Ischemic Heart Disease & CHF Flashcards
What are the risk factors for coronary artery disease?
Age HTN Smoking High Cholesterol Diabetes Family History Obesity
What accounts for one third of all deaths in people over the age of 35 in the United States?
Coronary artery disease
What is acute coronary syndrome?
Acute coronary syndrome is applied to patients in whom there is a suspicion of myocardial ischemia
What are the three types of acute coronary syndrome?
- STEMI (ST Elevation MI)
- NSTEMI (Non ST Elevation MI)
- UA (Unstable Angina)
What is myocardial infarction?
A clinical advanced consequent to the death of cardiac myocytes that is caused by ischemia
What are the criteria for myocardial infarction?
EKG changes
Rise and fall of cardiac biomarkers (troponin)
New wall motion abnormalities
Symptoms of ischemia
What is a biomarker?
Cardiac enzymes in the heart
Basically let you know something is happening
What are the two medical therapies for coronary artery disease and how do they differ?
Anti-anginal therapy (Controls symptoms) Preventative therapy (Stop from recurring)
What are the three types of antianginal therapy?
Beta blockers
Calcium channel blockers
Nitrates
How do beta blockers work?
By slowing the heart rate and reducing contractility
What is an example of a calcium channel blocker that is a vasodilator with reflex tachycardia?
Nifedipine
Which calcium channel blocker is the strongest inotrope and is used in the treatment of Wolff-Parkinson-White?
Verapamil
How did nitrates work?
They are short acting venous dilators
In what way is ephedrine similar to nitrates?
Both have tachyphylaxis
What are the three types of preventative therapy for coronary artery disease?
Antiplatelet therapy
Risk reduction
Statins
What is the mainstay form of antiplatelet therapy?
Aspirin
How do statins work and what are the risks associated with their use?
Lower cholesterol
Risks: Can cause myopathy and liver dysfunction
How is cardiac failure defined?
Failure of the heart to maintain a cardiac output sufficient to meet the metabolic demands of the body
How is cardiac output calculated?
CO = SV + HR
How is the diagnosis of heart failure made?
The diagnosis of heart failure requires that 2 major or 1 major and 2 minor criteria are met and not attributed to another medical condition.
What are some of the possible MAJOR criteria for heart failure?
Paroxysmal nocturnal dyspnea Orthopnea Elevated jugular venous pressure pulmonary rales Third heart sound Cardiomegaly on chest x-ray Pulmonary edema on chest x-ray Weight loss of 4.5 kg in five days in response to treatment of presumed heart failure
What are some possible causes of cardiac failure?
Ischemic versus nonischemic cardiomyopathy Alcoholism Infectious Inflammatory Congenital Valvular Oncological Pharmacological
What are the five main causes of cardiac failure that are treated?
- Heart rate
- Rhythm
- Preload
- Afterload
- Contractility
Ventricular arrhythmias are attributed to ______ until proven otherwise
Ischemia
What is cardiac resynchronization therapy?
A special pacemaker used to contract both right and left ventricle.
-30% of patients with CHF have asynchronous contractions of the right and left ventricle
Practically speaking, preload is synonymous with what?
Volume (or CVP)
What are some possible causes of impairment to venous return?
Hemorrhage
Dehydration
Vascular occlusion
Increased intrathoracic pressure
Practically speaking, afterload is synonymous with what?
Blood pressure (SVR)
What types of drugs are commonly used for afterload reduction?
Ace inhibitors
- nicardapine
- hydralazine
- nitroprusside
For a patient in cardiac failure, what is the relationship between blood pressure and forward flow?
Inversely related
Inotropic refers to ______
Lusitropic refers to _______
Contractility
Relaxation
What is contractility?
Intrinsic ability of a cardiac muscle fiber to contract at a given fiber length
What are the two main causes of contractility impairment?
Ischemia
Cardiomyopathy (congenital or acquired)
If a patient presents with mottling of the knees and is cool to the touch this is indicative of what?
Poor perfusion and decreased blood flow to the extremities
What does a pathologic S III sound indicate?
Decreased compliance of the ventricles (as in CHF) and may be the earliest sign of heart failure
True or false: The human body produces enough acid to kill us in about seven minutes if not for the body buffers
True
What is a normal amount of lactic acid as measured in the blood?
Less than 2 mg/dL
Where is mixed venous blood best obtained?
From the distal port of a PA catheter
Second best is from a central line
A decrease in venous oxygen saturation can cause what?
Decreased arterial saturation
Decreased hemoglobin
Decreased cardiac output
Increased consumption
What is HOCM?
Hypertrophic obstructive cardiomyopathy
How is HOCM different from other forms of cardiomyopathy?
Only cardiomyopathy that’s worse when pressure is higher
What are three important factors when treating HOCM patients?
- Tight (decreased afterload)
- Slow (decreased HR)
- Full (increased volume)
What drug is given with patients with aspirin allergies?
Chlopitigril (plavix)
When do most episodes of angina occur?
In early morning
What drug class is known to cause hypoxic pulmonary vasodilation?
Nitrates
What is an ICD?
Implantable cardiac defibrillator
What is SAM?
Systolic arterial/anterior motion
Is caused when a myopathy causes mitral valve to be sucked into aortic valve thus blocking flow
