A

resembles LDL w/added glycoprotein
few pharmacological agents lower Lp(a)
no research has demonstrated efficacy in CV risk reduction by lowering Lp(a)

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12
Q

hsCRP

A

high sensitivity C-reactive protein

useful in assessing patients w/intermediate framingham risk scores, reclassifies up to 30% into either low or high risk

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13
Q

reduction of risk

A 
aspirn
reduction of BP
reduction of hyperlipemia
smoking cessation
regular exercise
weight reduction and reduction of BMI (<25)
reduction of psychological stresses
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14
Q

HRmax

A

220-age

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15
Q

pharmacological stress tests

A

dobutamine- increase cardiac stress and O2 demand

adenosine/dipyridmole- vasodilate

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16
Q

TIMI trial risk indicators

A 
age >= 65
>= 3 traditional cadiac rsik factors
documented CAD w/ >=50% stenosis
ST segment abnormalities
>=2 anginal episodes in last 24hrs
used aspirin in last week
elevated cardiac enzymes
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17
Q

TIMI trial risk 0-1

A

low risk- medical therapy and stress test to evaluate therapy, if stress test abnormal - angiography

18
Q

TIMI trial risk 3-4

A

intermediate risk- medical therapy and early angiography

19
Q

TIMI trial risk 5-7

A

high risk

medical therapy and immediate angiography

20
Q

aortic dissection

A

widened mediastinum on chest x-ray

21
Q

PE

A

new onset of A fib

22
Q

CHF

A

orthopnea

SOB

23
Q

timing of thrombolytic therapy

A

less then 90min

most significant determining factor

24
Q

absolute contraindications to thrombolytic therapy

A

intracranial hemorrhage
ischemic CVA in last 3 months
facial trauma in last 3 months
bleeding diathesis

25
Q

relative contraindications to thrombolytic therapy

A 
after 12 hours
chronic, sever, poorly-controlled HTN
severe uncontrolled HTN on presentation
ischemic CVA>3 months, known intracranial pahtology
dementia
internal bleeding w/in last 4 weeks
pregnancy 
peptic ulcer disease
current anticoagulant use
26
Q

higher death risk w/thrombolytics

A 
new LBBB
Anterior wall mi
cardiogenic shock 
ventricular arrhythmias
advanced age >75
27
Q

early complications of IWMI

A

bradycardia and AV block- AV nodal perfusion by RCA
right ventricular infarction
hypotension for volume depletion

28
Q

early complications of AWMI

A

pump failure and CHF in large area infarcts, cardiogenic shcok

29
Q

late complications of MI

A 
24-28hrs
cardiogenic shock 
VSD
papillary m rupture and MR
free wall rupture
left ventricular thrombus
30
Q

cardiogenic shock

A

due to pump failure and inflammation

31
Q

VSD

A

new systolic murmur and thrill on LSB

32
Q

Papillary m rupture and MR

A

new systolic murmur, pulmonary edema, thrill, cardiogenic shock

33
Q

free wall rupture

A

electromechanical dissociation

first infarction, ant infarction, females, elderly

34
Q

left ventricular thrombus

A

blood stasis, endocardial injury and possible inflammation leading to hypercoagulable state
most often located in left ventricular apex

35
Q

indications for angiography before discharge

A

EF <40%
Clinically significant ischemia on non-invasive testing
arrhythmias during hospital stay
recurrent chest pain during hospital stay
significant heart failure during stay

36
Q

mortality intervention

A 
beta blockers
aspirin
ACE inhibitors
HMG-CoA reductase inhibitors
intense management of hyperglycemia
37
Q

coronary revascularization

A 
percutaneous intervention (PCI) 
coronary artery bypass grafting (CABG)
38
Q

PCI

A

shown not to have improvement overall in survival or recurrent acute events, except those w/silent ischemia by non invasive stress testing
primarily reserved for those w/positive stress stess, failure of medical therapy, or poor surgical risk

39
Q

CABG

A

in stable CAD is only indicated in patients w/left main disease, left main equivalent, 3 vessel disease, two vessels involving proximal LAD and EF<50%

40
Q

Left main equivalent

A

high grade stenosis >70% proximal LAD and Circ

41
Q

coronary angiography

A

gold standard
successfully resuscitated for cardiac arrest
life limiting angina despite medical therapy
unclear diagnositc evaluation
ST segment elevation MI

42
Q

coronary a calcium CT or MRI

A

highly effective in negative predictive value, also used to evaluate patients w/intermeidate framingham scores

Cardio 2 (17 decks)

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